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'Gluing' fissures closed

Discussion in 'General Issues and Discussion Forum' started by Adrian Misseri, Sep 11, 2008.

  1. Adrian Misseri

    Adrian Misseri Active Member


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    G'Day all....

    Had a dermatologist suggets to a patient to superglue her heel fissures closed. Now I'm not sure if he was refering to normal superglue (which is toxic), or whether he was refering to a surgical skin glue such as Dermabond (which is rediculously expensive). Has anyone else heard of this, or had practitions making suggestions like this? It has been suggested to the patient that maybe she shoudl get onto the foot file, change her footwear and start using creams, but the dermatologist suggested gluing them closed.
    :confused:
     
  2. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Yes, commonplace and much anecdotal support.

    Remember "supaglue" was developed by the American miltary to deal with combat wounds and lacerations.

    I recommend it frequently.

    LL
     
  3. Adrian Misseri

    Adrian Misseri Active Member

    As in superglue superglue???
     
  4. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    The one and only.

    "medical grade" vs. "home maintenance grade" are virtually identical. Just vastly different price tags.

    LL
     
  5. Admin2

    Admin2 Administrator Staff Member

  6. Tuckersm

    Tuckersm Well-Known Member

    We have used Histoacryl (the medical wound closure superglue) for a number of years on heel fissures. Whilst chemically similar to the hardware glue, it is sterile, arrives on dry ice, and must be kept refrigerated. the cost is about $220 for 10 vials and has been approved for medical use. Super glue has not, and if something went wrong....
     
  7. jb

    jb Active Member

    Stephen

    How did the case study on this topic that you mentioned in a earlier thread c2007 turn out?

    Jair
     
  8. Zac

    Zac Active Member

    Has there been any further developments in products for closing heel fissures (available in Australia & reasonably priced)? And are people still recommending "superglue"?
     
  9. PostMortem

    PostMortem Active Member

    Still using superglue, recommended to me by a GP and a dermatologist. Also if you keep superglue in the fridge it doesn't set or clog up the end.

    Don't use it on clients as I don't keep a supply, but have given instructions on it's use to appropriate clients. Tend to find it needs to be re-applied every few days to keep the fissure intact while the skin heals.
     
  10. Zac

    Zac Active Member

    Thanks Alastair. Are you able to give me your basic advice you give to patients?
     
  11. PostMortem

    PostMortem Active Member

    Simple, really, don't stick your fingers to your feet! :D

    That is a serious bit of advice I give, but generally make sure the area is clean and well debrided. You can sometimes use skin tension to bring the edges of the fissure together, then apply superglue sparingly, making sure to extend the area glued about 5mm beynd the edge of the fissure otherwise it doesn't hold the edges together. May also need to apply several layers to get enough strength for the glue to hold.

    Regular washing in warm water will disolve the glue within a few days, but it can be surprising how quickly the fissure can resolve. Still give all the regular advice, emol. abrasive, footwear.
     
  12. Paul Bowles

    Paul Bowles Well-Known Member

    We have been doing this clinically for years using Dermabond and Histoacryl - on the recommendation from I believe an award winning presentation at a national Podiatry Conference in Tasmania a few years back from Dr Julia Firth (Pod). I believe A Dr Stephen Tucker (Pod) also known as tuckersm around here may have also been a co-author on that paper!

    Rumour has it that that histoacryl study may have inspired a certain other histoacryl study looking at partial nail avulsion closure using a similar method! I can't confirm whether or not that crazy study may have indeed been hatched in a bar, after the awards and a few too many celebratory champagnes!

    Now we all feel old don't we....

    Adrian - it works best on fissures which are bleeding, we debride the edges back as far as possible then close it with several layers of dermabond or histoacryl - then cover in long steri strips to re-enforce. We review after about 7-10 days. All patients report better pain and after review we recommend urea based moisturizers regularly, care of any further callous, footwear advice and further consultation if required.
     
  13. Zac

    Zac Active Member

    If Dr Tucker, is around, any chance of getting a copy of the study?

    Paul, where do you get Histoacryl & Dermabond from? I had a brief Internet search & they appear to be US companies. Do you use both for different cases/reasons?
     
  14. Paul Bowles

    Paul Bowles Well-Known Member

    Tuckersm is around!!!! :) He posted above!

    I'm not sure who our supplier is - But I am in Australia and our practice manager gets them both easily. I'm happy to check out the details on Monday for you if you like....PM me....
     
  15. Tuckersm

    Tuckersm Well-Known Member

  16. Adrian et al.,

    Have used Dermabond on a few heel fissures with good success, but I think it is worth mentioning on any thread on heel fissures, that occlusive night time wraps with petroleum jelly and cling-wrap after bathing or soaking the feet first in warm water, works equally well in the vast majority of cases. When I have used dermabond, I get the patient to start a five night course of wraps two days after mechanical closure before progressing to a once-weekly regime. Rather old fashioned - and always worth remembering the fall risk factor with unsteady patients - but it works!

    Mark
     
  17. Tuckersm

    Tuckersm Well-Known Member

    Presentation attached.

    It is from 2007, but does indicate the technique that we used,
     

    Attached Files:

  18. blinda

    blinda MVP

    Not sure if this is relevant in your neck of the woods, but I have attached an article I wrote a few years back on the use of tissue adhesive for heel fissures;

    Cheers,
    Bel
     

    Attached Files:

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