Guest Column | August 4, 2025

The Sticky Truth: Why Surgical Glue Is Outperforming Conventional Sutures

By Dhandapani Nattarayan, Baxter Healthcare

Medical team performing surgery-GettyImages-155153177

In this article, I describe the disadvantages of surgical sutures, advantages of surgical glues/sealants, and the properties of currently used surgical sealants and adhesives.

Surgical sutures for closing wounds have several drawbacks:

Infection risk: While sutures are often treated with antimicrobial coatings, there's still a possibility of infection if they are not handled properly.
Tissue reaction: Sutures, especially natural sutures like catgut, can cause inflammation, redness, and swelling at the wound site. This can lead to compromised healing and may contribute to infection, particularly in sensitive areas like mucosa.
Need for removal: Many suture materials, especially non-absorbable ones, require removal after the wound has healed, which can be uncomfortable and may cause irritation.
Time-consuming: Suturing can be a lengthy process, particularly for large wounds, which can increase the overall time of the surgery and potentially the patient's discomfort.
Skill dependence: The quality of wound closure relies heavily on the surgeon's experience and technique. Poor suturing can lead to complications like wound dehiscence (reopening) or infection.

The development of advanced surgical adhesives like Dermabond (2-octylcyanoacrylate), approved by the FDA in 1998, is one example of the ongoing advancements in the field of surgical glues. Dermabond is known for its improved flexibility and strength compared to earlier cyanoacrylate formulations. It also poses less danger of irritation and bacterial infection.

Advantages Of Surgical Glue/Sealants Compared To Conventional Sutures

Rapid application and reduced need for sutures or staples: This saves time in the operating room for patients, doctors, and medical staffs.
Less invasive: Surgical glue application does not need numbing or needle punctures, so it is a much less painful process and is potentially suitable for all levels of patients, including pediatric patients.
No anesthesia required: Surgical glue can be used to close wounds without the need for local anesthesia.
Faster healing: Surgical glue promotes faster healing processes and has less post operative pain.
Low rate of infection: Surgical glue acts as a protective barrier, preventing bacteria from entering the surgical wound.
Reduced scarring and improved cosmetic outcomes: Surgical glue can minimize scarring by creating a protective barrier and holding wound edges together without penetrating the skin, unlike sutures, which leave stitch marks.
Cost effective: Surgical glue is often less expensive than traditional sutures. Their use also reduces the length of hospital stays and the need for post-operative care.

What Are Some Examples Of Surgical Sealants And Adhesives?

Fibrin Sealant

This consists of two major components, human or animal fibrinogen (also called sealer protein) and thrombin. These come in separate vials or in prefilled syringe form. Once these components are combined, they form a stable and elastic fibrin clot. Fibrin sealant can be used as an adjunct to hemostasis in adult and pediatric patients (>1 month of age) undergoing surgery when control of bleeding by conventional surgical techniques (such as suture, ligature, and cautery) is ineffective or impractical. It degrades physiologically into granulation tissue approximately two weeks after application. Fibrin sealant is the only FDA approved material for clinical use as a hemostat, sealant, and adhesive. Example products are Tisseel¹ and Artiss.²

Fibrin sealants are used as an adjunct to hemostasis during surgery and as an adjunct to standard surgical sealing to support sutures/ligatures in gastrointestinal anastomoses, vascular surgery, and neurosurgery. They also are used to improve adhesion of separated tissue (e.g., tissue flaps, split skin grafts).

Gelatin And Thrombin

Bovine-derived gelatin and human-derived thrombin are applied directly to the source of bleeding until the bleeding stops. The gelatin components perform mechanically by conforming to the bleeding site and providing a tamponade effect, while the thrombin component requires the presence of blood to be effective. Thrombin achieves hemostasis by converting blood fibrinogen into fibrin, thereby forming a hemostatic clot. These sealants are used in all surgical procedures (other than in ophthalmic) as an adjunct to hemostasis when control of bleeding by ligature or conventional procedures is ineffective or impractical. An example product is Floseal.³

Cyanoacrylate

Cyanoacrylate-derived adhesives are synthetic glues, stronger than fibrin sealants, used for external tissue repair. They are fast acting and provide a strong bond. Cyanoacrylate-derived adhesives are typically waterproof, somewhat flexible, and do not require secondary dressing. Cyanoacrylate adhesives have a potential for toxicity and tissue inflammation. However, the longer-chain derivative, 2-octyl cyanoacrylate, is less toxic and is a more flexible formulation approved by the FDA. It dries fast, stops the bleeding, keeps out dirt and air, and typically stays in place until the wounded area is healed. It is not, however, recommended for deep or jagged wounds or for use on areas of high mobility and flexion, such as joints. In addition to its surgical adhesive indications, it has also been FDA approved as a barrier against common bacterial microbes. The longer chain cyanoacrylate product is often used topically to reinforce tissue closure and for minor lacerations. An example product of 2-octyl cyanoacrylate is Dermabond.⁴

Polyethylene Glycol Polymer

This is a synthetic hydrogel used in surgery to seal suture lines and prevent or reduce adhesion formation and it does not require blood or collagen to activate. Synthetic hydrogel rapidly polymerizes and crosslinks with tissue proteins. It easily adheres to synthetic graft materials and also provides an immediate intraoperative seal at the suture line and maintains protection during the postoperative period. These sealants are used in vascular reconstructions, suture and staple line reinforcement, and adhesion prevention. An example product is Coseal.⁵

Albumin Cross-Linked With Glutaraldehyde

This is a protein-based tissue adhesive used as a hemostatic and structural adjunct in cardiac and vascular anastomotic repair procedures. The glutaraldehyde and bovine serum albumin create a strong crosslink that bonds tissues and seals defects, effectively stopping bleeding and reinforcing tissue integrity. An example product is Bioglue.⁶

Conclusion

Surgical glue has many benefits compared to conventional sutures and also acts as an additional protection in conjunction with other surgical methods to achieve hemostasis and tissue closure. However, conventional sutures are the best approach in a few scenarios, such as deep cuts, surgery in high movement areas, and to stop heavy bleeding. But scientists and medical companies across the world are continuing research on new and improved surgical glue/sealants for better performance and safety profiles.

References

About The Author:

Dhandapani Nattarayan is a senior project manager with over 22 years of experience in the medical technology and automotive industries and is currently a contractor for Baxter Healthcare. He has played a pivotal role in the successful development of many medical devices for major U.S. medical companies. He also played a major role in the successful completion of multiple regulatory programs, including EU MDR compliance and FDA compliance programs (test method validation and DHF remediation). He holds a bachelor’s degree in mechanical engineering from Bharthiar University, Coimbatore, India. For further inquiries, he can be reached at dhans3481@gmail.com or on LinkedIn.