Skin Glue

Until recently doctors had two main options for the closure of wounds—stitches and, more recently, staples. Although both of these techniques perform well—allowing good wound healing—they can cause scarring and are time consuming both to put in and take out. As recent as last year, a new method of wound closure became available—essentially a skin glue.

The company, Closure (CLSR) came out with a glue, called Dermabond, that can seal many kinds of wounds, allows healing with less scarring than stitches. It is also much faster to use, taking about a quarter the time to apply as it takes to put in stitches. This means less surgery time and, given the high costs of healthcare, that means lots of money saved. For simple wounds, no anesthetic is even needed when this glue is used. The glue eventually flakes off as the wound heals, eliminating the need for removal by a doctor. So it means the patient does not need to make as many trips to the doctor as long as the wound heals normally. With stitches and staples, the pain of application can require anesthetic, they take time to put in, and they require a later visit to the doctor for removal. So gluing the skin shut is potentially a far superior method.

One might ask why this idea is only coming about now. Well, first of all, remember that it takes time to develop a new medical technique and it has to be approved by the FDA. So probably this idea has been floating around for awhile but is only now approved and able to be used. But there would be other reasons why it took time to develop. A glue has to be made to be ideal for its particular application—a glue for paper will be different than a glue for plastic, etc. Skin, in particular, would require a very carefully designed glue. It would have to stick the wound edges together without irritating them. It would have to allow healing to occur at a normal rate. It would have to flake off as the wound heals, but not too fast or the wound would reopen. It also has to be able to be sterilized so that it doesn’t cause infection when applied to a wound. So, although the idea sounds easy, lots of problems had to be worked out before it could be used clinically.

There is another issue. Although Dermabond is now being used successfully for many applications, a doctor cannot use it for all kinds of wounds. A very large wound, for example, might not be adequately closed by a simple glue. For such wounds, stitches or staples would still be the best method, at least for now. However, for small wounds, a glue seems to work better than stitches with less discomfort.

I think this is a great, though in many ways simple, medical advance. It doesn’t accomplish anything that couldn’t already be done by existing methods, but it seems to do it better, more comfortably and cheaper than the older methods. In many ways that is as important an advance as flashier discoveries that cure new things. I predict that within 5 years or so, we will all be as familiar with "skin glue" as we are with stitches. Having had to endure many stitches and staples myself, I would welcome a less painful and cheaper method of wound closure.

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Email: michad03@mcrcr.med.nyu.edu