Superglue

[roja]

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So, this one isn't in Tintinalli's...


young women cut the hell out of her arm this morning, about 5 cm, didn't wash it and poured a bunch of super glue on it.

10 hours wants the superglue taken off and it 'sewn'.


What do you do?

 

[AmoryBlaine]

Bill her for wound repair with dermabond and send her on her way.

 

[roja]

Its already glued. Oh yes, she poured a bunch of nail polish remover on it as well...

 

[EM_Rebuilder]

I have always been curious...

My family and I have used Superglue for years to close cuts that we get. Seals it up and makes it go virtually pain free. Now we might all end up with some type of cancer one day...who knows. Would make an interesting comparison of ingredients in dermabond vs actual superglue.

So, what did you end up doing? I think I would have told the lady tough. The only way to remotely get it off would be something organic... soaking her arm in Paint Thinner would do the trick, but thats not very kosher.

 

[deleted109597]

Larger excision may be required.

 

[Hard24Get]

Its already glued. Oh yes, she poured a bunch of nail polish remover on it as well...

jeez, didn't that sting? What was she thinking????? 😕 She sounds a mite mentally impaired.


I think ethanol is the best way to unstick superglue. I guess it wouldn't get infected but wouldn't there be a granulomatous reaction potentially from the retained glue? Sounds like a case report, perhaps. I'd be interested to hear how this story ends.

oh, and after the wound issue is resolved I would consider admitting to psych since she is at least two standard deviations above the mean of crazy.

 

[BADMD]

So, this one isn't in Tintinalli's...


young women cut the hell out of her arm this morning, about 5 cm, didn't wash it and poured a bunch of super glue on it.

10 hours wants the superglue taken off and it 'sewn'.


What do you do?

Young, health and no medical problems? Wound looks good with minimal inflammation? I might actually close it primarily. I can't imagine the wound looks that way after getting bathed in superglue and acetone, but I might consider it.

 

[BADMD]

I Would make an interesting comparison of ingredients in dermabond vs actual superglue..

Superglue is ethyl cyanacrylate. Dermabond is octyl cyanoacrylate. Butyl cyanoacrylate was used as a tissue adhesive before Dermabond. The longer chain octyl stuff was developed to be more stable. Supposedly the shorter chain polymer was less stable and breaks down faster and cyanoacrylate breakdown product causes tissue inflammation. Faster breakdown leads to more inflammation...or so the theory says.

 

[tegs15]

I have always been curious...

My family and I have used Superglue for years to close cuts that we get. Seals it up and makes it go virtually pain free. Now we might all end up with some type of cancer one day...who knows. Would make an interesting comparison of ingredients in dermabond vs actual superglue.

So, what did you end up doing? I think I would have told the lady tough. The only way to remotely get it off would be something organic... soaking her arm in Paint Thinner would do the trick, but thats not very kosher.

According to a EP I know the only difference between Dermabond and superglue is that Dermabond is sterile. I wonder what type of organism would live in liquid superglue. Either way an absolute necessity in the first aid kit (right next to the duct tape).

 

[jbar]

Would make an interesting comparison of ingredients in dermabond vs actual superglue.

I wouldn't think it'd be that bad for you if you don't get it in the wound, just to hold together a non-gaping cut. I use it too, but on like paper cuts, not a 5cm lac.

 

[tegs15]

According to a EP I know the only difference between Dermabond and superglue is that Dermabond is sterile. I wonder what type of organism would live in liquid superglue. Either way an absolute necessity in the first aid kit (right next to the duct tape).

I guess their almost the same thing....



kinda like Ethanol and Methanol.

 

[roja]

indeed. research shows they are very similar. You could, in theory, soak it in 100% acetone to disolve it.

Large wounds, outside of vietnam, etc, should probably NOT be closed with it. much like dermabond. I told her to 1-not do it again. 2-watch for infection (as she hadn't cleaned the wound at all) and 3- not pick at it.

I wouldn't have closed it, even if I could have gotten all the superglue out. which I couldn't.

 

[bartleby]

I also would have told her to hit the road. Aside from what was mentioned above, the only other difference I've read about between crazy glue (ethyl-) and dermabond (octyl-) is that there is supposedly more of an exothermic reaction associated with curing of the ethyl- forms of cyanoacrylate, which can cause burns when used in large amounts. It's not clear to me how clinically significant this is.

Once you have a failure of primary closure in a non-cosmetically sensitive (i.e. facial) wound, the smart money is on letting the wound heal by secondary intention. Even if you did manage to open it up, clean it out and suture it closed, all you'd get for your hard work is a patient complaint and a free trip to the spotlight in your department's M&M when she comes back with an infected wound.

 

[EM_Rebuilder]

indeed. research shows they are very similar. You could, in theory, soak it in 100% acetone to disolve it.

Large wounds, outside of vietnam, etc, should probably NOT be closed with it. much like dermabond. I told her to 1-not do it again. 2-watch for infection (as she hadn't cleaned the wound at all) and 3- not pick at it.

I wouldn't have closed it, even if I could have gotten all the superglue out. which I couldn't.

I assume(d) Tetatnus questioning goes without saying...

 

[EdEmEr]

Larger excision may be required.

I agree: if that stuff is in the wound (which it most likely is) she needs debridement and a labotomy. Well maybe just the debridement.

 

[SomeDoc]

indeed. research shows they are very similar. You could, in theory, soak it in 100% acetone to disolve it.

Large wounds, outside of vietnam, etc, should probably NOT be closed with it. much like dermabond. I told her to 1-not do it again. 2-watch for infection (as she hadn't cleaned the wound at all) and 3- not pick at it.

I wouldn't have closed it, even if I could have gotten all the superglue out. which I couldn't.

