Super Glue for Wound Closure
We often get asked, especially on our Remote First Aid courses, if you can use Super Glue to close cuts? Yes it is perfectly possible to close wounds with glue but there is the legitimate clinical method and the 'have-a-go-Harry' approach with whatever Superglue comes to hand. And there are subtle differences.
When treating our own injuries we take responsibility for our own actions. When we are treating other people we have a Duty of Care to treat appropriately and cause no further harm or face the serious consequences of litigation. For this reason we would not suggest that glue is used to treat casualties where you are in a position of responsibility be it your role within your workplace or providing opportunistic care for a casualty to have come across.
You may still be inclined to use glue to treat yourself or maybe your trusted climbing partner, in which case, read on:
All Super Glues are not the same.
"Super Glue" or Cyanoacrylate (CA) is an acrylic resin which rapidly polymerises in the presence of water. The principle component of commercial CAs (SuperGlue, Krazy Glue, Loctite) is either methy-2-cyanoacrylate or ethyl-2-cyanoacrylate, the original forms of CA developed in 1942 by Kodak Laboratories. (The discovery was made whilst investigating potential, high clarity, acrylics for the use in gun sights. Whilst not suitable for this application CA was quickly identified as a fast acting, low shear strength adhesive.)
During the Vietnam war it was used in field surgery with good effect, however, despite the promising results it was not approved by the Unites States Food and Drug Administration due to the unknown toxicity and two significant side effects during the polymerization process:
- The curing process creates an exothermic reaction (heat) which can cause further tissue damage.
- The process releases cyanoacetate and formaldehyde - both irritants to the eyes, nose, throat and lungs.
To overcome these harmful issues, new CAs were developed with the express purpose of use in surgery. 2-octyl cyanoacrylate (Derma+flex® QS™, SurgiSeal, FloraSeal and Dermabond) causes less skin irritation and increased flexibility and strength compared to traditional 'Super Glue'. In 1998 the US FDA approved 2-octyl cyanoacrylate for the closure of wounds and surgical incision and in 2001 was approved as "barrier against common bacterial microbes including certain staphylococci, pseudomonads, and Escherichia coli".
n-butyl cyanoacrylate wound adhesives are available under the trade names: LiquiBand®, Histoacryl, Indermil, GluStitch, GluShield, and Periacryl (dental adhesive)
Octyl ester, while providing a weaker bond, are more flexible. Butyl esters provide stronger bond, but are rigid.
A cheaper alternative...Veterinary Glues
If you are looking for something for your personal first aid kit and don't fancy spending £120 on 6 x 5ml vials of Derma Bond, veterinary glues are commercially available as a happy compromise; not licensed for use on humans but essentially the same stuff in a different wrapper.
Wound adhesives are generally only used on minor wounds, no more than 5cm and with straight edges. Do not attempt to use glue on the following:
- wounds on the face
- wounds where the skin flexes or over joints
- wounds with uneven or jagged edges
- deep wounds
- wounds that are bleeding
- infected wounds
- animal bites
- puncture wounds
- dirty wounds
This last point is critical in a remote or industrial environment since most wounds encountered will typically be dirty in which case it is almost always preferable to clean the wound and pack it 'open' with Vaseline soaked dressings (Tulle Gras) or saline soaked dressings to prevent the wound drying out. The wound can then be properly cleaned and closed (if appropriate) in a hospital setting later on.
Using glue to close wounds may have been pioneered 50 years ago and continually perfected clinically ever since as well as an established treatment for climbers, string musicians and garage mechanics around the world...but that doesn't mean it is a panacea.
Given the number of limitations in its use and the issues of liability we would not advise glue is used to treat others. If you choose to use it to treat yourself, do so...with care and full understanding.
Direct Pressure will stop the majority of even the most serious bleeding wounds and where Direct pressure is not enough there are other options including tourniquets and haemostatic agents, both of which are covered on our Remote First Aid and First Person on Scene courses.