Dermabond (Cyanoacrylate Tissue Adhesive)
2-Octyl cyanoacrylate (Dermabond); n-butyl-2-cyanoacrylate (Histoacryl, Periacryl)
Brand names:Dermabond, Dermabond Advanced, Histoacryl, Indermil, SurgiSeal
A topical tissue adhesive that polymerizes on contact with skin moisture, creating a flexible water-resistant film that bridges approximated wound edges. Dermabond closes clean, low-tension lacerations under 4 cm without anesthesia or sutures, in 60 seconds. Operational utility is significant for the right wound type. Patient selection is everything: bites, contaminated, puncture, high-tension, and mucosal wounds are contraindicated.
Pharmacology and Actions
Cyanoacrylate monomers polymerize rapidly on contact with moisture (skin surface water or hydroxyl ions in tissue). Polymerization creates a flexible, water-resistant film bridging the approximated wound edges. 2-octyl cyanoacrylate (Dermabond) has greater flexibility and three times the tensile strength of n-butyl-2-cyanoacrylate. Tensile strength at 2.5 minutes is comparable to 5-0 monofilament suture. Polymerization is exothermic - wound area may feel warm briefly.
Indications
- Closure of clean, low-tension lacerations less than 4 cm in length
- Closure of incisions after minor procedures
- Replacement for sutures or staples in appropriate wounds
- Operational laceration closure when suturing is impractical (limited time, light, or supplies)
Absolute Contraindications
- Bites (animal or human)
- Heavily contaminated wounds
- Puncture wounds or stellate/ragged lacerations
- Wounds over joints or high-tension areas (knuckles, palms, soles)
- Mucosal surfaces
- Wounds requiring layered closure
- Active bleeding that cannot be controlled before application
- Known hypersensitivity to cyanoacrylate or formaldehyde (degradation product)
Precautions and Side Effects
Common: mild stinging or warmth during polymerization. Wound dehiscence if applied to high-tension or active areas, or if wound edges are not held in approximation. Contact dermatitis at adhesive site (rare). Infection rate is no greater than sutured wounds when used in appropriate wounds. Wound site discoloration during healing. No clinically significant drug interactions. Topical use only - no significant systemic absorption. Pregnancy: topical use considered safe. Compatible with lactation. Excellent option for selected pediatric wounds - avoids trauma of suture placement and removal. Useful in thin or fragile elderly skin where sutures would tear through tissue. Counsel patient: do not pick at adhesive, no swimming for 5 days, light showering with gentle drying acceptable after 24 hours.
Adult Dosing
Pediatric Dosing
Same technique as adult. Particular advantage in pediatric facial lacerations - avoids the trauma of suture placement and removal. Counsel parents on water exposure restrictions.
Pharmacokinetics
Peak Effect: Maximum tensile strength at 2.5 minutes.
Duration: Adhesive remains in place 5 to 10 days, sloughs with epidermal turnover.
Storage and Handling
Single-use applicator. Room temperature storage. Do not refrigerate. Protect from extreme heat. Discard if applicator is damaged or if adhesive appears polymerized within the applicator. Shelf life typically 2 years from manufacture.
Reconstitution:
Single-use sealed applicator. Crush ampule within the applicator or break per design (varies by manufacturer) immediately before use. Do not pre-activate; polymerization begins on exposure to ambient moisture.
TCCC and TECC Role
Dermabond is not in the TCCC core formulary - TCCC focuses on hemorrhage control rather than definitive wound closure in the tactical care window. Cyanoacrylate has tactical utility for non-emergent superficial lacerations in prolonged field care, in role 1 settings, or for operational reasons (avoiding evacuation for minor injury). Mission impact is minor: the operator can usually continue limited duty after small laceration closure. Mission may be impacted by wound location and operational demands.
Cyanoacrylate is an underused tool in tactical and operational medicine. The right wound (clean, linear, low-tension, less than 4 cm, on face, scalp, or extremity in a clean area) closes in 60 seconds with no need for anesthesia, no need for needles, and no need for follow-up suture removal. The wrong wound (puncture, bite, contaminated, high-tension, mucosal) needs different management. The discipline is patient selection - and the typical tactical lacerations from low-velocity blunt trauma, falls, or controlled lacerations during operations often fit the right-wound profile.
Applying adhesive into the wound rather than over the closed wound. Cyanoacrylate inside a wound interferes with healing, increases infection risk, and creates a foreign body. The technique is approximate the wound edges with pressure or forceps, then bridge the closed wound with thin layers of adhesive on intact skin. The other mistake is using cyanoacrylate on wounds that need irrigation, debridement, or exploration first - the adhesive will close visibly contaminated wounds and may incubate infection. Clean and irrigate thoroughly before closure decision.
This drug profile is provided as educational reference material for trained medical providers. It is not medical advice, not a substitute for formal training, and not a substitute for current published guidelines or medical direction.
Drug administration is governed by your scope of practice, agency standing orders, medical director protocols, and applicable state and federal regulations. Controlled substances are subject to additional handling, accountability, and documentation requirements per DEA and state law. Always verify dosing, indications, contraindications, and route of administration against current published guidelines and your local protocols before administration.
If this content is being viewed during a medical emergency, call 911 immediately and follow the direction of your local emergency dispatch and medical control. Do not use this reference as a substitute for emergency medical services.
Drug information evolves. Last reviewed dates and source citations are provided for each entry. Confirm currency against the cited source before clinical use.
Penn Tactical Solutions publishes this reference for educational purposes. PTS does not provide medical direction and does not assume responsibility for clinical decisions made in the field. Clinical responsibility rests with the administering provider, their medical director, and their agency.
Educational reference for trained medical providers. Not medical advice. Not a substitute for formal training, current published guidelines, or medical direction. Drug administration is governed by your scope of practice, agency standing orders, medical director protocols, and applicable state and federal regulations. Controlled substances require additional storage, accountability, and documentation per DEA and state law.
In a medical emergency, call 911. This reference is not a substitute for emergency medical services.
Verify dosing, indications, and contraindications against current published guidelines and your local protocols before administration. Confirm content currency against the source citation. Penn Tactical Solutions does not provide medical direction. Clinical responsibility rests with the administering provider, their medical director, and their agency.
Dermabond (Cyanoacrylate Tissue Adhesive)
| IV/IO | None (None) |
| IM | None (None) |
| IN | None (None) |
| PO | None (None) |