Skin Incisions Closure with N-Butyl Cyanoacrylate and Nylon Sutures in Sahel Bucks

Mutah AA, Mana HP, Yoksa DT, Haruna AA, Laku D and Bokko PB

Published on: 2023-12-23


The search for a suitable surgical incision closure material that will enhance a faster healing rate, minimal complications, and a satisfactory esthetic appearance has been a challenge since time immemorial. Conventional sutures have, over the years, offered varying healing rates and appearances, resulting in a less satisfied cosmetic appearance. N-butyl cyanoacrylate and nylon sutures were used for skin incision closure in ten (10) sahel goats (bucks) randomly grouped into two (5 goats each), A (N-butyl Cyanoacrylate) and B (Nylon). Following standard pre-surgical assessment, sedation, and local anesthesia, 5cm left flank skin incisions were made and closed using N-butyl cyanoacrylate and nylon for groups A and B. Healing rates were grossly and histologically observed, scored, and recorded for a period of 13 days using various indices. The gross and histological advantages offered by N-butyl cyanoacrylate outweighed those of nylon suture material.


Sahel bucks; Skin incisional wounds; N-butyl cyanoacrylate; Nylon; Cosmesis


Adequate incision wound closure is golden in invasive surgery and wound repair. This can be achieved through the use of a range of suture techniques and suture materials for wound closure [1]. Ideally, a wound closure method should produce the optimal cosmetic result [2]. The options for wound closure in the past have been largely limited to natural and synthetic sutures, with other alternatives such as staples and adhesive tapes, and the recent introduction of medical-grade cyanoacrylate into clinical practice [3]. The n-butyl cyanoacrylate (n-BCA, NBCA) developed in the 1970s was the first medical-grade tissue adhesive to have negligible tissue toxicity, good bonding strength, and acceptable wound cosmesis [4, 5]. The polymerized form of NBCA has excellent tensile strength and is very effective in closing surgical or wound incisions [6]. Butyl cyanoacrylate has a wide range of applications in laceration repairs, skin and mucosal grafts, and the fixation of mandibular fractures [7].

Surgical incisions are sutured to appose wound edges to facilitate healing and minimize scar formation [8, 9]. The main purpose of surgical wound closure is to achieve quick wound healing and a better cosmetic appearance, thereby reducing the risks of complications, including dehiscence and infection [10].

Materials and Methods

This study was conducted in accordance with the institutional Animal Care and Use Committee guidelines. All animals were humanely handled.

Experimental Animals (Sahel Bucks)

Ten (n = 10) clinically healthy bucks (male goats), aged 9.7±1.33 months with a mean weight of 13.2±1.31 kg, were procured from the Maiduguri-Borno State livestock market and housed in the large animal pens of the Veterinary Teaching Hospital, University of Maiduguri. The bucks were randomly separated into two (2) groups (A and B) of five (5) each and allowed to acclimatize for four (4) weeks under prevailing ambient conditions. They were fed groundnut and bean husk concentrates, and water was provided ad libitum throughout the study period.


On a right lateral recumbency, the left paralumbar fossa was shaved and aseptically prepared with 0.2% w/v chlorhexidine gluconate (SAVLON®, Johnson & Johnson Ltd., London). The goats were sedated using diazepam injection (JARZEPAM®, Swiss Parentarals PVT Ltd., India) at a dose rate of 0.3 mg/kg IV. An inverted L block with 2% lidocaine (XYLOCAINE® India) at 5 mg/kg was used for local infiltration of the paralumbaar fossa. A 5cm full-thickness skin incision was made on the upper paralumbar fossa of the left flank of each goat in a dorso-ventral orientation to expose the subcutaneous layer. The cutaneous incision dimensions and completeness were assessed. Thereafter, subcuticular closure of the incisions in both groups was carried out using polyglycolic acid (HINCRYL® Hll Lifecare Ltd., India) size 2 using simple continuous suture patterns. The apposed cutaneous wound edges in group (A) were closed by application of N-butyl Cyanoacrylate (3M Vet bond Tissue Adhesive, USA). The cutaneous incisions in group (B) were sutured with Nylon (TOPECARE® Huaian Angel Medical Instruments Co. Ltd., China) size 2 using a simple interrupted suture pattern.

Post-Surgical Care

Topical antibiotic spray was applied only to group B bucks.

Macroscopic Wound Repair Assessment

A surgical wound was scored (a triple blinded score) immediately for early healing (EHS) according to the method described by Marini [11].

Histological Assessment of Wound Repair

Elliptical incisional skin biopsy samples were obtained by aseptic excisions involving the epidermis and dermis at the point of clinical union of the wounds and were collected and preserved in 10% formalin. Formalin-fixed wound edges were embedded in paraffin and sectioned at 5µm. The tissue sections were deparaffinized and stained using the Masson trichrome staining technique to assess histomorphometric details. ImageJ computer software was used to digitally analyze collagen densitometry at 13 days post-wound closure.

Data Analysis

All data obtained were expressed as mean±standard deviation and analyzed using a T-test between groups. P-value<0.05 was considered statistically significant.


