A supramolecular hydrogel leveraging hierarchical multi-strength hydrogen-bonds hinged strategy achieving a striking adhesive-mechanical balance.

To obtain high-performance tissue-adhesive hydrogel embodying excellent mechanical integrity, a supramolecular hydrogel patch is fabricated through in situ copolymerization of a liquid-liquid phase separation precursor composed of self-complementary 2-2-ureido-4-pyrimidone-based monomer and acrylic acid coupled with subsequent corporation of bioactive epigallocatechin gallate. Remarkably, the prepared supramolecular hydrogel leverages hierarchical multi-strength hydrogen-bonds hinged strategy assisted by alkyl-based hydrophobic pockets, broadening the distribution of binding strength of physical junctions, striking a canonical balance between superb mechanical performance and robust adhesive capacity. Ultimately, the fabricated supramolecular hydrogel patch stands out as a high stretchability (1500 %), an excellent tensile strength (2.6 MPa), a superhigh toughness (12.6 MJ m-3), an instant and robust tissue adhesion strength (263.2 kPa for porcine skin), the considerable endurance under cyclic loading and reversible adhesion, a superior burst pressure tolerance (108 kPa) to those of commercially-available tissue sealants, and outstanding anti-swelling behavior. The resultant supramolecular hydrogel patch demonstrates the rapid hemorrhage control within 60 s in liver injury and efficient wound closure and healing effects with alleviated inflammation and reduced scarring in full-thickness skin incision, confirming its medical translation as a promising self-rescue tissue-adhesive patch for hemorrhage prevention and sutureless wound closure.

The effectiveness of fibrin sealants in head and neck surgery: a systematic review and meta-analysis.

BACKGROUND: Fibrin sealants are increasingly used in head and neck surgery to aid hemostasis, but individual studies lack conclusive evidence. This systematic review investigates their effectiveness compared to placebo or usual care in head and neck surgery. METHODS: Studies comparing fibrin sealant to placebo or usual care in patients 18 years or older who have undergone soft tissue surgery of the head and neck with drain placement were included. Primary outcomes include wound complications and time to surgical drain removal postoperatively. Secondary outcomes include length of hospital stay, drain volume output, surgical management of hematoma, blood transfusion rates, and adverse reactions. Electronic databases were searched on October 2023 for randomized controlled and quasi-experimental studies. Studies underwent independent screening, review, and appraisal by two reviewers using JBI appraisal tools. Certainty was assessed with GRADE, and meta-analysis was conducted using JBI SUMARI, presenting effect sizes as relative risk ratios or mean differences with 95% confidence intervals. RESULTS: Fourteen studies were included examining 904 patients. The fibrin sealant group exhibited reduced postoperative wound complications (hematoma, seroma, wound dehiscence, wound infection) (RR = 0.64, 95% CI = 0.45-0.92), shorter drain removal times (MD = - 0.49 days, 95% CI = - 0.68 to - 0.29), decreased drain output (MD = - 16.52 mL, 95% CI = - 18.56 to - 14.52), and shorter hospital stay (MD = - 0.84 days, 95% CI = - 1.11 to - 0.57) compared to controls. There was no statistically significant difference on the rate of intervention for postoperative hematoma and the rate of adverse reactions. DISCUSSION: Evidence demonstrates with low certainty that fibrin sealant use is associated with a modest reduction in the rate of wound complications, drain duration, and length of stay, and a small reduction in drain volume output. Methodological weaknesses and clinical heterogeneity limit these findings. Further research should focus on enhancing methodological quality and exploring the cost-effectiveness of fibrin sealant use in surgery. SYSTEMATIC REVIEW REGISTRATION: CRD42023412820. FUNDING: Nil.

Electrospun Polymeric Fiber Systems Inoculated with Cyanoacrylate Tissue Adhesive: A Novel Hemostatic Alternative during Open Surgery.

