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The cyanoacryalate tissue adhesives (CTA) are an exciting trend which
could potentially lead to home mangement of minor lacerations in the
future! However, there are some definite limitations that one must be
aware of. They are useful primarily for small linear lacerations (< 6-8
cm) which  have relatively clean edges and should not be on areas of
high tension like over joints or creases. They are most effective if
wound edge separation is < 0.5 mm. If there is greater separation, SC
sutures, as Dr. Simon suggested are warranted.
 
The Canadian surgical experience suggests that in toddllers who may pick
on the CTA, wound strength may be reduced significantly. I would like to
ask Dr. Simon and his group if he had that experience with his younger
patients during his recent study.
 
The other important point with CTA use is that the edges have to held
firmly approximated and the CTA placed over the wound. SC leak of the
CTA has been to produce histotoxicity and unwarranted increase in
inflammation of the wound.
 
Thanks
 
Jay Pershad
 
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