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Cyanoacrylate Tissue Adhesives — Dermabond, Histoacryl

Cyanoacrylate adhesives are liquid monomers that polymerize on contact with tissue moisture into a rigid adhesive film. Dermabond Advanced and U.S. Histoacryl are topical skin-closure products for clean, easily approximated wounds, used with any required deeper sutures.[1][2][4] Glubran 2's separate European instructions list mucosal application, urinary-fistula sealing, urethroplasty graft adhesion, and interventional embolization.[6]

Chemistry​

MonomerProducts (examples)Clinical use
n-butyl cyanoacrylateHistoacryl (B. Braun); Indermil; LiquiBand Surgical (Advanced Medical Solutions)Topical skin closure of minimum-tension wounds (US labeling for Histoacryl); stiffer, faster-setting film. Skin-closure products are not interchangeable with embolization or endoscopic products
2-octyl cyanoacrylateDermabond (Ethicon); SurgiSeal (Adhezion); LiquiBand Exceed (Advanced Medical Solutions)Topical skin closure standard; more flexible polymer
n-butyl + octyl blendIndermil flexifuzeFlexible skin application
n-butyl + methacryloxysulfolaneGlubran 2 (GEM)European Class III instructions include internal and external surgery, endoscopy, interventional radiology and topical skin application; U.S. authorization must be checked separately.[6]

Polymerization​

  • Liquid monomer applied to tissue
  • Moisture from tissue surface triggers anionic polymerization
  • Setting and apposition times depend on the product; full polymerization of Dermabond Advanced occurs when the film is no longer tacky
  • Exothermic reaction. Minor warmth during set
  • Polymer film sloughs off the skin over 5–10 days as epithelium turns over

GU Applications​

1. Topical skin closure​

Use a skin adhesive on clean, easily approximated skin edges after the required deeper closure. Port sites and abdominal incisions are common examples. Dermabond Advanced must not be placed on mucosa, across mucocutaneous junctions, or on skin regularly exposed to body fluids; repeated moisture and friction also limit use. Select the actual skin site and product accordingly.[2]

The polymerized film requires no routine removal. Dermabond Advanced instructions permit gentle showering as directed by the surgeon, but only transient wetting: no scrubbing, soaking or swimming while the film remains. Dermabond Advanced's gentle-showering guidance[2] differs from U.S. Histoacryl's instruction to keep the wound dry for 48 hours, then minimize wetting and avoid soaking or scrubbing for another 5–8 days.[4]

2. Off-label and investigational uses​

  • Sutureless circumcision: A nonrandomized pediatric series compared a Dermaflex (2-octyl cyanoacrylate) sleeve technique using monopolar diathermy (n = 54) with earlier suture closure (n = 72).[5] Mean operative cut time was 18.4 versus 28.6 minutes. The nonrandomized pediatric series detected no statistically significant difference in complications.[5] A 2022 meta-analysis of six randomized pediatric circumcision trials (817 children) found shorter operating time and less postoperative pain with tissue glue than absorbable sutures, with no significant difference in bleeding, infection, or dehiscence.[8] Dermabond Advanced has different product labeling that prohibits use across mucocutaneous junctions or on regularly wet skin.[2]
  • Mucosal, fistula-tract and lymphocele applications: The U.S. Histoacryl topical skin label prohibits internal and mucosal placement. Glubran 2 is a different product: its European instructions list endoscopic variceal treatment, urinary-fistula sealing and postoperative lymphorrhea treatment. The U.S. Histoacryl topical label excludes internal placement, while Glubran 2's indications are in European instructions.[4][6] A 2023 systematic review of genitourinary-fistula adhesives included 14 women treated with cyanoacrylate among 84 women treated with several adhesive types.[9]
  • Graft or flap fixation: U.S. Dermabond Advanced and Histoacryl skin-closure labels limit placement to the skin surface; Glubran 2's European instructions list urethroplasty graft adhesion.[2][4][6]
  • Prolapse mesh fixation: In a single-surgeon randomized trial of 54 women with stage III–IV prolapse, internal-use Ifabond shortened anterior mesh fixation versus sutures (median 4.6 versus 25.4 minutes), while total operative time did not differ significantly.[10] At 24 months, cystocele success was 15/17 with glue and 14/19 with sutures (p = 0.41).[10] Glubran 2's European instructions also list prolapse-mesh bonding.[6]

3. Interventional radiology (not surgical)​

  • N-butyl cyanoacrylate is used by IR for vessel embolization (for example AVMs; embolization products are separate from skin-closure products)

Application Technique (Topical Skin)​

  1. Complete the necessary deep closure and remove skin tension; an adhesive does not replace required deep dermal stitches.
  2. Cleanse the wound, achieve hemostasis, dry the skin and approximate the edges.
  3. Follow the exact applicator instructions. For Dermabond Advanced, hold the applicator away from the patient and crush the ampoule once at the midpoint; repeated crushing may drive glass through the outer tube and puncture skin. Apply one continuous layer without a routine second coat, then hold the edges together for about 60 seconds. Other formulations have different layer instructions.[2][3][4][6]
  4. Keep adhesive on the surface rather than inside the wound. Avoid excess applicator pressure, runoff and pooling.
  5. Wait for full polymerization before applying a protective dry dressing. Do not apply ointments or liquid medications over the film, which can weaken adhesion.[2]