Natural-based and synthetic tissue adhesives have attracted extensive attention in the last two decades for their ability to stabilize uncontrolled bleeding instances. However; these materials present several drawbacks during use that scientists have tried to minimize in order to optimize their usage. This study comprises the development of a novel wound dressing, combining the excellent properties of polylactic acid (PLA) non-woven textile, as substrate, obtained through electrospinning, and a cyanoacrylate-based (CA) tissue adhesive, for rapid hemostatic action. Thus, the fabrication of electrospun PLA membranes at three different PLA concentrations, the design and manufacturing of the support system and the production of surgical patches were carried out. SEM and FT-IR methods were employed for analyzing the morphology as well as the indicative markers for the shelf life evolution of the obtained patches. PLA fibers with well-defined structures and a mean diameter varying between 4.6 and 7.24 µm were obtained with the increase of the concentration of the PLA solutions. In vivo tests on a rat model as well as peeling tests for good patch adhesion on liver fragments harvested from the test animals, with a limit for the strength of the liver tissue of 1.5 N, were carried out. The devices exhibited excellent adhesion to the parenchymal tissue and a long enough shelf life to be used with success in surgical procedures, also facilitating prompt hemostatic action.

The surgical outcome of sutureless skin closures using Octyl-2-cyanoacrylate (Dermabond™) versus Steri-Strip™.

Introduction: Cosmesis is the primary concern for the patient undergoing facial surgery and there are numbers of well proven materials that are available such as adhesive tapes, subcuticular suture, skin adhesive or glue to achieve better cosmesis. The objective of our study was to assess the surgical outcome of sutureless skin closures using Octyl-2-cyanoacrylate (Dermabond™) versus Steri-Strip™. Method: The present prospective study was conducted in 20 patients. Patients were divided into two groups. After subcutaneous closure of wounds, either Dermabond™ or Steri-Strip™ was placed. The patients were assessed for wound complication (erythema, tenderness, dehiscence or any discharge), scar hypertrophy and cosmetic appearance also time consumed in surgical skin closure was evaluated. Wound assessment, scar hypertrophy and cosmetic appearance were assessed by using Chi-square test. Time closure was assessed by using Mann-whitney U test. Result: Twenty patients belonging to all age group were included in study. Ten patients undergone closure with Dermabond™ and ten with Steri-Strips™. Assessment of wound complications, cosmetic appearance and scar hypertrophy was done. There was no significant difference found between both the groups, but 2 patients had fair cosmetic outcomes at one month and 1 patient had fair scar hypertrophy at 6 month. However, excellent cosmetic outcome in terms of scar hypertrophy at 6 month was significantly more among group II. Conclusion: Octyl-2-cyanoacrylate (Dermabond™) and Steri-Strip™ provide similar outcomes in terms of wound complications. Cosmetic outcomes in terms of scar hypertrophy with steri-strip wound closure seem to be better and more economical.

Use of Fibrin Glue as a Surgical Adjunct in Bone Grafting of Fracture Non-unions.

Introduction: Non-union of long bones is a common challenge in the treatment of fractures. Bone grafting is commonly used to treat atrophic non-union, but mechanical displacement of the graft may occur, resulting in delay or failure of treatment. Fibrin glue has demonstrated positive results in management of bone defects in neurosurgery and oromaxillary facial surgery, however, there has yet to be any study on its use in long bone fractures. Materials and Methods: We conducted a prospective randomised controlled trial at a single tertiary centre involving adult patients with long bone fractures that had undergone non-union and requiring bone grafting only. Autologous iliac crest bone graft was applied to the debrided non-union site, with additional fibrin glue applied for the intervention arm. Patients were followed-up with serial radiographs until clinical and radiographical union. Results: Ten patients (3 male, 7 female), of mean age 41.7 (19 - 63) were recruited over five years, with one drop out. Eight out of nine fractures united after treatment. One patient underwent hypertrophic non-union requiring re-fixation and bone grafting. There was no difference in the time to union for patients in the fibrin glue group (19.5 weeks) versus the control group (18.75 weeks) (p=0.86). There were no complications sustained from usage of fibrin glue. Conclusion: Fibrin glue appears to be a safe adjunct for treatment of non-union of long bone fractures across varying fracture sites by holding the bone graft in place despite not demonstrating a faster time to union.

