Wound Glue - best practice?

Re: Wound Glue - best practice?

Georgie Hollis — Sat, 20 Mar 2010 21:27:17 GMT

On a totally economic (and selfish) note - is the cost of glue justified versus sutures? I've tried looking into it and would prefer a REAL answer!

Re: Wound Glue - best practice?

Jon Bray — Sat, 20 Mar 2010 21:04:13 GMT

I remember using it to seal the abdomen of a tarantula which had been dropped by its owner and commenting that getting myself stuck to it probably wouldn't help my love-life any.

On being informed of the incident later on my partner agreed with this presumption :-)

I don't suture rabbit scrotums either - I believe my source for the acceptability of this is the BSAVA Rabbit manual. I tuck the stumps back down into the abdomen and they seem happy to stay there; the scrotum sides stick to one another like two sheets of wet tissue paper.

I would definitely do something to close guinea pig scrotums, as I've seen an infection in one of these which recurred after antibiotics and further surgery, and I've also seen a dramatic exenteration in another, so the more layers between the important stuff and the outside the better as far as I'm concerned!

Re: Wound Glue - best practice?

Gillian Mostyn — Tue, 26 Jan 2010 20:40:22 GMT

Re: Wound Glue - best practice?

Vikki Halliday LLB — Tue, 26 Jan 2010 20:27:47 GMT

I'd just like to add to this thread, particularly from the point of best practice with wound glue.

1. DO instruct members of staff that it is for surgical use only

2. DONT allow your trainee nurse to try to use their initiative and use the stuff to fix the "wet floor" sign which has broken.

3. Failing all above, don't let them then leave aforementioned sign, drying nicely with wound glue on the prep room table, without a clear warning sign to vets, particularly those carrying a rather fractious cat in one hand and trying to clear the prep room table with the other. Need I say more?

Result: Vet nicely glued to sign and number of unprintable words following whilst trying to remove sign from hand and restrain cat with other.

Vet to trainee: " wound glue works by rapid dehydration"

Trainee " I guess you can't dehydrate the plastic then?"

Doh!

Re: Wound Glue - best practice?

Vikki Moran — Tue, 26 Jan 2010 17:56:43 GMT

me too. if you've done a good closed castration they seem to heal very rapidly without suturing or glue. was beginning to think there were no other vets alive who didn't suture them though! so at least i now don't need to think i'm the only one.

Re: Wound Glue - best practice?

Rob Davis — Fri, 22 Jan 2010 18:18:41 GMT

I also find it useful for small, clean skin wounds, often avoiding the need for GA/sedation, or reclosing wounds where sutures have been pulled out. I always tend to warn owners that the wound may break down and require suturing, but most are happy to accept this risk to avoid anaesthesia.

On another forum somebody recently reported having used tissue glue to stick omentum to the serosal gut surface after enterotomy with great success, though this is not something I have tried, and would be concerned about sterility and possibly foreign body reaction...

Re: Wound Glue - best practice?

Ian Mostyn — Fri, 22 Jan 2010 17:39:49 GMT

The stump stretches quite a lot and if the wound is at the distal end of the scrotum, the stump should be well clear

Ian

Re: Wound Glue - best practice?

Hanna Bennett — Thu, 21 Jan 2010 20:48:40 GMT

hmmm... have to admit i always glue my rabbit's scrotums - more worried that my stump would poke out the wound i guess, may be brave and try without next time...

Re: Wound Glue - best practice?

Georgie Hollis — Thu, 21 Jan 2010 20:22:52 GMT

Thank you all so much for your comments, i really appreciate the thoughts you have shared. I've nearly stuck myself together fairly recently - while trying to look professional of course - I was just testing the tack!! (yeah Right!)

Thank you again, Georgie.

Re: Wound Glue - best practice?

Ian Mostyn — Thu, 21 Jan 2010 18:47:21 GMT

About 10 - 15mm long, mid-to-end scrotum incision, closed castration with a single ligature. I have not had a problem this way but as scotal skin swells a lot and rabbits are prone to chewing sutures, this technique seems to work very well for me.

Ian

Re: Wound Glue - best practice?

Hanna Bennett — Thu, 21 Jan 2010 18:33:32 GMT

[quote user="Ian Mostyn"]Very useful following rabbit laparotomies but I don't stitch rabbit scrotal skins so never used it there [/quote]

so do you just leave them open? how big is your incision?

Re: Wound Glue - best practice?

