How to Apply Dermabond: A Step-by-Step Guide for Effective Skin Closure

Dermabond, also known as skin glue or liquid stitches, is a sterile adhesive used to close skin wounds. It’s a popular alternative to traditional sutures or staples for minor cuts, lacerations, and surgical incisions. Dermabond offers several advantages, including ease of application, reduced pain, and a lower risk of infection. This comprehensive guide provides a detailed, step-by-step process for applying Dermabond effectively, ensuring proper wound closure and optimal healing. It’s crucial to remember that Dermabond is not suitable for all types of wounds. Deep wounds, puncture wounds, infected wounds, or wounds located in areas of high skin tension (like joints) typically require alternative closure methods. Always consult a healthcare professional to determine the best approach for your specific injury.

Understanding Dermabond

Dermabond is a cyanoacrylate-based adhesive. Specifically, it’s 2-octyl cyanoacrylate. When applied to the skin, it polymerizes (hardens) rapidly upon contact with moisture, forming a strong, flexible bond that holds the wound edges together. This creates a barrier that protects the wound from bacteria and other contaminants, promoting faster healing. Unlike stitches, Dermabond does not require removal; it naturally sloughs off as the skin heals, typically within 5 to 10 days.

Advantages of Dermabond

• Reduced Pain: Application is generally painless, eliminating the need for needles or suture removal.
• Faster Healing: The protective barrier reduces the risk of infection and promotes quicker tissue regeneration.
• Cosmetic Results: Dermabond can often lead to less scarring compared to traditional sutures.
• Ease of Application: It is relatively easy to apply, especially in areas that are difficult to suture.
• No Removal Required: The adhesive naturally falls off as the wound heals.

Disadvantages of Dermabond

• Not Suitable for All Wounds: Inappropriate for deep, infected, or high-tension wounds.
• Risk of Allergic Reaction: Though rare, allergic reactions to cyanoacrylate are possible.
• Proper Technique Required: Incorrect application can lead to wound dehiscence (separation).
• Cost: Dermabond can be more expensive than traditional sutures.
• Specific Storage Requirements: Dermabond has specific storage requirements to maintain its effectiveness.

Who Can Apply Dermabond?

While Dermabond is relatively easy to use, it’s generally applied by trained healthcare professionals, including doctors, nurses, physician assistants, and emergency medical technicians. In some cases, individuals with specific training and experience in wound care may also be authorized to apply Dermabond under the supervision of a medical professional. It is important to receive proper training before attempting to use Dermabond.

Essential Supplies for Dermabond Application

Before you begin, gather all the necessary supplies to ensure a smooth and sterile application process:

• Dermabond Vial: Ensure the vial is unopened and not expired. Check the lot number and expiration date.
• Sterile Gloves: To maintain sterility and prevent contamination of the wound.
• Antiseptic Solution: Such as povidone-iodine (Betadine) or chlorhexidine (Hibiclens) for wound cleaning.
• Sterile Gauze Pads: For cleaning the wound and surrounding skin.
• Sterile Saline Solution: For irrigating the wound.
• Skin Protectant (Optional): Such as petroleum jelly, to protect surrounding skin from the adhesive. This is typically used only when you are very concerned about the flow of the Dermabond onto unintended areas.
• Forceps or Tissue Hooks (Optional): To precisely align wound edges.
• Adhesive Remover (Optional): For cleaning up accidental spills of Dermabond. Acetone works well, but should be used with extreme caution and only on intact skin, avoiding contact with the wound.
• Eye Protection: Protect your eyes from accidental splashes of the adhesive.

Step-by-Step Guide to Applying Dermabond

Follow these steps carefully to ensure proper Dermabond application and optimal wound closure:

Step 1: Prepare the Wound

Importance: Proper wound preparation is crucial for successful Dermabond application and minimizing the risk of infection.

