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What are the best uses for surgical glue in medicine

What-are-the-best-uses-for-surgical-glue-in-medicine-photoThere are three broad surgical applications where existing tissue adhesives have won a firm place. The first is where bonds are required in tissues which are so delicate that conventional stitching is either impossible or extremely time consuming. Brain surgery is one example where it is impossible to stitch thread in an organ which has a consistency (when alive) like soft peanut butter. Surgical glue, usually applied as drops rather than as a spray, is often used toward the end of a brain operation to seal regions that have become exposed or weakened by the surgeon’s scalpel.

Another area where surgical glue has already found a place is in combination with conventional stitching. This approach is now common in plastic surgery where tissue adhesive, usually applied as a spray, can leave much less of a scar than stitches.

Thread and glue can be used sequentially as well as simultaneously. Stitches are used at first where a strong bond is required. Then, just as soon as the wound has sealed, the stitches are taken out and the tissue is held in place with a light film of surgical glue. The final stages of healing can thus take place with no danger of stitch marks being left.

The third established use for surgical glue harks back to its battlefield trials in Vietnam: it is valuable in catastrophes and disasters where time is critical and where long-term disadvantages must take a back seat to the immediate priority of saving lives. Paramedics and emergency medical teams tending the victims of air crashes and earthquakes are increasingly being trained in the use of adhesive sprays. A derivative is also being used with great success to treat burns where it is important to halt fluid loss and to seal out infection.

Although these specialized applications are all important, surgical glue is today used in less than one per cent of operations. Partly, this is because surgeons are a cautious group and any innovation takes time to be accepted. But also, doctors are waiting for the drug companies to market a new generation of tissue adhesives which are free from the present limitations.

The most important breakthrough will come with the successful development of a surgical glue which is entirely nontoxic and which can be broken down by the body and absorbed into the bloodstream once the wound has healed. Certain compounds, particularly those based around ordinary gelatin, look promising. But remaining difficulties include insufficient bond strength and problems of applying the gelatin glue as a spray.

With an enormous market ready and waiting, sooner or later the drug companies will come up with a satisfactory surgical glue for general use. Then the needle and thread can be put away and surgery should become faster and safer, saving more lives and leaving fewer scars.