# Surgical Wound Repair with Innovative Hemostatic Glue: Clinical Case Report
## 3 Discussion
Among them, cyanoacrylates were applied to two opposing, wet, living tissue surfaces, and they showed the ability to fix them perfectly. Their general chemical formula is CH2@C(CN)-COOR, where R can be substituted for any alkyl group, ranging from methyl to decyl. Usually, cyanoacrylate glue generates heat for faster curing, and this may damage soft tissue and hamper blood supply [31]. Therefore, manufacturers have incorporated long chains of a methyl group, due to which the polymerization processis elongated and the rate of heat generation prolonged. Because intraoral mucosa is naturally moist due to saliva, the use of cyanoacrylate glue may find itself as an involuntary participant in the bonding process [32]. Polymerization of the cyanoacrylates occurs within 10-15 s, and they are not absorbable, so they are sloughed from the surface of the skin and mucosa 7-10 days after adhesive application [33; 34; 35]. Previously ethyl and methyl cyanoacrylate were used for wound closure; however, they were discarded, given their potential toxicities. Newer generation cyanoacrylate includes n-butyl-2-cyanoacrylate, octyl-2-cyanoacrylate, and n-hexyl-cyanoacrylate. They have unique properties, including faster tissue bonding capacity and curing. In addition, their excellent tensile strength, fast polymerization, biocompatibility, immediate hemostasis, ease of application, and bacteriostatic properties make them a good choice for fixing surgical wounds [33; 34; 35]. Recently, the literature reported the widespread use of cyanoacrylate adhesives during general surgery procedures, including gynecology, gastroenterology, neurosurgery, orthopedics, plastic surgery, dermatology, urology, and vascular and cardiac surgery. Common indications for use included esophageal fistula closure, myocardial surgery, bilateral mammoplasty, skin wound closure, bone and cartilage grafting, corneal surgeries, varicose vein occlusion, and embolization of arteriovenous malformations [36; 37]. In particular, the innovative n-hexyl-cyanoacrylate flabond glue has been used in laparoscopy, and this new technique is aimed at reducing the operating time, the number of surgical complications, and the required sutures [36; 37; 38; 39; 40]. In the maxillofacial field, some cyanoacrylates have been proposed for wound closure on extraction sockets, sinus perforation, mucogingival surgery, and biopsy [17]. However, despite the potential advantages of the use of innovative butyl and hexyl-cyanoacrylate surgical glues in oral surgery, fewer studies have been conducted on this topic. A study showed a reduced inflammatory response after the use of cyanoacrylates during the first postoperative days [30]. These results are in accordance with other studies reporting positive clinical outcomes in combination with surgical glues [29; 30; 31; 32]. Some studies highlighted the hypothesis that faster healing with cyanoacrylate could be promoted by the evidence that the adhesive may act as a scab, maintaining a moist surface over which epithelial migration occurs more readily, as well as preventing secondary infection [29; 30; 31; 32]. [PERSON] et al. reported that tissue adhesive significantly reduced the time needed for wound healing when a free gingival graft is positioned compared with traditional sutures [33]. Moreover, the absence of seepage under the covering formed by cyanoacrylate may be responsible for reduced postoperative pain [14; 41]. Therefore, in the present study, the use of n-hexyl-cyanoacrylate surgical glue has been described in oral surgery. The case report documented this glue's sealing and hemostatic ability during frenectomy, with positive results after 2 months of healing. Therefore, this n-hexyl-cyanoacrylate surgical glue could be proposed as a viable alternative to sutures during surgical procedures involving wide flaps, the impossibility of first-time healing, and patients with low compliance. Moreover, it could also be indicated to reduce operative time and postoperative pain, even if these hypotheses should be confirmed by future clinical studies.