1. Wash Your Hands: Thoroughly wash your hands with soap and water for at least 20 seconds. Alternatively, use an alcohol-based hand sanitizer. Wear sterile gloves.
2. Control Bleeding: Apply direct pressure to the wound using sterile gauze until the bleeding stops completely. This might take several minutes. If bleeding persists, seek medical attention. Dermabond will not adhere properly to a bleeding wound.
3. Clean the Wound: Irrigate the wound thoroughly with sterile saline solution to remove any debris, dirt, or contaminants. Use a syringe or squeeze bottle to apply the saline under pressure.
4. Disinfect the Wound and Surrounding Skin: Gently clean the wound and the surrounding skin with an antiseptic solution, such as povidone-iodine or chlorhexidine. Follow the manufacturer’s instructions for application and contact time. Allow the antiseptic to dry completely.
5. Dry the Wound: Ensure the wound and surrounding skin are completely dry. Dermabond adheres best to dry surfaces. Use sterile gauze to blot the area dry.

Step 2: Align the Wound Edges

Importance: Precise alignment of wound edges is essential for optimal cosmetic results and proper healing. Poor alignment can lead to unsightly scarring or wound dehiscence.

1. Approximate the Edges: Gently bring the wound edges together, ensuring they are properly aligned. Avoid overlapping or inverting the edges.
2. Use Forceps or Tissue Hooks (Optional): If necessary, use forceps or tissue hooks to precisely align the wound edges. Grasp the skin gently to avoid causing further trauma. This is particularly helpful for irregular or complex lacerations.
3. Maintain Alignment: Hold the wound edges together firmly until the Dermabond is applied and has had time to dry. An assistant can be helpful here.

Step 3: Prepare the Dermabond Vial

Importance: Correct preparation of the Dermabond vial ensures proper application and prevents premature hardening of the adhesive.

1. Open the Package: Carefully open the Dermabond package, avoiding contamination of the vial or applicator tip.
2. Crush the Ampule (if applicable): Some Dermabond vials have an internal glass ampule that needs to be crushed to release the adhesive. Follow the manufacturer’s instructions for crushing the ampule. Typically, this involves gently squeezing the vial in the designated area.
3. Attach the Applicator Tip: If the Dermabond vial has a separate applicator tip, attach it securely to the vial. Ensure the tip is properly seated to prevent leakage. Some vials have an integrated applicator.
4. Prime the Applicator (if applicable): Some applicator tips require priming before use. Gently squeeze the vial until a small amount of Dermabond flows to the tip.

Step 4: Apply the Dermabond

Importance: Proper Dermabond application ensures complete wound closure and prevents premature peeling or cracking of the adhesive.

1. Apply Thin Layers: Gently squeeze the Dermabond vial to apply a thin, even layer of adhesive along the entire length of the wound. Avoid applying excessive amounts, as this can lead to a thick, inflexible layer that is prone to cracking.
2. Bridge the Wound Edges: Ensure the Dermabond bridges the wound edges, creating a continuous, sealed barrier. Extend the adhesive approximately 5-10 mm (1/4 to 1/2 inch) beyond the wound edges onto the surrounding skin.
3. Apply Multiple Layers (if needed): Apply 2-3 thin layers of Dermabond, allowing each layer to dry for approximately 30 seconds before applying the next. This creates a stronger, more durable bond.
4. Maintain Wound Edge Alignment: Continue holding the wound edges together until the Dermabond is completely dry and hardened. This typically takes 1-2 minutes.
5. Avoid Getting Dermabond Inside the Wound: Apply the Dermabond to the surface of the skin only. Avoid allowing the adhesive to flow into the wound itself, as this can interfere with healing and increase the risk of infection.

Step 5: Protect the Wound

Importance: Proper wound protection helps prevent premature removal of the Dermabond and minimizes the risk of infection.

