Transcript DERMABOND ® TOPICAL SKIN ADHESIVE

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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® TOPICAL SKIN ADHESIVE INTRODUCTION
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 FEATURES AND BENEFITS
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 PRODUCTS
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
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® TOPICAL SKIN ADHESIVE PRODUCTS
DERMABOND®
Adhesive is supplied
in ampoule form
And in DERMABOND®
Adhesive ProPen
DERMABOND® TOPICAL SKIN ADHESIVE PREPARING A WOUND
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 subcuticular
(poliglecaprone 25) Suture or
Coated VICRYL* Plus Antibacterial
(polyglactin 910) Suture.
subcutaneous
Deep suturing may include
subcutaneous and deep dermal
closure (as shown here), or it may
be a combination
subcutaneous/deep dermal closure.
* Trademark
deep dermal stitch
DERMABOND® TOPICAL SKIN ADHESIVE –
PREPARING LONG WOUNDS
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.
The wound illustrated here has been
divided into segments using an
adhesive strip.
DERMABOND® TOPICAL SKIN ADHESIVE –
THE PATIENT EXPERIENCE
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
CYANOACRYLATES
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…
DIFFERENCES IN 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
PLASTICIZERS
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.
REFERENCES
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 woundbursting 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.neurosurgeryonline.com/pt/re/neurosurg/abstract.00006123-200501001-00018.htm. Accessed 4/10/2007.
CR Approved 5.13.09