Contraindications and Cautions​

  • Skin-adhesive indications are product-specific. Do not use Dermabond Advanced on mucosa, mucocutaneous junctions, regularly wet skin, or within the wound or body cavity.
  • Infection, gangrene and decubitus wounds: Both Dermabond Advanced and U.S. Histoacryl contraindicate these wounds. Histoacryl also excludes patients with preoperative systemic infection, uncontrolled diabetes or impaired wound healing, as well as high-tension wounds and areas of skin excision.[2][4]
  • Below the skin surface and internal tissue: Dermabond Advanced and U.S. Histoacryl topical skin adhesives are not absorbed when placed below the epidermis and may elicit a foreign-body reaction. Dermabond Advanced must not be used subcutaneously; the Histoacryl topical skin label prohibits internal-organ, vessel, nerve-tissue, mucosal and mucocutaneous-junction placement. The U.S. labels for Dermabond Advanced and Histoacryl do not authorize internal use; check any different product's U.S. authorization separately.[2][4][6]
  • Glubran 2 in the urogenital tract: Apply about one drop per cm²; excess can promote inflammatory reactions that progress to persistent infection. Its European instructions contraindicate use in pregnant or hypersensitive patients, direct brain contact, peripheral nerve anastomoses and intravascular placement outside specified endoscopic or interventional indications.[6]
  • Dense hair: Avoid Dermabond Advanced and U.S. Histoacryl on skin with dense natural hair.[2][4]
  • Allergy: Before Dermabond Advanced use, ask about cyanoacrylate, formaldehyde and benzalkonium chloride hypersensitivity; before Histoacryl Blue use, also ask about D&C Violet No. 2 hypersensitivity.[2][4] Ask about prior adhesive reactions; reexposure to 2-octyl cyanoacrylate is associated with increased allergic contact dermatitis. A meta-analysis of 20 analytic cohorts (25,442 exposed surgical patients) found a pooled 2-octyl cyanoacrylate allergic contact dermatitis incidence of 4% (95% CI 3%–5%; 95% prediction interval 0%–12%).[7] Assess a postoperative pruritic eruption at the adhesive site and remove residual adhesive when appropriate.[7]
  • Heat and wet preparations: polymerization releases heat and is accelerated by water or alcohol-containing fluid; both labels warn against wet wounds. Allow preparation solutions to dry, apply a thin single film (heavy application can cause thermal tissue injury and delayed healing) and avoid pooled adhesive.
  • Eye protection: Prevent runoff toward the eye; Dermabond Advanced has sealed eyelids shut, occasionally requiring surgical release. After Dermabond Advanced eye contact, flush copiously with saline or water; if adhesive remains, apply ophthalmic ointment and contact an ophthalmologist. If Histoacryl bonds the eyelids, use a warm wet pad to release eyelashes and keep the eye covered until debonding, usually within 1–3 days. Do not force the eye open.[2][4]
  • Tension, moisture and friction: inadequate support or repeated wetting can cause dehiscence. Dermabond Advanced is not a substitute for a suitable deeper closure.[2]

Choosing a Closure Method​

Adhesives can reduce closure time and avoid suture removal in appropriate wounds. The choice depends on tension, location, contamination, skin condition and the particular product. Topical cyanoacrylate adhesives are an option for skin closure.[1] A 2025 network meta-analysis of 19 randomized port-site closure trials (1,932 patients) found better early and late cosmesis with adhesives, with no statistically significant differences in infection, dehiscence, pain or overall wound complications across methods; dehiscence trended higher with adhesives.[11]

See Also​

References​

1. Singer AJ, Quinn JV, Hollander JE. The cyanoacrylate topical skin adhesives. Am J Emerg Med. 2008;26(4):490–6. doi:10.1016/j.ajem.2007.05.015

2. Ethicon. Dermabond Advanced Topical Skin Adhesive: Instructions for Use, LAB0012189v5. Manufacturer instructions.

3. Ethicon. Dermabond Advanced: Product application guidance. 2023. Application guide.

4. B. Braun. Histoacryl and Histoacryl Blue Topical Skin Adhesive: Package Insert (FDA P050013). FDA label.

5. Voznesensky M, Mutter C, Hayn M, et al. Pediatric sutureless circumcision: an effective and cost efficient alternative. Can J Urol. 2015;22(5):7995-9. PMID 26432971

7. Rouhani DS, Rosenbloom A, Zeng S, et al. "Systematic Review and Meta-Analysis of Allergic Contact Dermatitis from 2-Octyl Cyanoacrylate Adhesives." J Am Coll Surg. 2026;243(3):682-694. doi:10.1097/XCS.0000000000001907

6. GEM S.r.l. Glubran 2: Technical Data Sheet and Instruction Sheet. Rev. 15, 17 October 2023. Manufacturer instructions.

8. Azmi YA, Yogiswara N, Renaldo J. "The efficacy of tissue glue in pediatric circumcision wound approximation: A meta-analysis of randomized controlled trial." J Pediatr Urol. 2022;18(3):327-333. doi:10.1016/j.jpurol.2022.03.010

9. Bouchard ME, Stairs J, Hickling D, Clancy A, Khalil H. "The use of tissue adhesive in management of genitourinary fistulas: a systematic review and case report." Int Urogynecol J. 2023;34(2):445-451. doi:10.1007/s00192-022-05297-0

10. Lamblin G, Moufawad G, Becque C, et al. "Laparoscopic sacrocolpopexy with mesh fixation: a randomized trial comparing synthetic cyanoacrylate glue to sutures." World J Urol. 2025;43(1):598. doi:10.1007/s00345-025-05885-x

11. Kerin EP, Davey MG, Bouz Mkabaah L, Donlon NE. "Optimal port site skin closure method following minimally-invasive surgery: A systematic review and network meta-analysis of randomised clinical trials." Am J Surg. 2025;248:116542. doi:10.1016/j.amjsurg.2025.116542