Tissue Adhesive versus Skin Suture plus Waterproof Wound Dressings for Carpal Tunnel Wound Closure: A Prospective Randomized Controlled Trial.

Introduction: The popular wound closure methods for carpal tunnel decompression (CTD) include non-absorbable and absorbable sutures which have comparable results in clinical outcomes. However, these wound closure methods are recommended to keep a wound dry which may limit some ADLs. We conducted a prospective randomized controlled trial that compares clinical outcomes and cost-effectiveness in a skin closure following CTD between absorbable sutures plus a 2-octyl cyanoacrylate tissue adhesive (2OCA) versus non-absorbable skin sutures plus a waterproof dressing (NSPWD). Materials and Methods: We enrolled 120 patients undergoing CTD into two groups: 2OCA and NSPWD, with 60 patients in each group. Number of dressing changes, Quick DASH, pain VAS, cosmetic VAS, patient satisfaction VAS, and Hollander wound evaluation score, cost-effectiveness, and post-operative complications were collected at pre-operative period and two and six weeks post-operatively. Results: Slightly better patient satisfaction VAS (7.9 vs 7.2, p=0.018) and cosmetic VAS (8.0 vs 7.2, p=0.025) were observed in 2OCA at 2 weeks. Meanwhile, NSPWD revealed lesser times of dressing change (Median, mode, IQR: 0/0/0 vs 2/3/2, p<0.001). The total wound-related costs include dressing change and suture removal cost ($15.9 for 2OCA vs $19.2 for NSPWD, p=0.002) although an initial wound-related cost in 2OCA was higher ($15.7/case vs $7.9/case, p<0.001). Conclusion: Our study revealed that the supplementary tissue adhesive to absorbable sutures following CTD could reduce total wound-related costs while clinical outcomes might not be considered clinically significant.

An Innovative Primary Repair Technique for Large Cutaneous Defects Post-excision of Complicated Preauricular Sinuses: A Case Report.

Preauricular sinuses are congenital anomalies arising from the incomplete fusion of hillocks of His of the first and second branchial arches. Surgery is warranted when there is recurrent infection or abscess formation. However, the presence of scarring and skin thinning could result in large tissue defects after complete excision. In such cases, meticulous preoperative planning with regard to the reconstruction technique is imperative. We describe the clinical presentation, surgical technique, and postoperative outcomes of such a case in a young toddler, with a focus on the rationale behind the chosen management strategy. By sharing our experience, we aim to contribute to the existing literature on the management of complicated preauricular sinuses and provide insights that may guide clinicians facing similar challenges.

Injectable Tissue Adhesive Microgel Composite Containing Antifibrotic Drug for Vocal Fold Scarring.

Vocal fold (VF) scarring, a complex problem in laryngology, results from injury and inflammation of the layered architecture of the VFs. The resultant voice hoarseness, for which successful therapeutic options are currently limited, affects the patient's quality of life. A promising strategy to reverse this disorder is the use of antifibrotic drugs. The present study proposes a novel microbead-embedded injectable hydrogel that can sustain the release of the anti-fibrotic drug pirfenidone (PFD) for vocal fold scarring. Microbeads were developed using sodium alginate and gelatin, which were further embedded into a biomimetic and tissue adhesive gellan gum (GG) hydrogel. The microbead-embedded hydrogel exhibited improved injectability, viscoelasticity, tissue adhesiveness, degradability, and swelling compared to the hydrogel without beads. Additionally, the bead-embedded hydrogel could sustain the release of the PFD for a week. In vitro studies showed that the drug-loaded hydrogel could reduce the migration and proliferation of fibroblast cells in a dose-dependent manner. In summary, this study demonstrates the potential of a PFD-loaded injectable hydrogel with enhanced viscoelastic and tissue-adhesive properties for vocal fold scarring applications.

