History of Tissue Adhesive

Tissue adhesive

Image taken from http://www.surgiclose.com

Cyanoacrylates were first manufactured in 1949.

In late 1950s, simple cyanoacrylates were used for wound closure, primarily in combat situations. Several armies around the world have included tubes of superglue variants in their first aid kits for some time ­ if a soldier is hit by shrapnel, say, in the battlefield, he doesn't have time to mess around with needle and thread. He needs to stem the bleeding and patch himself together again until he can receive proper medical attention.

The first adhesives were noted to have extreme inflammatory effects on tissues. N-butyl-2-cyanoacrylate, which was developed in the 1970s, was the first adhesive to have negligible tissue toxicity and good bonding strength, as well as acceptable wound cosmesis.

The Bradford fire in 1985 highlighted the advantages. A huge number of skin grafts were required in a short space of time, and there weren't enough people around who could stitch them into place. Alan Roberts at the University of Hull and St Luke's Hospital, Bradford, was involved in the emergency team. He decided to risk using commercially available superglue, bought from local shops. The results were a delight ­ Roberts found that grafts that had been glued on gave much less scarring than those attached with stitches. The adhesives also broke down ­ to harmless byproducts ­ at about the same rate as the wounds healed up.

N-butyl-2-cyanoacrylate has been used in cartilage and bone grafting, coating of corneal ulcers in ophthalmology, repair of damaged ossicles in otolaryngology, coating of aphthous ulcers, embolization of gastrointestinal varices and embolization in neurovascular surgery. This adhesive is not labeled for this use by the FDA but has been used in Canada and numerous other countries for more than 20 years. 

2-octylcyanoacrylate, the latest in cyanoacrylate technology, has less toxicity and almost four times the strength of N-butyl-2-cyanoacrylate.15 Special plasticizers have been added to the formula to provide flexibility. This adhesive reaches maximum bonding strength within two and one-half minutes and is equivalent in strength to healed tissue at seven days post repair.