Ian Mostyn — Thu, 21 Jan 2010 17:38:40 GMT

A few tips -

don't get yourself stuck to the animal - very embarrassing!
Have some acetone handy for when you do get stuck or you get the pair of scissors stuck together opening the bottle. Don't get acetone free nail polish remover though!
Make sure it is dry before putting the animal onto the table again
Very useful following rabbit laparotomies but I don't stitch rabbit scrotal skins so never used it there
We use vetbond - not had a problem with it but I still prefer sutures given the opportunity

Ian

Re: Wound Glue - best practice?

James Allsop — Thu, 21 Jan 2010 16:10:17 GMT

I have used a few different types of glue and not noticed any significant difference between them other than colour.

Re: Wound Glue - best practice?

James Allsop — Thu, 21 Jan 2010 16:09:26 GMT

I agree - great for rabbit castrates. I also use it for hiding that intradermal knot that hasnt gone quite as well as I planned. The reaction around the knot I found became significantly less frequent when i stopped using vircyl for intradermals. I use either monocryl or caprosyn but have also used vicryl rapide with a similar improvement.

Back to glue - I wouldnt use it on other wounds unless I had a good and tidy sub cut layer as it can fail. It is great to have in the practice for use on cat scratches though

Re: Wound Glue - best practice?

Arlo Guthrie — Tue, 22 Dec 2009 09:02:31 GMT

[quote user="robloxley"]As for intradermal sutures, a good aberdeen knot should rarely leave ends poking out,[/quote]

Someone just sent me a private message to say what a good practical tip this would make for our new practical tips feed. Any chance I could get you to post the tip here, please, Rob:

http://www.vetsurgeon.org/blogs/veterinary-tips/default.aspx

Re: Wound Glue - best practice?

Rob Loxley — Tue, 22 Dec 2009 00:00:25 GMT

Great for rabbit castrates.

As for intradermal sutures, a good aberdeen knot should rarely leave ends poking out, but yes getting the last bit of the incision closed up takes practice.

We're trying Dermafuse, only complaint is the usual - why only 5 (or so) disposable tips for a bottle that does dozens of applications??

And don't stick yourself to the rabbit. And clean any blood up first or it is preserved in glue for the owner to see.

Re: Wound Glue - best practice?

Utlendigur — Mon, 21 Dec 2009 22:05:45 GMT

Don'ts

1. Don't use it on wounds where you want to remove the sutures

2. If using it for a quick repair on a minor wound on a small animal, make sure that bits of anatomy don't come into contact before the glue is dry - I once stuck a puppy's leg to its abdomen temporarily

3, If you spill some on the table, don't put the small furry down on that spot!

Re: Wound Glue - best practice?

Martin Jones — Mon, 21 Dec 2009 21:54:47 GMT

We use glue almost routinely, with intradermals. Basically, once the knot is buried, we tend to put a dab of glue over the top to seal the end of the wound. To Stuart, I'd say though that it's not great for unburied knots (and don't we all get those....) - everything is ok for about a week, and then this little purple (surgicryl) shadow starts showing through, followed by the knot. By this time, one can usually just pull the knot, clean and snip, but it does cause some reaction. Nothing fatal, but a bit of a pain in the bum.

Not useful for haemostasis - usually where the final bite of the needle has pierced a tiny but insistent skin bleeder. Not great at tension, obviously, so if used in isolation then only for partial thickness or very tiny superficial wounds in areas of plentiful skin; not great in infected wounds.

Good glue comes in a small bottle with a proper nozzle for direction and cost-efficiency. It's slightly coloured so one can see where it goes, and it never, never sticks the surgeon to the patient in front of the nurses. Do you have any - I could probably do with some.

Martin

Re: Wound Glue - best practice?

Noweia — Mon, 21 Dec 2009 21:45:03 GMT

We use it in our practice and I like it. It seals the wound over and the animals seem to feel the wound less.

I use it myself when I get cuts or scratches, it stops the stinging straight away.

Re: Wound Glue - best practice?

stuart mcmorrow — Mon, 21 Dec 2009 21:20:14 GMT

I have limited use with it as I always thought it was expensive and not really necessary. I have used some that came to me free recently and it is really useful for finishing off an intradermal suture that I didn't manage to get closed over properly.

[:'(]

Otherwise I did use it in the past for rabbits and small furries and think it worked OK?#

I'd be interested in hearing what others think and if it is good so you can be lazy or if it really can speed things up and possibly save money?