“My original thinking was that if the procedure can be performed faster, with the potential to improve cosmesis and reduce the chances for infection, then we should work to enhance the technique,” he said.
In addition to the rationale of shaving minutes off the procedure by eliminating the need for sutures, Dr. LiVecchi explained that using a tissue adhesive to close the wound also creates a microbial barrier between the outside and the wound—thus, eliminating the need for both antibiotics and suture removal postoperatively.
Over two decades, Dr. LiVecchi’s idea has moved from the use of a medical grade “crazy glue”; off-label to secure silicone stent knots in dacryocystorhinostomies and as a temporary tarsorrhaphy in adults, uncooperative children, and for one blepharoplasty.
A 2-octyl, cyanoacrylate, topical skin adhesive (SurgiSeal, Adhezion Biomedical) was a step forward for patients undergoing blepharoplasty. The adhesive was as strong as or stronger than 5.0 sutures, flexible, less exothermic than other topical skin adhesives, and acted as a microbial barrier.
Dr. LiVecchi tested the adhesive in an initial study that included 100 eyelids and a retrospective follow-up study that included 180 eyelids (90 patients; average age, 66.5 years).
The adhesive was delivered using an applicator (SurgiSeal Stylus, Pfizer) to promote effective application of the adhesive on the eyelid and prevent the adhesive from running off the eyelids into the eyes.
The adhesive provided wound closure that is equivalent to a 5.0 suture or 7 days of healing, Dr. LiVecchi noted.
John T. LiVecchi, MD, FACS, FSEE
E: [email protected]
This article was adapted from Dr. LiVecchi’s presentation at the American Academy of Ophthalmology. Dr. LiVecchi is editor of the Ophthalmology Times “Plastic Pearls” column and a member of its editorial advisory board. He has no proprietary interest in the subject matter.