Urgent care facilities routinely use medical tissue adhesive, or medical glue, for appropriate wounds. This method is a quicker, less painful alternative to traditional sutures or staples. This medical glue is a sterile, fast-acting liquid polymer, typically a formulation of cyanoacrylate, that forms a strong bond across the top layers of skin to hold the edges of a laceration together. This method of wound closure eliminates the need for a follow-up visit to remove stitches, making it a convenient option for minor injuries.
Criteria for Using Medical Glue on a Cut
Medical tissue adhesive is only suitable for cuts that meet specific clinical criteria, as the glue primarily provides surface-level closure and lacks the tensile strength of sutures. The wound must be a relatively shallow, simple laceration that involves only the top layers of the skin, such as the epidermis and superficial dermis. The edges of the cut must be clean and easily approximated, meaning they can be brought together without significant tension or pulling on the surrounding skin. If the wound is under too much stress, the glue may fail, and the wound edges could separate.
The location of the injury is a major factor in determining suitability for glue closure. Cuts over areas of high movement or tension, such as the hands, feet, or joints like the elbow or knee, are generally not good candidates because the constant stretching can cause the adhesive to break down prematurely. It is also contraindicated for application on mucosal surfaces, like the inside of the mouth, or in areas with high moisture, such as the armpit or perineum. Furthermore, the wound must be relatively clean and free from contamination like dirt, gravel, or foreign bodies.
The adhesive is generally reserved for lacerations that are shorter in length, often less than 5 centimeters. Using glue on larger cuts increases the risk of the wound opening up, which is known as dehiscence. For wounds that are deeper or longer but otherwise appropriate, the clinician may choose to use dissolvable sutures beneath the skin’s surface to manage tension before applying the glue to the outermost layer.
The Application Process and Post-Care Instructions
Application Process
If a cut is deemed appropriate for tissue adhesive, the medical provider will first thoroughly clean the wound to remove any debris and ensure hemostasis, meaning the bleeding has completely stopped. The skin surrounding the laceration must be completely dry, as the adhesive will not bond effectively to wet surfaces. The clinician then holds the wound edges together precisely to achieve good alignment, often using forceps or their fingers to approximate the skin.
The liquid adhesive is then applied directly to the surface of the closed wound in a thin layer, bridging the gap between the skin edges. It is crucial that the glue does not seep into the wound itself, as this can impede healing. The glue rapidly hardens, typically within 30 to 60 seconds, and the provider may apply two to four layers to build a strong, flexible seal. The adhesive creates a water-resistant barrier that protects the wound site.
Post-Care Instructions
Patient post-care focuses on protecting the adhesive until it naturally sloughs off, which typically occurs within 5 to 10 days as the skin cells exfoliate. During this time, the patient must avoid soaking the wound, meaning no swimming or long baths, though brief showering is generally permitted after the first 24 hours. Ointments, creams, or petroleum jelly should not be applied to the area, as these substances can soften and dissolve the cyanoacrylate polymer, leading to premature removal and potential wound opening. Patients should also avoid scratching, rubbing, or picking at the glue.
Patients must monitor the area for signs of localized infection, which can occur with any wound closure method. Specific warning signs that necessitate a call back to the clinic include:
- Increasing redness, tenderness, or warmth around the glue site.
- The appearance of pus (a thick, yellowish or greenish discharge).
- Red streaks extending away from the wound.
When a Cut Requires the Emergency Room
While urgent care can manage a wide range of lacerations, certain injuries require the specialized resources available in an emergency room setting. Any wound that is deep enough to expose underlying structures such as fat, muscle, or bone represents a severe injury that must be evaluated at the ER. These deep wounds often require complex closure techniques and a more extensive assessment for internal damage.
A cut that will not stop bleeding after 10 to 15 minutes of continuous, firm pressure is a medical emergency, especially if the blood is spurting, which can indicate an injured artery. Wounds that are highly contaminated, such as deep puncture wounds, those caused by animal or human bites, or crush injuries, carry a high risk of serious infection and may require advanced debridement and management. Cuts that result in numbness, tingling, or an inability to move the affected body part should go to the ER, as these symptoms suggest potential nerve or tendon damage.