Tissue Adhesives in Surgical Wound Closure

Tissue adhesives have emerged as a versatile alternative or adjunct to conventional sutures and staples in the closure of surgical wounds. Broadly divided into synthetic formulations such as cyanoacrylates and biological sealants such as fibrin glues, these products adhere tissues by a rapid polymerisation or clotting mechanism. Advantages include reduced operative time, watertight sealing, minimised foreign‐body bulk and often superior cosmetic outcomes. They may confer haemostatic and microbial‐barrier properties, reducing the risk of postoperative leakage and contamination. Applications range from orthopaedics and general surgery to paediatric and trauma settings, with special value in anatomically challenging or tension‐sensitive sites. Limitations encompass lower ultimate tensile strength compared with deep sutures, solvent sensitivity, potential for contact dermatitis and variable biodegradation profiles. Cost and regulatory considerations also influence uptake, particularly in resource‐limited environments. Ongoing innovation seeks to enhance elasticity, adhesion under wet conditions and controlled degradation, thereby broadening the global impact of tissue adhesives in surgical practice.

Research from Nature Portfolio

A recent prospective randomised trial compared two commercial cyanoacrylate skin adhesives—2-octyl and n-octyl formulations—for closure of ankle‐fracture incisions. Both groups demonstrated equivalent cosmetic scores at three and six months and similar patient satisfaction measures, as well as comparable functional recovery. No significant differences were observed in wound complications or healing rates. These findings support the interchangeable use of higher- and lower-alkyl cyanoacrylate adhesives in orthopaedic skin closure, with implications for surgeon choice based on handling characteristics rather than clinical outcome.

Tissue Adhesives in Surgical Wound Closure publication trend

The graph below shows the total number of articles in tissue adhesives in surgical wound closure across all publications each year (not limited to Nature Index journals).

Technical terms

Cyanoacrylate: Synthetic monomer that rapidly polymerises on contact with moisture to form a strong, flexible adhesive film.

Fibrin glue: Biological sealant comprising fibrinogen and thrombin that mimics the final coagulation cascade to create a clot‐like matrix.

Polymerisation: Chemical reaction in which monomer molecules join to form a polymer network, providing adhesive strength.

Tensile strength: Maximum stress a material can withstand while being stretched or pulled before failing.

Biocompatibility: Ability of a substance to perform with an appropriate host response in a specific application without eliciting adverse reactions.

References

1. Comparison of 2-octyl cyanoacrylate and n-octyl cyanoacrylate topical skin adhesives for wound closure after ankle fracture surgery: a prospective randomized trial. Scientific Reports (2023).
2. Comparison of the safety and efficacy of three superficial skin closure methods for multi-layer wound closure in total knee arthroplasty: a multicenter, prospective, randomized controlled trial. Arthroplasty (2024).
3. n-Butyl-2-cyanoacrylate tissue adhesive (Histoacryl) vs. subcuticular sutures for skin closure of Pfannenstiel incisions following cesarean delivery. PLOS ONE (2018).
4. Postoperative contact dermatitis caused by skin adhesives used in orthopedic surgery. Medicine (2021).