superglue wound closure tutorial

[Jim Malone]

There have been a lot of questions in the past about the use of superglue, or cyanoacrylate glue to close a wound, and how to do it.
Because i use superglue a lot with deeper cuts i thought about making a tutorial when it happend again.

And i had this opportunity today.

After receiving a anticipated package, i decided to open it with my Spydero Swick.
Of course I zipped thru the plastic like butter and made a 2cm wide cut, about 0.5 cm deep.



Luckily it wasn’t a deep cut, nor did it cut tendons (I believe), so I decided to make a quick tutorial because I had all the stuff I needed at hand.
First I closed the wound flap with thumb pressure to stop the bleeding.
Under normally conditions it good to letting a wound bleed for a while to bleed out possible dirt.
Then I took my hand sanitizer spray that contains 75% alcohol. I opened the wound up and sprayed alcohol inside and outside profusely to get rid of any bacteria.



I repeated this a few times.
Then I took my Loctite Cyanoacrylate glue tube.
I used Loctite 401 that has a thicker consistency ( not water like) to avoid spilling the glue.
I opened up the wound again and soaked up the remaining blood with a clean towel. The sprayed some more alcohol and applied the glue inside the skinflap.



Now comes the tricky part. You need to press down the skin flap to glue it together without gluing your pressure finger to your wound.



I sometimes use a q-tip with the head removed to push the skin together.
I then sprayed some more alcohol on the closed wound to make a semi sterile environment.
Then I encapsulated the wound with a glue dome, to make it airtight.



After the glue was hardened I checked for any leaks



I used a flexible “compeed” bandage to put pressure on the wound and to shield it from possible contamination ( it's also watertight)



I opened up the package and found inside my long awaited book titled “contemporary knife targeting by Michael Janich!






My daughter just walked in and said "what's wrong with your finger?"
i replied "i cut it"
She replied "did you glue it?"

[kbuzbee]

Excellent post! Loved your daughter's comment. Kids know so much!

I've tried this a few times and you are right, the "tricky" part is not gluing the pressure finger (as it will tear the cut open when you try to remove it).

Anyway, well done! Heal fast!

Ken

[2cha]

This goes on my list of top 10 posts of all time!!!!

[Bolster]

I see you're very careful about bacteria, and using alcohol to keep the wound sterile, that's good.

Are you certain that the superglue is sterile???

[Jim Malone]

The bottle is not sterile, but the glue on itself has a antibacteriological function. The polymerisation process actually kills bacteria wile curing. So next to the alcohol as a desinfectant the chemical bonding process is antibacteriological as well. Once cured the glue still has limited antibacteriological properties against new bacteria. I found this from a research article:

"Cyanoacrylate polymers have been used as biological adhesives in the cornea for over 40 years. [1],[2],[3] Their monomers are obtained through the condensation of cyanoacetate with formaldehyde in a base-catalyzed reaction. [4] A polymer is formed as a number of monomers join together under the effect of a catalyst, such as water. [5]

The polymerized adhesive promotes wound healing, vascularization, and epithelialization of the injured corneal stroma. [6] It also inhibits corneal melting by directly antagonizing collagenases and by blocking the migration of inflammatory cells, such as polymorphonuclear leukocytes. [4]

The antimicrobial properties of cyanoacrylate tissue adhesives have been reported previously and some authors have even promoted its use in the prophylaxis or treatment of infection in corneal ulcers. [7],[8],[9] It has also been postulated that the antimicrobial effects may be derived, at least in part, from the polymerization process itself, although no study has specifically analyzed this assumption. [8]

The aim of the study was to establish the role of the polymerization reaction in conferring additional antibacterial properties to cyanoacrylate tissue adhesives. "

"Purpose: To ascertain if the polymerization reaction also contributes additionally to the antibacterial effects of two commonly used cyanoacrylate tissue adhesives.
Materials and Methods: Fresh liquid ethyl-cyanoacrylate (EC) and N-butyl-cyanoacrylate (BC) adhesives were applied onto 6-mm sterile filter paper discs. In the first group, the adhesive-soaked discs were immediately placed onto confluent monolayer cultures of bacteria, allowing the polymerization reaction to proceed while in culture. In the second group, the adhesive-soaked disc was allowed to first polymerize prior to being placed onto the bacterial cultures. Four types of bacteria were studied: Staphylococcus aureus , Streptococcus pneumoniae , Escherichia coli , and Pseudomonas aeruginosa . Immediately after the discs were applied, the cultures were incubated at 35° C for 24 h. Bacterial inhibitory halos were measured in the cultures at the end of the incubation period.
Results: For EC, exposure of the bacteria to the cyanoacrylate polymerization reaction increased the bacterial inhibitory halos in Streptococcus pneumonia, Staphylococcus aureus and Escherichia coli. For BC, it increased the bacterial inhibitory halos in Staphylococcus aureus and Streptococcus pneumoniae . No inhibitory halos were observed in Pseudomonas aeruginosa. The bactericidal effect was higher in actively polymerizing EC, compared to previously polymerized EC in Staphylococcus aureus , Streptococcus pneumoniae, and Escherichia coli ; however, no such differences were observed for BC.
Conclusions: The polymerization reaction may also be an important factor in the antibacterial properties of EC and BC.
source: Antibacterial properties of cyanoacrylate tissue adhesive: Does the polymerization reaction play a role?

