A Randomized, Clinical Trial Comparing Butylcyanoacrylate with Octylcyanoacrylate in the Management of Selected Pediatric Facial Lacerations

Abstract

Abstract. Objective: To compare two tissue adhesives, butylcyanoacrylate and octylcyanoacrylate, in the treatment of small (<4 cm) superficial linear traumatic facial lacerations in children. Methods: This was a randomized, clinical trial with parallel design. 94 children <18 years of age seen in the ED of a tertiary care pediatric hospital with a facial laceration suitable for tissue adhesive closure underwent laceration closure using either butylcyanoacrylate or octylcyanoacrylate. The primary outcome was the cosmetic result at three months rated from photographs by a plastic surgeon on a visual analog scale (VAS). Secondary outcomes included the time to perform the procedure, the perceived difficulty of the procedure, the pain perceived by the patient, and a wound evaluation score at ten to 14 days and three months. Results: Ninety-four patients were randomized with 47 in each group. The two groups were similar for baseline demographic and clinical characteristics. There was no difference in the three-month cosmesis VAS (median, 70.0 mm for n-butyl-2-cyanoacrylate vs 67.5 mm for octylcyanocrylate, p = 0.84). There was no difference between the groups for time to complete the procedure (p = 0.88), parent/patient-perceived pain of the procedure (p = 0.37), or physician-perceived difficulty of the procedure (p = 0.33). Similarly, there was no difference between the groups for the percentage of early (p = 0.58) or late (p = 0.71) optimal wound evaluation scores. Conclusions: In the closure of small linear pediatric facial lacerations, octylcyanoacrylate is similar to butylcyanoacrylate in ease of use and early and late cosmetic outcomes. The superior physical properties of octylcyanoacrylate appear to add little benefit to the management of these selected lacerations. Physician preference and differing costs may dictate use for these small selected lacerations.

A Comparative Study of the Surgically Relevant Mechanical Characteristics of the Topical Skin Adhesives

“…A study comparing Histoacryl to a previously available low-viscosity Dermabond adhesive in children with simple, short, low-tension facial lacerations found no differences in clinically relevant outcomes such as dehiscence and cosmesis. 10 In contrast, a study comparing the rates of incomplete wound edge apposition among children undergoing pediatric surgery found higher rates with Histoacryl adhesive compared with low-viscosity Dermabond adhesive. 11 Due to their lower strength and flexibility, the use of the butylbased adhesives has generally been limited to short (up to 4 to 8 cm) surgical incisions and lacerations.…”

Efficacy of pain control with topical lidocaine–epinephrine–tetracaine during laceration repair with tissue adhesive in children: a randomized controlled trial

“…3,4 Quinn and Okun showed different peak temperatures and varying polymerization times in several different formulations of commercially available tissue adhesive using an aluminum foil model, 25 although no in vivo difference in pain ratings between n-butyl-2 cyanoacrylate and a popular octylcyanoacrylate formulation were found in a randomized trial com paring the two. 20 Although the generalizability of our results to other tissue adhesives may be limited, lidocaine -epinephrinetetracaine is likely to have comparable effects with these products.…”

“…Using previously published pain scores for tissue adhesive, 20 we calculated a desired sample size of 115 participants in each of the study arms to capture an improvement of 1 unit on the colour Visual Analogue Scale with a p value of 0.05 and power of 80%. Ten percent of a scale's range (e.g., 1 unit…”

“…No previously validated tools for these secondary measures exist, although the same scale for difficulty of repair has been used in a previous study of tissue adhesives. 20 Two weeks after wound repair, participants were contacted by telephone and asked about unscheduled follow-up visits and their overall satisfaction.…”

Comparative Study of Primary Skin Closure with Adhesive Skin Glue and Conventional Suture Material in Clean Elective Surgery

“…At present, 2-Octylcyanoacrylate has replaced, 2-Butylcyanoacrylate, as skin adhesive [5]. The cyanoacrylates first were synthesized in 1949 by Airdis.…”