Matched cohort study evaluating the hemostatic efficacy of fibrin sealant versus conventional approaches following dental surgery in patients with hemophilia.

Patients with hemophilia frequently require supplementary interventions, either invasive (suturing, gel foam, or cauterization) or non-invasive (fibrin sealant/glue), to attain hemostasis post dental procedures. This study aimed to compare the efficacy of fibrin sealant against traditional methods for achieving hemostasis post dental surgery. The medical records of patients with factor VIII or IX deficiency, or von Willebrand disease, who underwent dental procedures in the Department of Dentistry, Seth GSMC and KEM Hospital, were evaluated for inclusion in this retrospective matched cohort study. Cohort-1 included those treated with a fibrin sealant (Tisseel Lyo) with/without traditional hemostatic measures post-procedure, while cohort-2 (controls) included those in whom no fibrin sealant was used. A total of 128 patients, 64 in each group, were evaluated. There was no statistically significant difference in demographics, disease-related variables, dental complaints, or preoperative treatment given between the groups. However, there was a significant reduction (P < 0.001) in the requirement for secondary procedures for hemostasis (suturing, gel foam application, and/or cauterization) and postoperative requirement for factor replacement (P = 0.003) in the fibrin glue group as compared to the controls. In this study, fibrin sealant demonstrated superior efficacy in mitigating the necessity for active hemostasis control.

Synergistic potential of gellan gum methacrylate and keratin hydrogel for visceral hemostasis and skin tissue regeneration.

In recent years, the development of biodegradable hydrogels as an alternative over the traditional wound dressing has become increasingly significant. These specific hydrogels are able to offer suitable microenvironments to further aid the process of tissue or organ regeneration. However, application of biodegradable hydrogels in clinical medicine remains uncommon due to most biodegradable hydrogels struggle with achieving satisfactory adhesiveness property, high mechanical support and cell compatibility simultaneously. In order to overcome these constraints and enhance the applicability of biodegradable hydrogels, methods have been employed in this study. By reacting gellan gum with methacrylic anhydride and incorporating a biodegradable protein, keratin, we endowed the hydrogels with high pliability via photo-polymerization chain extension, thereby obtaining a biodegradable hydrogel with exceptional properties. Through a series of in vitro tests, GGMA/keratin hydrogels exhibited great cell compatibility via providing an appropriate environment for cell proliferation. Furthermore, this hydrogel not only exhibits extraordinary adhesive ability on visceral tissues but also extends to scenarios involving skin or organ damage, offering valuable assistance in wound healing. Our design provides a suitable platform for cell proliferation and tissue regeneration, which shows prospects for future medical research and clinical applications.

Temperature- and pH-induced dual-crosslinked methylcellulose/chitosan-gallol conjugate composite hydrogels with improved mechanical, tissue adhesive, and hemostatic properties.

Gauze or bandages are commonly used to effectively control bleeding during trauma and surgery. However, conventional treatment methods can sometimes lead to secondary damages. In recent years, there has been increased interest in developing adhesive hemostatic hydrogels as a safer alternative for achieving hemostasis. Methylcellulose (MC) is a well-known thermo-sensitive polymer with excellent biocompatibility that is capable of forming a hydrogel through physical crosslinking owing to its inherent thermo-reversible properties. However, the poor mechanical properties of the MC hydrogel comprising a single crosslinked network (SN) limit its application as a hemostatic material. To address this issue, we incorporated a chitosan-gallol (CS-GA) conjugate, which has the ability to form chemical crosslinks through self-crosslinking reactions under specific pH conditions, into the MC hydrogel to reinforce the MC hydrogel network. The resulting MC/CS-GA hydrogel with a dual-crosslinked network (DN), involving both physical and chemical crosslinks, exhibited synergistic effects of the two types of crosslinks. Thus, compared with those of the SN hydrogel, the composite DN hydrogel exhibited significantly enhanced mechanical strength and tissue adhesive properties. Moreover, the DN hydrogel presented excellent biological activity in vitro. Additionally, in rat hepatic hemorrhage models, the DN hydrogel exhibited high hemostatic efficiency, showcasing its multifunctional capabilities.