1. Do Not Cover the Wound: Generally, it is best to leave the Dermabond-covered wound uncovered to allow for air circulation and promote healing. Dressings can trap moisture and increase the risk of infection.
2. Avoid Excessive Moisture: Keep the wound dry. Avoid prolonged exposure to water, such as showering or swimming. When showering, gently pat the area dry.
3. Avoid Picking or Rubbing: Do not pick, scratch, or rub the Dermabond. This can weaken the bond and lead to premature peeling.
4. Avoid Applying Ointments or Creams: Do not apply ointments, creams, or lotions directly to the Dermabond. These products can interfere with the adhesive and reduce its effectiveness.
5. Protect from Friction: Avoid activities that may cause friction or pressure on the wound. Wear loose-fitting clothing to prevent rubbing.

Post-Application Care and Monitoring

Proper post-application care is crucial for ensuring optimal healing and preventing complications. Instruct the patient to follow these guidelines:

• Keep the Wound Clean and Dry: Gently cleanse the area around the Dermabond with mild soap and water. Pat dry with a clean towel.
• Monitor for Signs of Infection: Watch for signs of infection, such as increased pain, redness, swelling, pus, or fever. If any of these symptoms develop, seek medical attention immediately.
• Avoid Strenuous Activities: Refrain from strenuous activities that may put stress on the wound and cause the Dermabond to crack or peel prematurely.
• Expect the Dermabond to Slough Off: The Dermabond will naturally slough off within 5-10 days as the skin heals. Do not attempt to remove it prematurely.
• Follow Up with a Healthcare Provider: Schedule a follow-up appointment with a healthcare provider to assess the wound and ensure proper healing. This is particularly important for wounds that are large, deep, or located in areas of high skin tension.

Troubleshooting Common Problems

• Premature Peeling: If the Dermabond peels off prematurely, the wound edges may separate. If this occurs, seek medical attention to have the wound re-evaluated and potentially re-closed.
• Cracking: Cracking can occur if the Dermabond is applied too thickly or if the wound is subjected to excessive tension. While small cracks are usually not a cause for concern, large cracks may compromise the wound closure.
• Allergic Reaction: Although rare, some individuals may experience an allergic reaction to Dermabond. Symptoms may include redness, itching, swelling, or rash. If an allergic reaction occurs, discontinue use and seek medical attention.
• Infection: If signs of infection develop, seek medical attention immediately.

Important Considerations and Precautions

• Contraindications: Dermabond is contraindicated for use on infected wounds, puncture wounds, deep wounds, or wounds located in areas of high skin tension.
• Eye Contact: Avoid contact with eyes. If Dermabond comes into contact with the eyes, flush immediately with copious amounts of water and seek medical attention.
• Storage: Store Dermabond in a cool, dry place, away from direct sunlight and heat. Follow the manufacturer’s instructions for storage.
• Expiration Date: Do not use Dermabond past its expiration date.
• Consult a Healthcare Professional: Always consult a healthcare professional to determine the best wound closure method for your specific injury.

Alternatives to Dermabond

While Dermabond is a popular and effective wound closure method, it is not always the best option. Alternatives to Dermabond include:

• Sutures: Traditional stitches that are used to close deeper wounds or wounds in areas of high skin tension.
• Staples: Metal clips that are used to close surgical incisions.
• Adhesive Bandages (Steri-Strips): Adhesive strips that are used to close small, superficial wounds.
• Wound Closure Strips: Similar to Steri-Strips but often wider and stronger, providing more support to the wound edges.

Conclusion

Dermabond is a valuable tool for closing minor skin wounds and promoting faster healing. By following these detailed steps and precautions, you can ensure proper application and optimal results. However, it’s essential to remember that Dermabond is not a substitute for professional medical care. Always consult a healthcare provider to determine the best treatment option for your specific injury. With proper wound care and monitoring, you can minimize the risk of complications and achieve successful wound closure with Dermabond.

Disclaimer: This article is intended for informational purposes only and should not be considered medical advice. Always consult a qualified healthcare professional for diagnosis and treatment of any medical condition.