Plastic Adhesives Cyanoacrylates

During the past ten years, new adhesives have been developed whose properties surpass those of any of the older, better known organic adhesive compounds. One of these is the cyano-acrylate monomer, known more commonly as the Eastman 910 Adhesive. It is a colourless liquid which, in the monomer form, has the appearance and the viscosity of water. When it is applied to any surface in a thin film a polymerisation reaction occurs, and it becomes a tough solid. Polymerisation takes place within a few seconds. The time varies between two and 30 seconds, depending on the material and the amount of moisture present. The reaction takes place remarkably rapidly, and the bond is firm and permanent. When a violent effort is made to break the bond, most substances will separate in a plane other than that which was recently joined. One of these adhesives was methyl-2 cyanoacrylate (Eastman 910 monomer), developed in 1960 as industrial glue. In 1960, bucrylate was made available, and it was found to be better tolerated. Heumann and Steinbach45 undertook a study, in which, 50 healthy rabbits were used. In one group, the incud-ostapedial joint was dislocated with a small hook. The ossicles were subsequently re-united with enbucrilate (Histoacryl). The histolog-ical examination of the evaluated ears showed a severe tissue reaction to the enbucrilate. Advanced erosion of the bone at the site of application of the glue on the ossicles was found. The adhesive was present in the middle ear of some of the rabbits, three months after surgery. The enbucrilate was also found to be embedded in granulation tissue surrounded by foreign body giant cells. In 1963, Mathes and Terry46 conducted a study on six mongrel dogs (12 kidneys) to evaluate Eastman 910 monomer adhesive's efficacy for non-suture closure of nephrostomy. Eastman 910 adheres to moist living tissues and is sterile, but it is not flexible when dry and is somewhat initiating to the tissues. In 75 cases of nephrolithotomy, 24 complications occurred and 11 patients required nephrectomy. The rate of secondary haemorrhage was 9%, as reported by Jordan and Tomskey.47 Other investigators have studied the use of No. 910 adhesive for re-enforcement of maxillofacial injuries and cerebral aneurysms, corneal grafts, non-suture closure of arteriotomy incisions, closure of the pericardium about a flanged cannula during cardiac surgery, and non-suture closure of vena cava linear and circumferential incisions.

In Japan, Inou48 used this adhesive to successfully close more than 70 laparotomy incisions, without conventional sutures. Recently, Clark49 used this adhesive to seal the severed ends of the anterior jugular vein without sutures, in a man who underwent radical neck dissection. He reported no complications after a month. He also reported 168 successful vein repairs in 170 dogs with the adhesives alone. There were two instances of bleeding. In 40 dogs, whose venae cavae were repaired with the adhesive alone by Healey et al..50 in 1961 and associates, there were no deaths due to haemorrhage, thrombosis or infection at the site of repair. After three months the site of incision could be detected only with difficulty.

In 1962, O'Neil et al.51 conducted a study for non-suture intestinal anastomosis that did not employ the principle of applying serosa to serosa and did not result in inversion of the bowel wall. Twenty-six mongrel dogs were used for this purpose. There were five failures, four of which occurred in the large intestinal group and one in the small intestinal group. The failures in the large intestinal group presented a common finding of necrosis of the entire intestinal wall on either side of the anastomosis and complete disruption of the anastomosis leading to generalised peritonitis and death. The failure of the small intestinal group also showed histological evidence of extensive necrosis, but grossly the anastomosis was intact. In 1962, Fischl52 used the Eastman 910 monomer adhesive for primary closure of skin incisions. The first attempts were made on segments of excised skin. These were successful, and the skin margins adhered well. Since then, it was used to close incisions on the skin of laboratory animals. Five mongrel dogs were used and 15 incisions made on them. Thirteen of them healed without incident. The vigorous scratching by one dog disrupted the other two. No toxic effects were encountered.

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