Evaluation of the Efficacy of Iso Amyl 2-Cyanoacrylate Glue in Closure of Extraoral Surgical Wound When Compared with Other Non-Absorbable Suture Materials- A Prospective Clinical Study.

Introduction: Appropriate wound closure with appropriate suture material is of prime significance in surgery. Hence, we aim to assess the efficiency of ISO amyl 2-cyanoacrylate glue in closure of extraoral surgical wound when compared with other suture materials like polypropylene (prolene), nylon (ethilon) and silk (mersilk). Materials and
Methods: We conducted a prospective clinical observational study in which 60 subjects were divided into two groups: suture group and cyanoacrylate group. They were compared for wound healing complications on days 1, 3, 7, 12, and at 1 month postoperatively with P < 0.05 as significant.
Results: We observed that there was no statistically significant difference between the groups for the various parameters of the wound healing for the different time periods except that color acceptability and visibility were significantly superior in the cyanoacrylate group.
Conclusion: Iso amyl 2-cyanoacrylate can be used successfully in the suture closure with excellent patient satisfaction and can be considered as an alternative to the routine suture materials. Copyright:

INTRODUCTION

Wound closure is of great significance after surgery. It depends on various factors of which the suture material is very important.[1] Several materials like “synthetic absorbable sutures, staples, tapes and adhesive compounds” have been used for suturing.[2345] The most common method of wound closure is suturing, that is commonly practiced in the clinics. However this may lead to “permanent suture tracks, wound dehiscence, needle prick injuries, foreign body reaction, granulations, tissue ischemia, tissue tearing, infection” and other complications.[2345] Hence, there is a constant search for new modalities. Different cyanoacrylate tissue adhesives have been used in oral surgery for the extraoral site wound closure.[6] Hence we aim to assess the efficiency of iso amyl 2-cyanoacrylate glue in the closure of extraoral surgical wound when compared with other suture materials like polypropylene (prolene), nylon (Ethilon) and silk (mersilk).

MATERIALS AND METHODS

We conducted a prospective clinical observational study with 60 subjects who were divided into two equal groups: the suture group (polypropylene (prolene), nylon (ethilon) and silk (mersilk)) and the cyanoacrylate group. The institutional ethics approval and the patients' consent were taken for the study. The extraoral areas chosen for wound closure were of minimal tension and with minimal underlying movement, particularly the lower eyelid regions. They were compared for wound healing in terms of hemostasis, inflammatory reaction, epithelialization, and complications on days 1, 3, 7, 12 and at 1 month, postoperatively. Statistical analysis was done with P < 0.05 taken as significant.

RESULTS

We observed that there was statistically significant variation in the demographics and the gender between the groups. We also observed there was no statistically significant variation among the groups for erythema, itching, burning, swelling, dehiscence, discharge, wound, necrosis, pigmentation of patients, pliability of patients among group, pain, itching, color, stiffness, acceptability, visibility. Color acceptability and visibility were superior significantly in the cyanoacrylate group [Table 1].

Table 1

Comparison of the suture groups and cyanoacrylate group

Group	P
	Erythma	Itching	Burning	Swelling	Dehiscence	Discharge	Wound Necrosis	Pain	Itching	Colour	Stiffness	Acceptability	Visibility
Suture	0.232	0.486	0.136	0.406	0.56	0.0127	0.1	0.1035	0.4861	0.000023	0.3292	0.0001	0.002
Cyanoacrylate

DISCUSSION

Cyanoacrylate tissue adhesives have certain distinct advantages over sutures which make them an attractive alternative to sutures.[6] In the present study, wounds when evaluated for healing complications had no statistically significant differences between both the groups. Itching, burning, erythema, and swelling were seen in patients. In our study, dehiscence was not evident in the cyanoacrylate group. The wounds then healed without further complications and gave an acceptable cosmetic outcome after 1 month postoperatively. In the cyanoacrylate group, no infections occurred though the wounds were left open and required no dressings unlike the suture materials. The cyanoacrylates are bactericidal as they hinder the growth of Bacillus subtilis.[7] The glued wounds in our study were allowed to peel off by themselves. It is prudent that the patients are instructed to keep the glued site absolutely dry. The distinct advantage of adhesives over sutures is that the discomfort associated with suture removal is not there with adhesive. In our study, patients in the cyanoacrylate group had significantly better outcome than the suture group in terms of patient satisfaction and visibility of scar. The depth and width of the scars that were evaluated in both the groups did not differ significantly, clinically and statistically.[126] The limitation in our study was shorter follow up for the adhesive groups for the carcinogenic effect on the tissue. Hence, we propose a longer follow up.

CONCLUSION

The cyanoacrylates are better alternatives as they aid in lowering the time for the closure, are better cosmetically, are bacteriostatic in nature, requires no additional dressings, and are highly accepted by the patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.