In addition to sutures and staples, surgeons sometimes use adhesives on the skin to close wounds. Glue seals the skin, and patients treated with adhesive may not require a follow-up with their doctor. Over time the glue wears away and new skin cells replace it, says Upvan Narang, director of marketing for Ethicon's New Product Development division.
While adhesives have been used in surgery for the past decade, Ethicon believes the future of the technology is its Prineo Skin Closure System, available in Europe since 2007 and pending U.S. Food and Drug Administration approval.
The Prineo system uses a dispenser, like one for cellophane tape, to lay down mesh that a surgeon then covers with glue. The combination of mesh and adhesive is strong—capable of withstanding 150 millimeters of mercury of pressure.* That's about what a patient would experience by running, jumping or coughing, Narang says. (See a video of Narang demonstrating how Prineo works.)
Although neurosurgeon Nelson has used adhesives, he says he has been "underwhelmed" by their performance. "I haven't found anything that's better at closing a wound than a suture," he says. "I like for the wound to be able to breathe, so I don't like coating it with glue." Nelson has tried Ethicon's DermaBond as well as DuraSeal, made by Confluent Surgical, Inc., based in Waltham, Mass. (Covideon also makes a tissue adhesive called Indermil.)
Surgical adhesives can also be expensive. While Ethicon says the sale price of its products varies depending on the contract with the individual healthcare facility, Nelson estimates that the surgical glues he has used cost between $500 and $800 per five-cubic-centimeter dose. (A package of 10 sutures generally costs about $150, he adds.)
Given the variety of sutures, needles and adhesives available to surgeons, it is becoming increasingly difficult to impress them. Outside of developing some better way of sealing the dura mater following brain surgery, suture makers "have come just about as far as they can come," Nelson says. "If surgeons didn't upgrade their tools for the next 100 years, no one would bat an eyelash, for the most part."
*Correction (05/14/09): This article originally stated that the Prineo system is capable of withstanding 150 pounds per square inch of pressure.