CJEM Articles: failure
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Adam J. Singer, Christopher Carleo, Henry C. Thode Jr.
Objectives: Frequent soaking of lacerations closed with tissue adhesives is not recommended for fear of premature adhesive sloughing and wound dehiscence. This recommendation is based on studies of sutured lacerations, and may not be directly relevant to wounds closed with tissue adhesives. The objective of our study was to determine whether frequent soaking of octylcyanoacrylate would result in premature sloughing of the adhesive.
Methods: This randomized controlled study enrolled healthy volunteers between 10 and 65 years of age. All subjects had 0.5 mL of low viscosity octylcyanoacrylate applied in two 4-cm lines made on intact skin on both of the subjects’ forearms. One arm was randomized to daily immersion in soapy water; the other arm served as a control. The primary outcome was the area of remaining adhesive, which was traced and calculated daily until complete sloughing, and expressed as percent slough. Kaplan–Meier survival curves were constructed and compared using log-rank tests. A Wilcoxon’s signed-rank test to account for paired sample design was also used.
Results: We enrolled 20 subjects, 12 female and 8 male, with a mean age of 32 years (range, 10–62 yr). Mean time until complete sloughing in control and immersed arms was 5.2 and 4.2 days, respectively, with a mean difference of 1.0 days (95% confidence interval, 0.2 to 1.8; p = 0.01).
Conclusions: Daily immersion accelerates the sloughing of low viscosity octylcyanoacrylate applied to intact skin.