Hemostasis was achieved immediately following application of N-butyl Cyanoacrylate in Group A bucks compared to Group B bucks, where hemostasis was delayed for 150–190 seconds after incision closure with a nylon suture. No apparent discharge was observed in both groups; however, at 5 hours post-incision closure, the wound edges appeared moist with a fibrin seal in group B bucks, while in group A bucks, the wound edges were completely sealed by the N-butyl cyanoacrylate and appeared dry and glassy. Better epitheliazation with less wound edge inflammation was grossly seen in group A bucks compared to group B, where wound edge inflammation was pronounced at day 5. There was no apparent sign of sepsis in both groups throughout the study period. Dehiscence was noticed in a buck belonging to group B at day 12 post-suture removal, while none was noticed in group A bucks. Two bucks belonging to group A showed a subcutaneous tissue reaction at 24 hours after incision closure lasting up to 4 days and resolving at day 5. Wounds in group A bucks healed with a good cosmetic appearance, having good apposition and smooth and even surfaces at day 13, compared to group B bucks. Furthermore, bucks in group B showed a painful reaction during suture removal on day 12. In group A bucks, the adhesive spontaneously resolved 8–10 days postsurgery. No apparent sign of sepsis or wound infection was observed in the course of this study. Figure 1 shows the daily macroscopic observable healing rates between N-butyl cyanoacrylate and nylon for a period of 13 days.

Figure 1: Gross Healing Rates in Incisions Closed with Cyanoacrylate and Nylon for 1-5, 8-13 Days Post Incision Closure.

The Early Healing Score by Marini [11] was adopted for assessing healing at 24 hours post-incision closure. Group A animals had 45 points (50 maximum) compared to group B, which had 42 points. Group A animals showed a percentage score of 90 higher with a mean EHS of 9.00±1.73 (maximum 10) compared to group B animals having a percentage score of 84 with a mean EHS of 8.40±1.52 (Table 1).

Table 1: Early Healing Score (EHS) and Percentage Wound Healing Score Post Incision Closure in Sahel Bucks.


EHS (Mean±SD)

% Score

N-butyl Cyanoacrylate






Key: EHS=Early wound Healing Score, SD=Standard Deviation

Histopathologic Determination of Wound Healing

The distribution of collagen fibers in groups A (figures 2a and b) and B (figures 3a and b) shows that skin sections from group A show more collagen distribution than in group B at 13 days post-surgery. The mean percentage collagen distribution of skin healing rate at 13 days post-incision closure was 10.04±6.80 and 8.06±3.47 for groups A and B, respectively. Although group A has a higher collagen distribution than group B, there is no significant difference (p > 0.05) between the two groups, as indicated in figure 4.

 Figure 2: (A&B) Photomicrograph of Skin section at day 13 after closure with N-butyl Cyanoacrylate showing collagen distribution (C) in the dermis (D) and hair follicle (arrow) in group A bucks. Masson’s Trichrome stainx100 (A) x400 (B).

Figure 3: (A&B) Photomicrograph of Skin section at day 13 after closure with Nylon showing collagen distribution (arrow) in group B bucks. Masson’s Trichrome stainx100 (A) x400 (B).

Figure 4: Mean Percentage of Collagen Distribution between N-Butyl Cyanoacrylate and Nylon at 13 Days Post Incision Closure.


Wound healing processes are aimed at restoring the injured tissue to its normal architecture [12]. Devices aimed at achieving faster healing minimize tissue scarring. There was immediate haemostasis after the application of N-butyl cyanoacrylate compared to nylon sutures in groups A and B, respectively. This finding agrees with work done by Howard [13], where he used bucrylate to achieve haemostasis in tooth extraction. This is probably due to N-butyl Cyanoacrylate’s ability to form a complete seal to the wound edges and surface after polymerization. Good epitheliazation and minimal wound edge inflammation were observed in group A bucks compared to group B, where wound edge inflammation was pronounced with poor epitheliazation. This agrees with studies done by Devrukhkar [14], where he compared silk sutures and N-butyl Cyanoacrylate in the closure of pediatric lacerations. Wound dehiscence was recorded in group B, where nylon was used for wound closure, while no dehiscence was recorded in group A. This finding agrees with work done by Vaaka [15], where he compared silk suture and cyanoacrylate. Dehiscence may occur, probably due to Nylon's poor knot quality, knot slippage, and suture failure tendencies. Polymerized N-butyl Cyanoacrylate in this study also acted as a water-proof dressing, thereby reducing the number of hospital visits with no need for suture removal. This finding agrees with the study by Shivamurthy [16], where none of his patients require hospital suture removal schedules. A response to pain was observed in group B bucks during suture removal. Skin wounds of full thickness had developed to proliferation after 13 days, as was obvious with the collagen fibers and vascularized vessels. The Early Wound Healing Score (EHS), adopted from Marini [11], was used in this study to assess healing by primary intention 24 hours after surgical intervention. It revealed a higher healing score percentage of 90% in group A compared to group B, which had a score of 84%. Clinical signs of re-epitheliazation (CSR) in group A have a lower score of 27 points compared to 30 points in group B; clinical signs of haemostasis (CSH) have a higher score of 10 points in group A compared to B with a score of 8; clinical signs of inflammation have a score of 8 points higher compared to 4 points in group B. The summation of these points revealed a higher score of 45 points for group A and a lower score of 42 points for group B. This result is in compliance with studies by Quinn [17] and Singer [2], where they compared the healing rate between cyanoacrylate and conventional sutures for up to 10 days. Histologically, group A shows more collagen concentration and organization and suggests type 1 collagen is associated with better healing formation than group B, whose collagen distribution is less organized, suggesting type 3 collagen. This finding agrees with studies by Myllyharju [18]. In clinical studies, the production and deposition of collagen are essential in the initial wound healing stages, as stated by Frade [19]. This is probably due to the faster healing rate in group A compared to group B bucks.


In this study, N-butyl Cyanoacrylate gives a better wound closure because it tends to prevent hemorrhage and wound dehiscence following surgery in comparison to Nylon suture materials.


This research component was funded by Tertiary Education Trust Fund (TETFund) as part of TETFUND/DESS/NRF-20/4/VOL1 Grant.

Conflict of Interest

Authors have no conflict of interest to declare.


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