Name of the Procedure:

Adhesive, Liquid or Equal (HCPCS Code: A4364)
Common Names: Tissue Adhesive, Medical Adhesive, Skin Glue
Technical Terms: Cyanoacrylate Adhesive, Liquid Adhesive

Summary

Liquid adhesive is a topical tissue adhesive used to close wounds and surgical incisions. It acts as a non-invasive alternative to stitches, staples, or bandages, providing a protective layer that promotes healing.

Purpose

Medical Conditions or Problems

• Superficial cuts and lacerations
• Post-surgical incisions
• Minor wounds that require closure and protection

Goals or Expected Outcomes

• To close and protect the wound
• To promote a clean and optimal healing environment
• To reduce the risk of infection

Indications

Specific Symptoms or Conditions

• Minor cuts or wounds less than 5cm
• Surgical incisions
• Wounds that are not heavily bleeding or at high risk of infection

Patient Criteria

• No known allergy to cyanoacrylates
• The wound must not require deep stitches

Preparation

Pre-Procedure Instructions

• Clean the affected area with mild soap and water
• No need for fasting or significant medication adjustments
• Inform the healthcare provider of any known allergies

Diagnostic Tests or Assessments

• Physical examination of the wound
• Medical history review to check for allergies or contraindications

Procedure Description

1. Cleansing: The wound area is cleaned and disinfected.
2. Drying: Ensure the wound is dry.
3. Application: The liquid adhesive is applied directly to the wound edges while approximating the edges until the adhesive sets.
4. Drying Time: Allow the adhesive to dry completely, forming a protective film.

Tools and Equipment

• Cyanoacrylate-based adhesive
• Sterile gloves
• Cleansing solution

Anesthesia or Sedation

• Typically, no anesthesia or sedation is required as the procedure is non-invasive.

Duration

The procedure usually takes about 5-10 minutes.

Setting

• Emergency room
• Outpatient clinic
• Physician's office

Personnel

• Physician or surgeon
• Nurse or medical assistant

Risks and Complications

Common Risks

• Mild skin irritation
• Temporary sensitivity at the application site

Rare Risks

• Allergic reaction
• Infection if the wound was not properly cleaned

Possible Complications and Management

• If the adhesive bond fails, alternative wound closure techniques may be needed.
• Infection management may require antibiotics.

Benefits

• Minimally invasive
• Quick application
• Reduced scarring compared to stitches
• Provides a protective barrier

Recovery

Post-Procedure Care

• Keep the adhesive film dry and avoid submerging in water.
• Monitor for signs of infection.
• Allow the adhesive to slough off naturally within 5-10 days.

Expected Recovery Time

• Healing usually occurs within 1-2 weeks, depending on wound size and location.

Restrictions and Follow-Up

• Avoid strenuous activities that may stress the wound.
• Follow-up may be needed if signs of infection or adhesive failure are noticed.

Alternatives

Other Treatment Options

• Sutures (stitches)
• Staples
• Traditional bandages or wound dressings

Pros and Cons of Alternatives

• Sutures/Staples: More secure but invasive and may leave noticeable scars.
• Bandages/Dressings: Less secure and may require frequent changes but are non-invasive.

Patient Experience

During the Procedure

• Minimal discomfort expected.
• Tingling as the adhesive dries.

After the Procedure

• Possible mild itching or sensitivity.
• Pain management typically not necessary, but over-the-counter pain relievers can be used if needed.

By following these guidelines, patients can understand what to expect and how to prepare for the use of liquid adhesive as a wound closure method.