The current status of cyanoacrylate and fibrin tissue adhesives

Surgical tissue adhesives could simplify complex surgical procedures by stabilizing tissue surfaces through hemostasis, sealing wounds, and fixating tissue in areas inaccessible to suture placement. The most common surgical tissue adhesives available to the surgeon include the cyanoacrylate derivatives and the fibrin tissue adhesives. Butyl-2 cyanoacrylate (Histoacryl) is a cyanoacrylate derivative that is frequently used in Canada and Europe. This adhesive has excellent binding strength for skin closure; however, subcutaneous implantation can result in inflammation and foreign body giant cell reaction. Fibrin tissue adhesives use a fibrin clot as the binding moiety and vary in adhesive strength depending on the fibrinogen concentration of the preparation. Autologous fibrin tissue adhesives are prepared using one of several different methods, which vary in fibrinogen yield and concentration. The currently available autologous fibrin tissue adhesives demonstrate good hemostatic properties with relatively low binding strengths. This article reviews the status of cyanoacrylate adhesives and the preparation, efficacy, and clinical applications of the fibrin tissue adhesives.