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TOPICAL SKIN ADHESIVES

DERMABOND® Topical Skin Adhesive

Product 1

Product 2

DERMABOND® TOPICAL SKIN ADHESIVE - INTRODUCTION

DERMABOND® Adhesive is a strong and

highly flexible topical skin adhesive

with a chemical composition that gives

it flexibility and strength superior to

those of competitors’ products.1

DERMABOND® Adhesive may be used in

place of sutures or staples to close

wounds in conjunction with deep

dermal stitches (you will learn more

about this later in the tutorial). It may

be used to close wounds of any length

(DERMABOND® Adhesive has been

clinically shown to be effectively close

skin on wounds of up to 69 cm), with

excellent cosmetic outcomes.

DERMABOND® TOPICAL SKIN ADHESIVE - INTRODUCTION

When DERMABOND® Adhesive is used

in addition to skin sutures or staples it

functions as a microbial barrier to

protect wounds from bacteria that can

cause infection.

DERMABOND® TOPICAL SKIN ADHESIVE - INTRODUCTION

DERMABOND® Adhesive is a highly viscous, sterile,

nonabsorbable, single-use liquid made from the polymer

2-octyl cyanoacrylate (you will learn more about why this is

important in Tutorial 2). It is dyed with D&C Violet #2 for easier

visualization during application.2

DERMABOND® TOPICAL SKIN ADHESIVE - FEATURES AND BENEFITS

DERMABOND® Adhesive:

• 7 days of wound-healing strength in 3 minutes4

• Faster and as strong as 4-0 suture5,6

• Acts as a microbial barrier and as its own dressing7,8

• Has been clinically proven to close skin effectively in both short and long

incisions (up to 69 cm)9

• Can save the surgeon significant amounts of time in some procedures5

DERMABOND® TOPICAL SKIN ADHESIVE - FEATURES AND BENEFITS

DERMABOND® Adhesive:

• Is water-resistant enough for a patient to shower a few minutes

after application10

• Holds securely to the wound and sloughs off as the skin re-epithelializes

at around 5 to 10 days2

• Does not require a return visit for removal

• Can be stored at room temperature for up to 24 months11

Throughout the tutorial, we will learn more about the many

features and benefits of DERMABOND® Adhesive.

DERMABOND® TOPICAL SKIN ADHESIVE - FEATURES AND BENEFITS

DERMABOND® Adhesive is supplied in the following

3 packaging options:

• DHV12: DERMABOND® Adhesive High Viscosity, in 0.5 mL

ampoule form• DPP6: DERMABOND® Adhesive ProPen, containing 0.5 mL• DPPXL6: DERMABOND® Adhesive ProPen XL, containing 0.75 mL

DERMABOND® TOPICAL SKIN ADHESIVE - PRODUCTS

We will be learning more about each of these later in

this tutorial.

First, let’s take a look at how DERMABOND® Adhesive is

applied to a wound using the DERMABOND® Adhesive ProPen

XL.

DERMABOND®

Adhesive is supplied

in ampoule form

And in DERMABOND®

Adhesive ProPen

DERMABOND® TOPICAL SKIN ADHESIVE - PRODUCTS

When applying DERMABOND® Adhesive to a wound, the wound

should be clean and dry, and adequate hemostasis should be

achieved.2

In the following frames, we will look at how DERMABOND®

Adhesive is used in conjunction with sutures to close deeper

wounds that extend below the skin.

DERMABOND® TOPICAL SKIN ADHESIVE - PREPARING A WOUND

In such a case, the surgeon should first utilize deep dermal sutures in the wound to relieve the tension, using absorbable suture such as MONOCRYL* Plus Antibacterial (poliglecaprone 25) Suture or Coated VICRYL* Plus Antibacterial (polyglactin 910) Suture.

Deep suturing may include subcutaneous and deep dermal closure (as shown here), or it may be a combination subcutaneous/deep dermal closure.

deep dermal stitch

DERMABOND® TOPICAL SKIN ADHESIVE - PREPARING A WOUND

* Trademark

subcuticular

subcutaneous

In some cases, a wound may be too

long to be easily approximated in

one section.

If this is the case, after applying

deep dermal sutures the surgeon

should divide the wound

temporarily into segments using

adhesive strips, forceps, or fingers.

DERMABOND® TOPICAL SKIN ADHESIVE – PREPARING LONG WOUNDS

The wound illustrated here has been

divided into segments using an

adhesive strip.

