Surgical glue, formally known as tissue adhesive, is a modern solution for closing wounds and binding tissues without traditional sutures or staples. This sterile, medical-grade material adheres safely to biological tissue, forming a strong bond that supports the body’s natural healing process. The use of these adhesives offers surgeons a method that is often faster and less invasive than conventional techniques. These liquid formulations solidify rapidly upon application, creating a protective barrier that holds tissue edges together and serves as a seal against fluid or air leaks.
The Primary Types of Surgical Adhesives
The materials used for surgical adhesion fall into two primary categories: synthetic and biological. Synthetic adhesives are dominated by cyanoacrylates, which are single-component liquid monomers. These compounds are popular for external applications due to their high tensile strength and ability to cure quickly at room temperature. The longer-chain varieties, such as octyl-cyanoacrylate, are preferred in medical settings because their breakdown products are less toxic to surrounding tissue than older counterparts.
Fibrin sealants are biological adhesives derived from human or animal plasma components, specifically fibrinogen and thrombin. These two components are stored separately and mixed upon application, mimicking the final stage of the body’s natural blood clotting cascade. Because they are protein-based and biodegradable, fibrin sealants are generally favored for internal use where they can be safely absorbed over time. Other synthetic options include polyethylene glycol (PEG) hydrogels and mixtures of gelatin and glutaraldehyde, which are used as sealants against fluids.
The Science of Sealing: How They Work
The two main types of tissue adhesives employ different chemical reactions to achieve bonding. Cyanoacrylates utilize anionic polymerization, a rapid chain reaction initiated by weak bases like the hydroxyl ions found in water or tissue fluid. When the liquid monomer contacts the moist tissue surface, it quickly solidifies into a polymer film that physically bridges the wound edges. This polymerization is an exothermic reaction, meaning it releases a small amount of heat as it cures.
Fibrin sealants rely on an enzymatic reaction that replicates the body’s natural response to injury. Application involves simultaneously spraying the fibrinogen and thrombin components onto the wound site. Thrombin acts as an enzyme, cleaving fibrinogen molecules to form fibrin monomers. These monomers spontaneously aggregate and are then cross-linked by Factor XIII, resulting in the formation of a stable, three-dimensional fibrin clot that adheres to the tissue.
Beyond Skin Deep: Applications in Surgery
Surgical adhesives are utilized across a broad range of medical procedures, extending beyond simple external wound closure. For superficial closure, cyanoacrylates are a common alternative to sutures for skin lacerations and surgical incisions where wound edges can be easily brought together without tension. The adhesive forms a flexible, water-resistant barrier that protects the site until healing is complete.
For internal applications, particularly in delicate or moist environments, fibrin sealants are employed for hemostasis and sealing. These biological glues control bleeding in highly vascular organs like the liver or spleen. They are also used extensively in thoracic surgery to seal air leaks after lung resection. Specialized procedures, such as corneal repair in ophthalmology or reinforcing a vessel anastomosis in vascular surgery, also benefit from these adhesives.
Glue vs. Sutures: Which is Better and Why
The choice between a tissue adhesive and traditional sutures depends on the wound characteristics and surgical context. Adhesives offer distinct advantages in patient comfort and efficiency, as application is much faster than suturing, significantly reducing overall procedure time. Glues eliminate the need for needle passes, which lowers the risk of accidental needle-stick injuries and avoids puncture marks that contribute to scarring.
However, tissue adhesives are not suitable for all wounds due to their relatively low tensile strength compared to sutures. They should not be used on deep wounds, jagged lacerations, or areas subjected to high tension, such as joints. In these high-stress situations, sutures provide the superior structural integrity required to prevent wound breakdown. For low-tension skin closure, glues often yield comparable cosmetic results and eliminate the need for a follow-up visit for removal.