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Adhesive Biomaterials for Tissue Repair and Reconstruction
Published in Severian Dumitriu, Valentin Popa, Polymeric Biomaterials, 2020
A listing of commercially available cyanoacrylate tissue adhesives, along with their approved indications, is given in Table 17.4. Cyanoacrylates are approved for external closure of topical skin incisions and trauma-induced skin lacerations; the commercial cyanoacrylate glue Omnex® (J&J/Ethicon, Somerville, New Jersey) is approved for internal hemostasis during vascular reconstruction surgery. When used for skin closure, the cyanoacrylates are recommended to be used with deep dermal sutures, because dehiscence can occur if the cyanoacrylates are the only means of skin attachment. In addition to their surgical adhesive indications, the 2-octyl-cyanoacrylate glues Dermabond and Indermil® (Covidien, Mansfield, Massachusetts) are approved for use as barriers against common bacterial microbes including certain staphylococci, pseudomonads, and Escherichia coli. However, cyanoacrylate-based tissue adhesives have found numerous off-label uses in a variety of surgical disciplines.
Surgical applications of intracorporal tissue adhesive agents: current evidence and future development
Published in Expert Review of Medical Devices, 2020
Nicholas Gillman, David Lloyd, Randy Bindra, Rui Ruan, Minghao Zheng
Cyanoacrylates are liquid monomers which rapidly polymerize in the presence of a nucleophile, usually water or a basic fluid, to form a strong adhesive network [156]. Along with rapid curing, the sealant shows strong adhesive strength, which can be beneficial in a clinical setting to prevent fluid loss and tends to be cheaper than other surgical sealants [12]. As part of their chemical structure, cyanoacrylate monomers contain an alkyl group, which may be modified to influence the mechanical properties of the polymer network. One potential consequence of cyanoacrylate use is exposure to toxic degradation products. Cyanoacrylate polymers can be metabolized via hydrolysis, forming formaldehyde and have been shown to cause toxic damage to major organ systems including respiratory, nervous, and genitourinary and are therefore generally limited to the external application [157–159]. ETHICONTM OMNEXTM Surgical Sealant (EOSS) is the only cyanoacrylate-based adhesive approved for intracorporal use. The agent is composed of 2-octyl cyanoacrylate (2-OCA) and butyl lactoyl cyanoacrylate (BLCA) [160]. The sealant is indicated as an adjunctive method to achieve hemostasis through the mechanical sealing of anastomotic closure lines in vascular reconstruction [161]. A prospective clinical trial assessing the efficacy of EOSS found immediate hemostasis was achieved in 71.3% of patients [162]. Another study found EOSS was superior to simple sutural anastomosis, with 54.5% of patients achieving immediate hemostasis compared to 10% in the control group [163]. EOSS has also been trialed with success for sutureless colonic anastomosis [164,165]. However, one study found that it was inferior in preventing colonic leakage compared with another commercially available adhesive and promoted an increased inflammatory response [166]. It must be noted that the long-term safety effects of the breakdown products have not been established [160]. The possible side effects of formaldehyde should be seriously considered. The sealant degrades over a prolonged period of time (36 months) [167], which may negate the effects and prevent formaldehyde-related toxicity, however, more research should be undertaken.