DERMABOND® Topical Skin Adhesive

•The Final Layer of Protection

DERMABOND PLUS SUTURES SUTURE STAPLES STRIPS

Closure Strength Equivalent to 4.0 Variety Variety Strongest Weak

Microbial barrier Yes Zone of inhibition No No No

Cosmesis Excellent Excellent Excellent May leave track marks

Inconsistent

Patient Comfort - showering

Can Shower Immediately

Not recommended for period of time

Not recommended for period of time

Not recommended for period of time

Not recommended

For period of time

Ease of Care Simple Complicated Complicated Complicated Complicated

Enduit to bacterial colonization

No No Yes Yes Yes

Removal Sloughs off naturally

May need removal May need removal Needs removal Self removal

DERMABOND® Adhesive is equivalent to other commercially available skin closure devices, studied effectively from small to long incisions up to 69cm.

What is DERMABOND Topical Skin Adhesive?

Cyanoacrylates were developed in 1949• 1970s - n-butyl-2-cyanoacrylate• 1999 - 2-Octyl-Cyanoacrylate (DERMABOND)

1st FDA approved Topical Skin Adhesive

• Today – over 5 million patients a year are treated with DERMABOND Adhesive

DERMABOND Adhesive is a unique technology• 2 Octyl cyanoacrylate has the longest carbon side

chain for increased flexibility and, increased breaking strength versus butyl cyanoacrylate1

• In vivo and In vitro studies demonstrate a proven microbial barrier against bacteria which may cause infection.

• 24 months shelf life, stores at room temperature

• a violet, non tattooing dye for easy observation

1. Quinn, JV Tissue Adhesives in Wound Care, BC Decker 1998. Attached are chapters from the book.

Mechanism of action is a combination of monomer and plasticizers, that polymerizes to form a flexible/pliable adhesive film

• Sets or cures within 45-90 seconds following

final layer

• Reaches full mechanical strength in 1 min

• If needed, can be wiped from skin within 10

seconds after application or with a petroleum

based product after setting

• Adhesive film sloughs or falls off wound

within 7-10 days as skin re-epithelialize

• Equivalent to 7 days wound healing strength

in 3 minutes1

3

OCA: 300-500 microns thick compared to other N- Butyls at : <50 microns thick

1. Singer and Hollander, Lacerations in Acute Wounds: An evidence-based guide, p.85 2. DERMABOND adhesive package insert

DERMBOND Adhesive has proven strength over n-butyls and n-butyl blends due to it’s unique formulation. This strength is critical for topical wound closure and microbial barrier.

Wound Bursting Strength Compliance Analysis

In vivo studies demonstrated DERMABOND Adhesive microbial barrier provides greater protection than sutures alone as well as n-butyls/ n-butyl blend adhesives.

DERMABOND® Adhesive has unique benefits that offer the potential to impact the cost of care.

Sutures Staples OCA Sutures, Staples &

OCA

Overall P Value

Significant pairwise

comparisons1

Overall P-Value

Significant pairwise

comparisons2

Hysterectomy Cohort N= 21,201 N=23,441 N=880 N=489

Percent Unadjusted Analysis Adjusted Analysis 2

Infection as reflected by non-prophylactic antibiotic treatment

12.93% 17.51% 11.14% 23.72% <0.0001 1a,3a,4a,5a,6a <0.0001 1a,3a,5a,6a

Unadjusted Means

Total costs (dollars) $5862 $6965 $5816 $9434 <0.0001 1a,3a,4a,5a,6a <0.0001 1a,3a,5a,6a

C-Section Cohort N=102,797 N=50,097 N=2,391 N=272

Percent Unadjusted Analysis Adjusted Analysis 2

Infection as reflected by non-prophylactic antibiotic treatment

12.83% 12.76% 9.50% 13.97% <0.0001 2a,4a <0.0001 2a,4a

Unadjusted Means

Total costs (dollars) $5572 $5594 $5010 $5949 <0.0001 2a,4a,6a <0.0001 1a,2a,4a,6a

*Health and Economic Outcomes after OB-GYN Surgery: A Comparison of Skin Closure Techniques

Susan G. Murrmann, MD1, Jeffrey S. Markowitz, DrPH2, Elane M. Gutterman, PhD2, Glenn Magee, MBA3

1 University of Tennessee, Department of Obstetrics & Gynecology, Memphis, TN 2 Health Data Analytics, Princeton Junction, NJ 3 Ethicon Inc., Somerville, NJ

*Poster Presentation at 2008 Annual Clinical Meeting of The American College of Obstetricians and Gynecologists, New Orleans, LA, May 3-7, 2008

DERMABOND Adhesive for final skin closure provides benefits for surgeons, nurses, patients, and hospitals.

Physician, Hospital -centered Benefits• Proven microbial barrier for lasting protection

• 7 days of wound healing strength in 1 minutes for strong closure and peace of mind

• No time spent removing staples or sutures

• Reduces needle stick exposure

• Increases patient satisfaction

• Reduced Hospitalization Costs

Nurse, Patient -centered Benefits• Reduces number of suture set ups

• Ease of Post Op wound checks

• Reduces number of wound dressings

• Shower immediately

• Excellent CosmesisScott GR, Carson, CL, Borah, GL, DERMABOND skin closures for bilaterial reduction mammoplasties:a review of 255 consecutive cases. Plast Reconst Surg.2007;120:1460-1465.

Things to consider for successful outcomes

• Standard wound management Remove surgical prep solution Ensure hemostasis

• Precise application technique Thin layers Dry before bandage No petroleum-based products over

DERMABOND Adhesive Post surgical ChloraPrep wipe downs

ok as long as DERMABOND Adhesive has dried and the area is not vigorously scrubbed