Dermabond: A Great Shortcut? by Kevin Klauer, D.O.
Tuesday, August 4, 2009 
Kevin Klauer, D.O.Dermabond is definitely a shortcut. It will put you on the fast track to a malpractice lawsuit. It is human nature, particularly when busy, to take the path of least resistance and the easy way out. Often patients or their families request tissue adhesives, making this decision even easier. They want it. It's easy for us. It's a win-win. Right? Hardly! Patients often request Dermabond because they don't know any better. Our risk experience reflects poor decision making with tissue adhesives. Quite honestly, even if you believe the claims that cosmesis is no different between tissue adhesives and standard wound closure, this does not hold true for those with wound dehiscence.
The preponderance of data has shown at least a small increased incidence of dehiscence with tissue adhesives (Beam JW. Tissue adhesives for simple traumatic lacerations.J Athl Train. 2008 Apr-Jun;43(2):222-4.). Remember, these studies include only patients who meet the narrow application guidelines for tissue adhesives. They do not include the various others that our colleagues independently choose to include (i.e. joints, knuckles, jagged traumatic lacerations, high skin tension sites). Tissue adhesives have the additional risk of inadvertent adhesive. The manufacturers report that adhesives are indicated for facial lacerations. However, they also report cases of inadvertent eye gluing. This is great if you want to play pirate. However, the parents are never laughing. In fact, several cases have required surgical intervention in the OR to reopen the eye.
Our group's risk experience has proven that tissue adhesives increase the risk of wound separation and other complications such as eyelid closures. This is in part due to the product itself and secondarily due to the irresistible urge to use it when and where it shouldn't be. Tissue adhesives cause more harm than good. Need to close a wound? Don't take a short cut! Use some sutures.
Kevin M. Klauer, DO, FACEP
Director, Quality and Clinical Education, EMP, Ltd.
Director, Center of Emergency Medical Education
Editor in Chief, Emergency Physicians Monthly
Dermabond, Klauer, Malpractice in Risk Management
Reader Comments (12)
While I agree that it may be tempting (myself included) to convince ourselves that a wound is appropriate for adhesives, it is really our problem. If you go ahead anyway and use it in a wound that does not meet accepted criteria for adhesive closure then this is the fault of the clinician and not the product. If precautions as simple as placing moist gauze over the eye are not used when using it in close proximity, again this is the fault of the clinician. I agree that there is pressure to use it in inappropriate circumstances (self, staff and parental induced) however this is where a physician makes their best judgement and resists their own temptations and educates parents why it may be inappropriate. Adhesives definately have their place.
I agree with all of the above, actually. Keep in mind that tissue adhesives may be the best solution for elderly patients with skin tears. Almost any other approach has very significant drawbacks. The adhesives are atraumatic to apply, do not need to be removed like tape or dressings, and allow the thin flap to cover the defect.
While I agree with the risks, Dermabond (like most treatments) needs to be used judiciously. A side point: is it about the legal issue or the quality of patient care? Thanks.
Protect us from ourselves and our own stupidity! Let us not blame a product line that has been around for more than 30 years for our lack of judgment; a product that has stood the test of time in elderly wounds, for young children etc. To quote Walt Kelly: "we have seen the enemy and he is us".
Oh, come on! Tissue adhesives are completely safe and appropriate when used correctly. Of course you shouldn't us it over a joint and you shouldn't pour it in someone's eye. (File that under "Duh")
But it's simply false to imply that there's anything suboptimal about a adhesive repair in selected wounds. It's a shortcut only in the sense that it's quicker, not because of a compromise in care.
To stop dermabond from spreading everywhere:
1) take tegaderm and cut a hole that is somewhat larger than the wound
2) place over wound
3) approximate edges
4) dermabond laceration
5) place together for a couple of mins.
6) remove tegaderm.
Source: Tricks of the trade.
My understanding of dermabond and indermil is that its use was based on a study showing efficacy. I beleive that there are roles of tissue adhesives
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