Breaking the boundaries of wound closure: A novel polyurethane tissue adhesive with enhanced healing properties.

Over the past few decades, there have been advancements in the development of high-performance tissue adhesives as alternatives to traditional sutures and staples for rapid and effective wound closure post-surgery. While tissue adhesives offer advantages such as ease of use, short application time, and minimal tissue damage, they also face challenges related to biocompatibility, biodegradability, and adhesive strength. In this study, L-lysine diisocyanate (LDI) and trimethylolpropane (TMP) were utilized as the primary raw materials to produce a prepolymer terminated with NCO, resulting in the development of a new biocompatible polyurethane tissue adhesive (TMP-LDI). Additionally, SiO2 nanoparticles were incorporated into the prepolymer, significantly enhancing the adhesive strength of the TMP-LDI tissue adhesive through the "nanobridging effect," achieving a strength of 170.4 kPa. Furthermore, the SiO2/TMP-LDI tissue adhesive exhibited satisfactory temperature change during curing and degradation performance. In vitro and in vivo studies demonstrated that SiO2/TMP-LDI exhibited good biocompatibility, efficient hemostasis, antimicrobial properties, and the ability to promote wound healing. This research presents a novel approach for the development of tissue adhesives with superior adhesive performance.

A biguanide chitosan-based hydrogel adhesive accelerates the healing of bacterial-infected wounds.

The development of tissue adhesives with good biocompatibility and potent antimicrobial properties is crucial for addressing the high incidence of surgical site infections in emergency and clinical settings. Herein, an injectable hydrogel adhesive composed of chitosan biguanidine (CSG), oxidized dextran (ODex) and tannin (TA) was synthesized primarily through Schiff-base reactions, hydrogen bonding, and electrostatic interactions. TA was introduced into the CSG/ODex hydrogel to prepare a physicochemically double cross-linked hydrogel. The hydrogel formulation incorporating 2 wt% TA (CSG/ODex-TA2) exhibited rapid gelation, moderate mechanical properties, good tissue adhesion, and sustained release behavior of TA. Both in vitro and in vivo studies demonstrated that CSG/ODex-TA2 showed significantly enhanced adhesion and antibacterial effectiveness compared to the CSG/ODex hydrogel and commercial fibrin glue. Leveraging the positive charge of CSG, the CSG/ODex-TA2 hydrogel demonstrated a strong contact antibacterial effect, while the sustained release of TA provided diffusion antibacterial capabilities. By integrating contact and diffusion antibacterial mechanisms into the hydrogel, a promising approach was developed to boost antibacterial efficiency and accelerate the healing of wounds infected with methicillin-resistant Staphylococcus aureus (MRSA). The CSG/ODex-TA2 hydrogel has excellent biocompatibility, hemostatic properties, and antibacterial capabilities, making it a promising candidate for improving in vivo wound care and combating bacterial infections.

Endoscopic band ligation or endoscopic tissue adhesive injection in the treatment of gastric varices: Which is better?

The combination of endoscopic ultrasound with endoscopic treatment of type 1 gastric variceal hemorrhage may improve the robustness and generalizability of the findings in future studies. Moreover, the esophageal varices should also be included in the evaluation of treatment efficacy in subsequent studies to reach a more convincing conclusion.

A Comparison between 2-Octyl Cyanoacrylate and Conventional Suturing for the Closure of Epiblepharon Incision Wounds in Children: A Retrospective Case-Control Study.

