Surgical Glue Removes Much Pain, Time From Closing Wounds

During baseball batting practice in Ringgold, Ga., 8-year-old Clinton Harwood bent down to pick up a ball, only to be slammed in the chin by another child's bat.

As Clinton's parents rushed him to the emergency room, they realized the ugly, gaping wound would probably require stitches, a prospect that terrified their son.

But once they arrived at T.C. Thompson Children's Hospital in Chattanooga, Tenn., their doctor told them of another, pain-free option: a new surgical glue that eliminates the need for sutures. Clinton "was screaming, frantic and very upset," says his mother, Ann Marie Harwood. But when he learned he wouldn't need stitches, she says, "he was very calm." Later, when Clinton returned to school, "he told everyone he had his face glued up."

Sewing with sutures is one of the oldest known medical procedures. The ancient Egyptians are believed to have been the first to stitch wounds with needle and thread 4,000 years ago, and the procedure hasn't changed much since then. Most doctors still sew stitches: More than 11 million facial lacerations are stitched up in U.S. emergency rooms every year.

But things are beginning to change. During the summer the Food and Drug Administration approved a surgical glue that is expected one day to replace as much as 40 percent of traditional sutures. The glue, called Dermabond, is made by Closure Medical Corp. of Raleigh, N.C., and has been in use by veterinarians to close surgical incisions in dogs, seal the bleeding paws of declawed cats and protect leg abrasions on horses.

Dr. Thomas Bruns, a pediatric emergency-medicine physician at T.C. Thompson, conducted one of the first clinical studies of the glue. He says it has been a godsend for treating children. The biggest advantage, he says, is that in most cases there's no need for a shot of local anesthetic to numb the wound. "Kids are terrified of needles," Bruns says. "When you offer tissue adhesive, they get pretty excited about getting glued instead of sutured."

The glue is applied from a small plastic tube that looks similar to the ones used for fast-drying household products such as Krazy Glue. Indeed, backpackers have been known to use those nonmedicinal products on scrapes when hiking, and some of them contain the same key ingredient - cyanoac rylate - as Dermabond. Temporary liquid bandages also are available in stores.

Doctors say Dermabond is different in several important ways. It is sterile and doesn't contain the toxic chemicals found in some common fast-drying glues, which, if applied to an open wound, could irritate or lead to infection. It takes about 50 seconds to set - just enough time for a doctor to manipulate the skin edges so they fit together well.

The surgical glue goes on bluish-purple and is applied in at least three thin layers. After about two and half minutes, it is said to be as strong as week-old sutures. It sloughs off in five to 10 days, meaning patients don't have to return to the doctor to have stitches removed.

Although the cost is roughly the same as the price of a suture kit - about $25 - a wound can be closed with glue about 75 percent faster than it can be with stitches. So use of the glue should cut medical costs associated with a physician's time as well as the cost of an anesthetic.

A May 1997 study in the Journal of the American Medical Association said there isn't any cosmetic difference between wounds closed with stitches and those closed with surgical glue.

Although Dermabond isn't sold directly to consumers, a Johnson & Johnson unit licensed to market it is believed to be considering an advertising campaign urging people to ask doctors for the adhesive instead of stitches. But be warned: The glue isn't always an option. It can't be used on elbows and knees - where children often get cuts and scrapes - because the excessive motion would probably cause it to peel too soon. For similar reasons, it isn't a good choice for hands and feet, and it can't be used in the mouth, groin or other moist areas.

Right now, Dermabond is the only topical surgical glue the FDA has approved for use in the U.S., although other surgical glues have been used in Canada and Europe. Similar adhesive products are being developed to replace stitches for other types of injuries and incisions. Baxter HealthCare Corp.'s Tisseel adhesive, made from blood proteins, has been approved to help control bleeding during surgery. Next year, Atrax Medical Group Ltd. has plans to release a surgical "zipper" - polyester strips attached to either side of a wound and then joined with a zipper.

Even though Dermabond is still new and may not be used by every doctor, physicians say it pays for patients to know it exists as an alternative to stitches. Bruns says one Tennessee family recently waited two hours in the emergency room to have their 3-year-old daughter treated for a gash in her forehead after she fell against some furniture.

When she was finally seen by a doctor, her parents, who had heard about the glue, found out that the hospital had run out. Instead of opting for painful stitches, they decided to take the child to another hospital to have the wound closed with glue.

"Kids are always a little bit terrified when they know they have to be held down," says Bruns. Once they realize they don't need a shot, they're fine, he says. And the glue "leaves a nice little blue covering that they can show off to their friends."

(Copyright 1998, Dow Jones & Company Inc.)