Once in place, DERMABOND® Adhesive provides an

extremely flexible microbial barrier that helps prevents

some of the most common infection-causing bacteria from

entering a wound.1,12

DERMABOND® TOPICAL SKIN ADHESIVE – THE PATIENT EXPERIENCE

The common bacteria that DERMABOND® Adhesive

has been shown in vitro to serve as a barrier to:7

• Staphylococcus epidermidis

• Staphylococcus aureus

• Escherichia coli

• Pseudomonas aeruginosa

• Enterococcus faecium

DERMABOND® TOPICAL SKIN ADHESIVE – THE PATIENT EXPERIENCE

A wound to which DERMABOND® Adhesive has been

applied needs no other dressing and the patient, if mobile,

can shower immediately after application.7

DERMABOND® Adhesive remains on the skin until after

healing has occurred. Ultimately, it will slough off as a

result of natural epithelialization.2

DERMABOND® TOPICAL SKIN ADHESIVE – THE PATIENT EXPERIENCE

For tissue adhesives, the increase in the length of the

carbon chain means an increase in certain important

physical characteristics of the monomer.

DERMABOND® Topical Skin Adhesive is a 2-octyl

cyanoacrylate with an 8-carbon chain…

CYANOACRYLATES

…unlike its competitors,

which are N-butyl-2-octyl

cyanoacrylates and have a

4-carbon chain.

DIFFERENCES IN CYANOACRYLATES

The increased length of the

carbon chain gives

DERMABOND® Topical Skin

Adhesive many advantages,

such as strength, flexibility

and microbial barrier

performance.

DIFFERENCES IN CYANOACRYLATES

The 2-octyl cyanocrylate that is used in DERMABOND®

Adhesive provides a 3-dimensional strength

(ie, flexibility – that is 3 to 4 times stronger than that of

N-butyl-2 cyanoacrylate).1,12 – Demonstrated in vivo

DIFFERENCES IN CYANOACRYLATES

In addition to using different base formulas, manufacturers

can vary the physical characteristics of cyanoacrylates by

adding components, such as plasticizers and elasticizers.

The plasticizers used in DERMABOND® Adhesive produce

a stronger, more pliable tissue-compatible end product

that flexes with the skin and remains in place for longer.

DERMABOND® Adhesive provides more dependable

closure than butyl-based skin closure products, which

become brittle and weak.1,12, 13 – Demonstrated in vivo.

PLASTICIZERS

1 Data on file. Ethicon, Inc.

2 DERMABOND® Adhesive Package Insert.

3 INDERMIL® Tissue Adhesive (package insert). Norwalk, CT: United States Surgical/Syneture;

2002.

4 Quinn J, Wells G, Sutcliffe T, et al. A randomized trial comparing octylcyanoacrylate tissue

adhesive and sutures in the management of lacerations. JAMA. 1997;277:1527-1530.

5 Toriumi DM, O’Grady K, Desai D, Bagal A. Use of octyl-2 cyanocrylate for skin closure in facial

plastic surgery. Plast Reconst Surg. 1998; 102:2209-2219.

6 Shapiro AJ, Dinsmore RC, North JH. Tensile strength of would closure with cyanoacrylate glue.

Am Surg. 2001;67;1113-1115.

7 Bhende S, Rothenberger S, Spangler DJ, Dito M. In vitro assessment of microbial barrier

properties of Dermabond Topical Skin Adhesive. Surg Infect. 2002;3:251-257.

8 Kannon GA, Garrett AB. Moist wound healing with occlusive dressings: a clinical review.

Dermatol Surg. 1995:21:583-590.

9 Blondeel MD. Closure of long surgical incisions with a new formulation of 2-octylcyanoacrylate

tissue adhesive versus commercially available methods. AmJ Surg. 2004;186;307-313.

REFERENCES

10 Rubio PA. Use of semiocclusive, transparent film dressings for surgical wound protection:

experience in 3637 cases. Int Surg. 1991;7:253-254.

11 Laura McCrum, Final Report – Marketing Claims Support: Wound Length Coverage for High

Viscosity DERMABOND Products.

12 Singer AJ, Zimmerman T,Rooney J, Cameau P, Rudomen G, McClain SA. Comparison of wound-

bursting strengths and surface characteristics of FDA-approved tissue adhesive for skin closure.

J Adhes Sci Technol. 2004;18:19-27.

13 Perry L.C. An evaluation of acute incisional strength with tramaseal surgical tissue adhesive

wound closure. Findings by: Dimensional Analysis Systems, Inc. Leonia, NJ. 1995.

14 Hall, LT, MD, Bailes, JE, MD. Using DERMABOND for wound closure in lumbar and cervical

neurosurgical procedures. Abstract taken from Neurosurgery. 56(1) Operative Neurosurgery

Suppliment 1:147-150. Viewed January 2005.

http://www.neurosurgery- online.com/pt/re/neurosurg/abstract.00006123-200501001-00018.htm.

Accessed 4/10/2007.

REFERENCES

CR Approved 5.13.09