Suture or Superglue?

Superglue: Be careful where you put it!

Yesterdays article ‘Stitching Wounds in Emergency Situations’ has aroused a good deal of interest…and generated a VAST amount of emails…I will get back to you all in time.

One of the recurring themes in the emails is the use of superglue to close wounds.

Mark, who left a comment over at the Daily Sheeple wants to know when to glue and when to stitch, which is a very valid question so here we go.

I appreciate that many of you have used superglue to seal wounds, and it has been a success, which is great, but, and there’s always a but. You were lucky, or you didn’t have a severe wound in which case you were very lucky. If you used superglue on a severe wound without ill effect you were very, very lucky.

Superglue, is a quick dying contact adhesive that as we all know sticks almost anything to almost anything. The thing is it is just too good at it’s job to be used on some types of wound.

By sealing the wound completely any infection that does occur has not got a way out. This leaves a few choices:

• Pus will either to collect under the skin until the skin breaks and leave you with a foul smelling , grossly infected wound that will take months to heal via granulation. (Explained below)
• Pus will collect in a ‘pocket’ a gap of any kind and form an abscess which will be excruciatingly painful and will need drainage and possible removal of the capsule that contained the pus.
• The infection will track deeper into the body which will make the patient feel very ill. It’s possible that systemic spread will occur, and this can lead to septicaemia and death in short order if medical assistance and antibiotics are not available.

Using superglue to fix shallow, preferably skin deep only wounds is far safer than using it on a deep tissue wound. Even then though it would be better to put in a drain. This can be as simple as a cotton thread that will allow any pus collecting under the skin a way out.

If you have no other choice but using superglue on a deeper or more substantial wound my advice has to be, DON”T. I know some of you will anyway so please at least follow a few safety standards:

• The wound should be as clean as you can get it.
• If you have antibiotics crush them and put the powder directly in the wound.
• DO NOT let the glue get inside the wound
• Put in a wick. This is something thin and absorbent that can conduct pus and liquid away and out of the wound. It should be near the centre of the wound not near either end.
• DO NOT glue the wick in.
• When the wound is well on the road to healing, and you are sure no infection is present you can dampen the wick with cooled boiled water and gently pull it out.
• The small hole needs to be sealed, either glued or stitched.

Gaping wound where tissue is missing should not be glued or stitched. Doing either would pull the tissues to tightly together and would most likely be unsuccessful either because the wound bursts due to tension or due to infection. These wounds should be left to granulate.

Granulation is the formation of new tissue. It is a natural process. New skin cells grow in from the edges of the wound until the entire defect is covered with new skin. Wounds left to granulate can take months to heal. They are often tender for a long time after the healing process is over. Granulation tissue is prone to infection but putting a decent amount of regular table sugar onto the wound before dressing it has been shown to keep the wounds clean and aid the granulation process. You can read about that here.

Animal and human bites should never be glued or sutured. These are the types of wound most likely to become infected at a deep tissue level and sealing them in any way is a disaster waiting to happen.

Any wound that has ulcerated edges is not suitable for amateur closure and burns, however wound-like they look, should never be subject to an attempt to close the defect.

Gunshot wounds are best plugged and left for a while before any decision is made as to what to do with them. A tampon is ideal for encouraging the wound to clot off. It needs to be removed VERY carefully to avoid dislodging a blood clot that is sealing the wound. Suturing a hole left by a bullet leaves a nice pocket for infection to collect in. Personally I would be inclined to use antibiotic powder for a day or two, then sugar and clean dressings and then wait a few days to make sure there was no infection before closing the wound. If I did decide to close instead of granulate I would suture with a wick in place to allow drainage.

Well, I hope that’s helped to clear up a good few of the questions.

Take Care

Liz