Background: Tissue adhesive has been widely used in ophthalmic surgery for various procedures, proving both effective and safe. However, no studies have compared the surgical efficacy of the tissue adhesive 2-octyl cyanoacrylate (SurgiSeal®) to that of traditional suture closure in Asian children undergoing surgery for lower lid epiblepharon. Methods: This is a single-center retrospective case-control study. Surgical correction for epiblepharon was performed on 22 patients from November 2019 to May 2023. A total of 20 patients who were followed up for at least 1 month were included for analysis. After standardized epiblepharon surgery, group A underwent wound closure with a subcuticular suture and 2-octyl cyanoacrylate, and group B underwent closure with a 6-O fast-absorbing surgical gut suture. Patients were followed up at 1, 4, and 12 weeks post-surgery. Results: A total of 10 patients (20 eyes) underwent skin closure with tissue adhesives (group A), and 10 patients (18 eyes) underwent wound closure using conventional suture material (group B). No significant differences in the sex ratio, mean age at operation, pre- and postoperative best-corrected visual acuity (BCVA), or average surgical time were observed between groups. Both groups exhibited improved postoperative BCVA, with symptom relief and a significant decrease in the severity of keratopathy after surgery. Neither recurrence nor complications were reported during follow-up. The aesthetic results were similar between groups, while caregivers of children in the tissue adhesive group expressed high satisfaction regarding the ease of postoperative care. Conclusions: Successful closure of lower lid epiblepharon surgery wounds in children can be performed using 2-octyl cyanoacrylate (SurgiSeal®). This method is simple, safe, and effective when compared to conventional sutures.

Synthesis and Analysis of Novel Hyaluronic Acid-Based Dual Photocrosslinkable Tissue Adhesive: An In Vitro Study.

Background Tissue adhesives are mainly used for aiding in the attachment of adjacent tissues or to nearby hard tissue surfaces. They promote the natural healing processes of the tissues, especially for less painful closure, simple application, no need for sutures following surgery, and localized drug release. This study aimed to synthesize and assess the properties of hyaluronic acid (HA)-based, dual photocrosslinkable tissue adhesive. Materials and methodology N-hydroxysuccinimide (NHS), 1-ethyl-3-(3-dimethylaminopropyl)-carbodiimide (EDC), HA, and polymethylmethacrylate, which served as a photoinitiator, were combined to synthesize a tissue adhesive. The prepared formulation was characterized, and its biocompatibility was assessed. Results Surface morphology, mechanical properties, and biological properties of the HA adhesive were comparable to those of conventional fibrin glue. Scanning electron microscopy (SEM) analysis showed the average size of the molecules, 10-25 mm in diameter, and also showed a smooth and nonporous surface. The specimens experienced maximum compressive stress of 0.06 ± 0.02 MPa, compressive strain of 3.07 ± 2.02, and a compressive displacement at break of 3.04 ± 1.23 mm, with a maximum force of 2.33 ± 0.07 N at break. The cytotoxicity assay results for HA and fibrin glue are almost equal. Conclusion HA-based photocrosslinkable tissue adhesive could be a potential biomaterial in various applications in the field of medicine, especially in soft tissue management.

Endoscopic treatment of bleeding gastric ulcer causing gastric wall necrosis: A case report.

BACKGROUND: Gastric wall necrosis is a rare complication of endoscopic treatment for bleeding gastric ulcer, which may exacerbate the patient's condition once it occurs and may even require surgical intervention for treatment. CASE SUMMARY: A 59-year-old man was admitted to our department with melena. Endoscopy revealed a giant ulcer in the gastric antrum with a visible vessel in its center, which was treated with sclerosants and tissue glue injection and resulted in necrosis of the gastric wall. CONCLUSION: Injection of sclerosants and tissue glue may lead to gastric wall necrosis, which is a serious complication. Therefore, before administering this treatment to patients, we should consider other more effective methods of hemostasis to avoid gastric wall necrosis.

Sutureless vascular anastomotic approaches and their potential impacts.

