Surgical tissue adhesives.

Surgical tissue adhesives continue to evolve as an important technology for the facial plastic and reconstructive surgeon. Twelve years ago there was little routine use of these substances; however, in the past 5 years there have been significant advances. It is becoming increasingly important for the facial plastic and reconstructive surgeon to be familiar with the indications and shortcomings of these compounds. This article will summarize the evolution of surgical tissue adhesives to their present-day applications, including technical points for their successful use. An ideal surgical tissue adhesive must meet the following criteria: strong binding strength, ease of application, tissue biocompatibility, biodegradable byproducts, minimal tissue reactivity, and reasonable cost. Currently available surgical tissue adhesives can be categorized as either fibrin tissue adhesives or cyanoacrylates. Although fibrin tissue adhesives and cyanoacrylates are often discussed under the general topic of surgical tissue adhesives, these two substances have different indications and mechanisms of action. Fibrin tissue adhesives use naturally occurring substrates that are part of normal endogenous clotting mechanisms. In contrast, the adhesion achieved by cyanoacrylates is a result of synthetic compounds not naturally occurring in the human body. These two types of adhesives also have different clinical indications. Fibrin tissue adhesives are typically applied below the dermis as a biologic hemostat or as a sealant for use with skin grafts and flaps. Cyanoacrylates have been shown to be histotoxic when applied below the dermis and have been used most successfully at the level of the epidermis for superficial skin closure [1].