title: Sutureless circumcision using 2-octyl cyanoacrylate (Dermabond): appraisal after 18-month experience.
abstract: BACKGROUND
  2-Octyl cyanoacrylate (2-OCA; Dermabond) is a synthetic tissue adhesive that has proven utility in the closure of minor surgical incisions. Recently, we began using this adhesive for skin closure after circumcision and herein report our experience.
  
  
  METHODS
  A total of 267 patients (mean age 4 years) underwent circumcision (n = 208) or circumcision revision (n = 59) using 2-OCA for skin closure. The circumcision was performed using a sleeve technique in 219 patients and a Gomco clamp in 48. After meticulous hemostasis, the incision was cleansed, and the skin edges were aligned. Two thin layers of 2-OCA were applied to the incision and allowed to dry. Antibiotic ointment was then applied to the glans and penis. The technique was not used if poor skin edge apposition or bleeding was noted after circumcision. The skin closure time using 2-OCA averaged 3 minutes for the first 150 patients and less than 90 seconds for the last 120 patients, reflecting a learning curve associated with application. At a mean follow-up of 13 months (range 2 to 18), three postoperative complications had occurred. The cosmetic outcomes have been subjectively better than those with standard closure using interrupted 5-0 or 6-0 sutures, with no risk of suture tracks or sinuses. Parental satisfaction has been consistently great.
  
  
  CONCLUSIONS
  Sutureless circumcision closure using 2-OCA is a safe, fast, and cosmetically appealing alternative to standard interrupted suture reapproximation. These advantages have made it our technique of choice. A direct economic and outcome comparison to sutured repairs is ongoing.
authors.affiliation: Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Elmore
authors.forename: Edwin A
authors.initials: EA
authors.lastname: Smith
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kirsch
mesh_terms: D002675:Child, Preschool; D002944:Circumcision, Male / Q000379:methods*; D003487:Cyanoacrylates / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D014014:Tissue Adhesives / Q000008:administration & dosage*
chemical_list: D003487:Cyanoacrylates; D014014:Tissue Adhesives; C100832:octyl 2-cyanoacrylate