http://www.ijo.in/article.asp?issn=0...;aulast=Romero

[BW_BW]

I am curious about this liberal use of alcohol. I am far from a doctor, but I've heard people caution against using alcohol on cuts. Here is a quote from utahmountainbiking.com:

Alcohol is a disinfectant for INTACT skin or inanimate objects. Use it to clean gear such as splinter forceps. It can also be used to clean skin around (not inside) a wound. Individual pads are more practical than a bottle.
Alcohol should NOT be used inside wounds or on open wounds. When used on exposed tissue, alcohol kills some of your tissues along with the germs. This delays healing. When used INSIDE a wound, alcohol can actually make the wound MORE infection prone by turning your tissue into dead "germ food."

Again, far from a medical source, but I heard that sort of thing from a variety of people. Perhaps someone with more knowledge can shed some light on this?

[JBE]

Betadine (Povidone-Iodine) is a much, much better disinfectant for wounds than alcohol or peroxide.

[enduraguy]

I'm concerned about putting glue INSIDE a wound. That just seems counter-intuitive.

[Michael Janich]

Dear Jim:

Thank you very much for sharing your methods and having the presence of mind to document them so thoroughly.

Thank you also for the purchase of the book. My co-author, Chris Grosz, did the majority of the research for it to get the PPCT (a law enforcement defensive tactics program) to stop using Fairbairn's timetable as a reference. After I helped him write a paper for PPCT, we contracted with Paladin to adapt the material to a book. Tragically, Chris passed away several months afterward, leaving his daughter and wife (then pregnant with their second child). I finished the book in his honor and signed all my royalties over to his family, so sales of the book go to a very good cause.

I hope you heal quickly and enjoy the book.

Stay safe,

Mike

[Monkeywrangler]

What'd you do to the Swick? Is that black Dip-It on there?

[monsterdog]

What'd you do to the Swick? Is that black Dip-It on there?

I too want to know this, looks like plasti dip to me. Excellent idea.

Other than that, great tutorial

[defenestrate]

Typically what I do (on myself) is disnfect the wound (peroxide, iodine, etc.) stop the bleeding (if direct pressure hasn't done a good job within a minute or so then I use a tourniquet of appropriate scale) and then just glue the wound shut, letting it set at however I prefer (in relation to the skin and surrounding tissue like joints - I don't want it to set and then if the skin stretches to have it tear BACK open) - if no antiseptics are available, I usually cauterize the wound a little bit in hopes of killing whatever is nasty there. Great writeup and pictorial, Jim! Thanks!

[markg]

Dear Jim:

Thank you very much for sharing your methods and having the presence of mind to document them so thoroughly.

Thank you also for the purchase of the book. My co-author, Chris Grosz, did the majority of the research for it to get the PPCT (a law enforcement defensive tactics program) to stop using Fairbairn's timetable as a reference. After I helped him write a paper for PPCT, we contracted with Paladin to adapt the material to a book. Tragically, Chris passed away several months afterward, leaving his daughter and wife (then pregnant with their second child). I finished the book in his honor and signed all my royalties over to his family, so sales of the book go to a very good cause.

I hope you heal quickly and enjoy the book.

Stay safe,

Mike

I give a thumbs up for this book. It is great. I do give a word of caution. Not a "coffee table" sort of book. It is eye opening and deals with a subject that is rather graphic, however of vital importance to anyone who considers such topics. If you are into MBC, martial arts, or LEO/security/military it is a must have. And as Mike points out, the royalties go to a good cause.

[Jim Malone]

Finger is healed!

Read the book, i recommend it too anyone.
The handle is indeed "plasti dipped". It works very well.

[SkullBouncer]

Thanks Jim for the great thread here, and to others posting with their pearls of wisdom as well...

(Michael: reading your post particularly made my day, Thanks Also + Kudos.)


I'd learned about cyanoacrylate wound bonding from a good friend of mine whom quite a while back was assaulted in a biker bar from behind with the 'application to his scalp of a smashing beer mug'.

He's fine, his friends there with him at the time had his back and the situation was 'defused' further without excessive additional violence -- point being, my buddy Aaron had thus sustained a very complex and exaggeratedly broad wound pattern atop his (fortunately) shaved cranium.

After they got themselves out of there and not wanting to get involved with a hospital (or LEOs) due to the overall nature of the situation, they went to their worktruck at a nearby location and, following painstaking removal of glass fragments imbedded in the wound, did pretty much the same procedure Jim described here, albeit a far larger, more intricate and aggravatingly detailed job.

Worked amazingly well, all things considered -- to this day Aaron only sports a 'bootcamp buzzjob' -- the damage from the wound was remarkably well-managed, and, Hell -- Aaron's one tough, big muh-fuggah...he wears those scars like a combat medal to this day, HA!!


The only additional agent applied while bandaging during healing was a topical steroidal antibacterial ointment (veterinary)....just in case.

/ SB