Histotoxicity of Cyanoacrylate Tissue Adhesives: A Comparative Study

Abstract

Cyanoacrylate derivatives have been used as surgical adhesives for many years. Shorter-chain derivatives (methyl- and ethyl-cyanoacrylate) have proved to be histotoxic. Longer-chain derivatives (butyl- and isobutyl-cyanoacrylate) are much less histotoxic. Many surgeons continue to use ethyl-2-cyanoacrylate (Krazy Glue) despite the availability of a less toxic derivative, butyl-2-cyanoacrylate (Histoacryl). In this study, the histotoxicity and bone graft-cartilage binding ability of Krazy Glue and Histoacryl were compared. Bone grafts harvested from the anterior wall of the maxillary sinus were placed in a subcutaneous pocket and glued to auricular cartilage in the rabbit. Krazy Glue and Histoacryl were used in opposite ears, harvesting specimens at 1, 2, 4, 12, 24, and 48 weeks. The Krazy Glue-treated ears developed seromas with histologic evidence of acute inflammation, tissue necrosis, and chronic foreign body giant cell reaction. The Histoacryl-treated ears showed mild acute inflammation and mild foreign body giant cell reaction. The Krazy Glue was completely degraded within 12 months, while some Histoacryl was still present at 1 year. Histoacryl had minimal histotoxic effect and good bone graft-cartilage binding ability, whereas Krazy Glue demonstrated severe histotoxicity.

Reparo de fissura de lóbulo auricular usando cola cirúrgica de menor custo

“…O ECA como adesivo tissular tem sido usado com resultados satisfatórios em Odontologia, Cirurgia Abdominal, Ginecologia, Gastroenterologia, Neurocirurgia, Cirurgia Maxilar, Ortopedia, Cirurgia Plástica, Urologia, Cirurgia Vascular, Cirurgia Cardíaca, Cirurgia Torácica e Medicina Legal [1][2][3][4][5][6] . Não obstante, a colagem de lóbulo auricular ainda não tem sido descrita como modalidade de síntese 7 .…”

“…No entanto, estes estudos são de pequenas casuísticas, merecendo, assim, avaliações adicionais. Além disso, outros trabalhos têm confirmado que os efeitos desfavoráveis do uso de cianoacrilatos em pele restringem-se a complicações locais discretas, em especial inflamações e deiscências parciais, e são provavelmente devido às próprias cirurgias e não ao uso específico do adesivo 2,4,8 .…”

“…Diversos autores têm demonstrado que a principal desvantagem dos cianoacrilatos é a citohistotoxicidade, manifesta por meio de lise celular in vitro e formação de reações inflamatórias agudas ou crônicas in vivo [2][3][4][5] . Eles atribuem a toxicidade, sobretudo, à metabolização com liberação de produtos tóxicos.…”

Estudo experimental comparativo entre o butil-2-cianoacrilato, a mistura gelatina-resorcina-formaldeído e sutura na estabilização de enxertos de cartilagem em coelhos

“…Its first commercial name was coined: "Eastman 910 Monomer"11. Cyanoacrylate long chain spin offs, such as butyl-2-cyanoacrylate (Histoacryl®) and n-butyl cyanoacrylate (Nexaband®) are degraded in cyanoacetate and formaldehyde slowly enough in order to properly reduce its citotoxic effects 12 . Cyanoacrylate polymerization causes the hardening of cyano-alkyl esters, which is responsible for both its adhesive capacity and its little elasticity.…”

“…posing a formaldehyde-caused irritation 5,12,17 . Apparently, suturing caused the greater reaction (around the wire) and cyanoacrylate the least (without statistical significance).…”