Surgical glues (also called surgical sealants or adhesives) are used after a surgery or traumatic injury to bind together external or internal tissue. Surgical glues can be used in conjunction with or as an alternative to sutures and staples; they use a chemical bond to hold tissue together for healing or serve as a barrier to stop the flow of bodily fluids. The five main types of surgical glues are fibrin sealants, cyanoacrylates, collagen-based compounds, glutaraldehyde glues and hydrogels.
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Fibrin sealants are a type of surgical adhesive derived from both human and animal (bovine) blood products. Ingredients in the fibrin sealant interact during application to form a clot made from the blood protein called fibrin. Fibrin sealants are effective for use in cardiovascular surgery, lung surgery and closure of the dural (a fibrous membrane covering the brain and spinal cord) and can be used to close spleen and liver lacerations.
Cyanoacrylates are surgical adhesive compounds that are used to close topical or minor lacerations. They are commonly used to close laparoscopic incisions and are much stronger than fibrin sealants and sutures. Cyanoacrylates are waterproof, flexible and require no dressing on the wound. Unfortunately, they are not bio-absorbable and must be restricted to external and temporary applications.
Collagen-based compounds are surgical adhesives made from bovine collagen, bovine thrombin or human plasma. Collagen-based compounds assist with coagulation by delivering fibrinogen to the wound area, which helps to control bleeding. Collagen-based adhesives are bio-absorbable and suitable for cardiovascular surgery, though further study is needed to assess long-term risks.
Glutaraldehyde glues are compounds consisting of bovine albumin and a strong tissue adhesive. They can be used in the repair of aortic dissections to fill in the dissection area. This provides a strong arterial wall that assists in aortic repair. Glutaraldehyde bonds quickly, can withstand high pressures and is used primarily for internal surgeries. The long-term effects from exposure to glutaraldehyde glues is unknown.
Hydrogels are synthetic polythene glycol (PEG) polymers commonly used in lung and thoracic surgery due to their ability to seal air leaks. Hydrogels are bio-absorbable and stronger than fibrin sealants. They are also photoactivated, meaning that the sealant sets with exposure to light, which can be a drawback in situations where a patient is hemorrhaging.
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