Yep, acetone will work great- used it to get superglue off my fingers in the past- soak a cotton swab in it, wipes off easily; not sure how safe it is to use on open wounds, however (MS1 here). This is an interesting thread. RE: superglue use on wounds, I remember reading in an old Emergency Medicine issue about the use of superglue in the ED in sealing minor lacs. Concerning organisms living in superglue, it would be surprising if anything can survive in cyanoacrylate-not so sure about spores though.

Update: apparently superglue and dermabond both contain cyanoacrylate as their active ingredients. I just learned something new.

 

[CueDoc]

This kind of reminds me of a guy i saw once who spilled a vat of hot glue onto his arm and had a fairly good sized area of glue on his arm covering a 2nd/third degree burn... Had to be debrided by surgery if anyone cares and no we did not institute the parkland formula

 

[EdEmEr]

This kind of reminds me of a guy i saw once who spilled a vat of hot glue onto his arm and had a fairly good sized area of glue on his arm covering a 2nd/third degree burn... Had to be debrided by surgery if anyone cares and no we did not institute the parkland formula

Try tripping and falling hands first into a vat of hot tar. Poor b@st@rd had bilateral 3rd degree burns of the arms to the elbows. He came in with the arms looking like they were dipped in dark chocolate.

 

[WilcoWorld]

So, this one isn't in Tintinalli's...


young women cut the hell out of her arm this morning, about 5 cm, didn't wash it and poured a bunch of super glue on it.

10 hours wants the superglue taken off and it 'sewn'.


What do you do?

The first thing I'd do is roll my eyes.

 

[mikecwru]

I also would have told her to hit the road. Aside from what was mentioned above, the only other difference I've read about between crazy glue (ethyl-) and dermabond (octyl-) is that there is supposedly more of an exothermic reaction associated with curing of the ethyl- forms of cyanoacrylate, which can cause burns when used in large amounts. It's not clear to me how clinically significant this is.

Once you have a failure of primary closure in a non-cosmetically sensitive (i.e. facial) wound, the smart money is on letting the wound heal by secondary intention. Even if you did manage to open it up, clean it out and suture it closed, all you'd get for your hard work is a patient complaint and a free trip to the spotlight in your department's M&M when she comes back with an infected wound.

Another option is to clean the wound out, give it a protective dressing, and have them follow up for a delayed primary closure if there no signs of infection after a couple of days. I've had some surgeons willing to do that in clinic.

mike

 

[fab4fan]

According to a EP I know the only difference between Dermabond and superglue is that Dermabond is sterile. I wonder what type of organism would live in liquid superglue. Either way an absolute necessity in the first aid kit (right next to the duct tape).

The derm. I used to go to told me the only difference between the two was $$$. Actually, superglue/krazyglue lasts longer, though I certainly wouldn't use it for something that needed to be sutured. My fingertips crack frequently, and superglue is my saving grace. Guitar god Stevie Ray Vaughn used to glue his fingertips back together so he could keep playing.

As far as the pt., it bears repeating: You can't cure stupid.

 

[roja]

The first thing I'd do is roll my eyes.

I rolled them so far back I almost went blind. 😀

 

[bartleby]

If we aren't talking about a cosmetically sensitive (i.e. facial) wound or something that is grossly gaping and will take eons to heal by secondary intention, there is only modest benefit to delayed primary closure.

Another option is to clean the wound out, give it a protective dressing, and have them follow up for a delayed primary closure if there no signs of infection after a couple of days. I've had some surgeons willing to do that in clinic.

mike

 

[Katydid]

I rolled them so far back I almost went blind. 😀

Can't say I blame you. While you may be able to fix lacerations, you can't fix stupid.

And I never even thought of using superglue to close a cut. But then, the last time superglue and I tangled, I had managed to glue my wedding ring to my finger while trying to repair a votive candle holder, which necessitated much cursing and swearing while on the drive to the drugstore, where I proceeded to purchase acetone nail polish remover.

I figured that if I couldn't unstick my wedding ring with that? Then I'd be stuck going to the ER. Fortunately, I didn't become a story repeated by residents about the lady who stuck her wedding ring to herself with superglue!

 

[deuist]

Interesting note of history: the U.S. military used super glue during the Vietnam War to close wounds.

 

[EM2BE]

Can't say I blame you. While you may be able to fix lacerations, you can't fix stupid.

And I never even thought of using superglue to close a cut. But then, the last time superglue and I tangled, I had managed to glue my wedding ring to my finger while trying to repair a votive candle holder, which necessitated much cursing and swearing while on the drive to the drugstore, where I proceeded to purchase acetone nail polish remover.

I figured that if I couldn't unstick my wedding ring with that? Then I'd be stuck going to the ER. Fortunately, I didn't become a story repeated by residents about the lady who stuck her wedding ring to herself with superglue!

You'd just be known as a devoted wife that didn't want to lose the ring

 

[Katydid]

You'd just be known as a devoted wife that didn't want to lose the ring

Awww, you're too sweet! My husband was snickering at me being the nitwit who stuck her ring to her finger, lol! I considered smacking him, but figured that then, we'd BOTH have to drive to the drugstore, and that would not have been my idea of fun! 😉

That was certainly an interesting night. I'm just glad I didn't stick myself to the steering wheel of the car!

 

[aphistis]

Interesting note of history: the U.S. military used super glue during the Vietnam War to close wounds.

Annoying sequela: My Vietnam veteran VA patients still use it for practically every dental/prosthodontic problem under the sun. Some days I wish they'd outlaw the stuff.

 

[NSAIDAllergy]

The only real difference between SUperGlue (methyl-2-cyanoacrylate) and Dermabond (2-octyl cyanoacrylate) is the number of carbons in the side chain, making Dermabond less toxic to the skin.😉