Sutureless anastomotic devices present several advantages over traditional suture anastomosis, including expanded global access to microvascular surgery, shorter operation and ischemic times, and reduced costs. However, their adaptation for arterial use remains a challenge. This review aims to provide a comprehensive overview of sutureless anastomotic approaches that are either FDA-approved or under investigation. These approaches include extraluminal couplers, intraluminal devices, and methods assisted by lasers or vacuums, with a particular emphasis on tissue adhesives. We analyze these devices for artery compatibility, material composition, potential for intimal damage, risks of thrombosis and restenosis, and complications arising from their deployment and maintenance. Additionally, we discuss the challenges faced in the development and clinical application of sutureless anastomotic techniques. Ideally, a sutureless anastomotic device or technique should eliminate the need for vessel eversion, mitigate thrombosis through either biodegradation or the release of antithrombotic drugs, and be easily deployable for broad use. The transformative potential of sutureless anastomotic approaches in microvascular surgery highlights the necessity for ongoing innovation to expand their applications and maximize their benefits.

Injectable ChitHCl-DDA tissue adhesive with high adhesive strength and biocompatibility for torn meniscus repair and regeneration.

Suture pull-through is a clinical problem in meniscus repair surgery due to the sharp leading edge of sutures. Several tissue adhesives have been developed as an alternative to traditional suturing; however, there is still no suitable tissue adhesive specific for meniscus repair treatment due to unsatisfactory biosafety, biodegradable, sterilizable, and tissue-bonding characteristics. In this study, we used a tissue adhesive composed of chitosan hydrochloride reacted with oxidative periodate-oxidized dextran (ChitHCl-DDA) combined with a chitosan-based hydrogel and oxidative dextran to attach to the meniscus. We conducted viscoelastic tests, viscosity tests, lap shear stress tests, Fourier transform infrared (FTIR) spectroscopy, swelling ratio tests, and degradation behavior tests to characterize these materials. An MTT assay, alcian blue staining, migration assay, cell behavior observations, and protein expression tests were used to understand cell viability and responses. Moreover, ex vivo and in vivo tests were used to analyze tissue regeneration and biocompatibility of the ChitHCl-DDA tissue adhesive. Our results revealed that the ChitHCl-DDA tissue adhesive provided excellent tissue adhesive strength, cell viability, and cell responses. This tissue adhesive has great potential for torn meniscus tissue repair and regeneration.

Octyl-2-cyanoacrylate Tissue Adhesive Closure Versus Subcuticular Suture for Post-Auricular Incisions.

BACKGROUND: Skin closure techniques in otolaryngology vary based on surgeon preference and wound site. Octyl-2-Cyanoacrylate may be a safe, rapid, and cost-effective option for post-site closure. AIM: This randomized controlled trial study aimed to compare Octyl-2-Cyanoacrylate and conventional subcuticular sutures in ear surgeries, assessing wound closure results in both case and control groups. METHODS: This prospective, randomized, controlled, single-blind study was conducted at Ohud Hospital from May 2021 to May 2022. Ear surgery and cochlear implantation in patients were examined, and each group was randomly assigned to receive Dermabond TM and deep layer subcuticular sutures closure. Incisions were assessed at various time points, including 3 weeks, 6 weeks, 6 months, and 1 year post-surgery. The patient and observer Scar Assessment Scale was used, and two independent ear surgeons used the Stony Brook Scar Evaluation Scale for initial scar assessment. RESULTS: This study involved 126 ear surgery and cochlear implantation patients randomized to use cyanoacrylate tissue adhesive or subcuticular suture for port site closure. The study found that tissue adhesive (OCA) was faster and more efficient than standard sutures, saving an average of 12 min per incision in each ear. Incision cosmesis showed immediate results and significant differences, and patient satisfaction with OCA wound closure was higher than standard sutures. CONCLUSION: The findings confirmed that cyanoacrylate tissue adhesive significantly reduced the time needed for skin closure during ear surgery and showed immediate cosmetic improvements without any documented instances of bleeding, hematoma, infection, or wound separation. LEVEL OF EVIDENCE: This is a randomized controlled trial, it follows Level 2 of evidence. Randomized trial or observational study with dramatic effects Laryngoscope, 134:4036-4041, 2024.