An open study of tissue adhesive in full-thickness skin grafting

Background: Securing full-thickness skin grafts (FTSG) by suturing is a time-consuming procedure, even in experienced hands. The advent of tissue adhesives has led to their use in a variety of surgical procedures, providing an acceptable alternative to conventional suturing, Objective: Our purpose was to identify whether the tissue adhesive n-butyl-2-cyanoacrylate (NBCA) can be used to secure FTSG and to compare the outcome with conventional suturing. Methods: Twenty-one patients with defects after Mohs micrographic surgery were enrolled into the study. An initial pilot study of 8 patients compared NBCA and sutures within individual grafts; the subsequent 13 patients had grafts secured with between 4 and 8 cardinal sutures and NBCA alone. Results: No differences in healing, complications, or cosmetic appearance were observed between the sides secured with NBCA and with sutures in the pilot study. Of the grafts in the subsequent 13 patients, 2 patients experienced superficial necrosis with subsequent healing and a good cosmetic outcome, the remainder healed in place without complications, with excellent cosmetic outcome. Conclusion: NBCA is suitable for securing selected FTSG and provides a significant time-saving over the traditional approach of suturing such grafts into place.