Surgical glues are specialized medical adhesives used to close wounds, bond tissues, seal wounds, or attach medical devices. They offer a modern alternative to traditional methods like sutures and staples. Their purpose is to minimize invasiveness, reduce scarring, and improve patient outcomes. These adhesives create a secure bond, supporting tissue approximation in the body’s moist environment.
Primary Types of Surgical Adhesives
One common category is cyanoacrylates, synthetic glues known for their strong bond and rapid setting time. Medical-grade cyanoacrylates, such as octyl-2-cyanoacrylate (e.g., Dermabond) and butyl-2-cyanoacrylate (e.g., Indermil, Histoacryl), are commonly used for topical skin closure. They form a flexible, waterproof bond on the skin surface, often eliminating the need for stitches in superficial wounds.
Fibrin sealants are another major type, derived from human or animal blood proteins like fibrinogen and thrombin. These sealants mimic the body’s natural blood clotting process, forming a fibrin clot that promotes hemostasis and tissue sealing. Examples include Tisseel and Evicel, widely used for controlling bleeding and sealing tissues in various surgical fields.
Another class consists of albumin and glutaraldehyde-based adhesives, such as BioGlue. This type is often used in internal surgeries, particularly for vascular and cardiac repairs, where it provides a strong seal as an adjunct to sutures or staples. BioGlue is composed of purified bovine serum albumin and glutaraldehyde, which polymerize quickly upon application.
Polyethylene Glycol (PEG) hydrogels, like DuraSeal, are synthetic glues that form a flexible, watertight seal. These hydrogels are particularly useful for sealing air and fluid leaks, often employed in neurosurgery for dura mater repair or in lung procedures.
How Surgical Adhesives Work
Surgical adhesives achieve their bonding effect through various mechanisms, depending on their chemical composition.
Many synthetic glues, such as cyanoacrylates, work through polymerization. This involves liquid monomers rapidly linking to form long, solid polymer chains upon contact with moisture or anionic substances on tissue surfaces. This reaction creates a strong, flexible film that securely holds tissue edges together.
Other adhesives, particularly fibrin sealants, mimic natural biological processes. They replicate the final stages of blood coagulation. When two components, typically fibrinogen and thrombin, are mixed, thrombin converts fibrinogen into fibrin monomers, which then cross-link to form a stable, three-dimensional fibrin clot that adheres to the tissue.
Some surgical glues form a barrier or gel to physically seal tissues. Polyethylene glycol (PEG) hydrogels, for instance, undergo a cross-linking reaction to form a gel. This gel creates a physical barrier that prevents leaks of fluids or air.
Key Applications in Surgery
Surgical adhesives are used across a wide range of medical specialties, offering benefits like faster closure. In skin closure, they serve as an alternative to sutures for superficial wounds, providing a good cosmetic outcome and reducing the need for needle sticks. This application is particularly common for minor lacerations and surgical incisions.
Internally, these glues are valuable for sealing organs and preventing leaks. For example, they are used in lung surgery to prevent air leaks, in liver and spleen operations to control bleeding, and in vascular repair to seal blood vessels. Their ability to create a watertight or airtight seal is crucial in these delicate procedures.
In neurosurgery, surgical adhesives are applied to seal the dura mater, the protective membrane surrounding the brain and spinal cord, helping to prevent cerebrospinal fluid leaks. Ophthalmology also benefits from these glues, particularly in corneal repair procedures. The versatility of surgical adhesives allows them to address areas that are difficult to suture, reduce operative time, and improve patient comfort.
Safety and Important Considerations
Surgical adhesives are designed with patient safety as a primary concern, undergoing rigorous testing and approval processes. A key factor is biocompatibility, meaning the materials are safe within the human body and minimize adverse reactions or inflammation.
Many surgical adhesives are also designed for degradation, meaning they are absorbed by the body over time as healing progresses. This eliminates the need for removal and allows the body’s natural tissues to take over the mechanical support. The rate of degradation is carefully controlled to match the tissue’s healing time.
The adhesive’s strength and flexibility are matched to the specific tissue it will bond. For instance, adhesives used on highly mobile areas need to be more flexible than those on static tissues. These properties are balanced to ensure effective bonding without hindering the natural healing process. Additionally, some surgical glues can create a barrier that helps in infection control by preventing pathogens from entering the wound site.