AESCULAP HISTOACRYL AND HISTOACRYL BLUE TOPICAL SKIN ADHESIVE

K111959 · Aesculap, Inc. · MPN · Feb 6, 2012 · General, Plastic Surgery

Device Facts

• Record ID: K111959
• Device Name: AESCULAP HISTOACRYL AND HISTOACRYL BLUE TOPICAL SKIN ADHESIVE
• Applicant: Aesculap, Inc.
• Product Code: MPN · General, Plastic Surgery
• Decision Date: Feb 6, 2012
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 878.4010
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

Histoacryl and Histoacryl Blue topical skin adhesives are intended for topical application to hold closed easily approximated skin edges of minimum-tension wounds from clean surgical incisions and simple, thoroughly cleansed, trauma-induced lacerations. Histoacryl and Histoacryl Blue may be used in conjunction with, but not in place of, dermal sutures.

Device Story

Sterile liquid topical skin adhesive; n-butyl-2-cyanoacrylate monomer base. Histoacryl is colorless; Histoacryl Blue contains D&C Violet #2 for visualization. Supplied in 0.5 ml single-patient plastic ampoules. Polymerizes upon contact with water or water-containing substances (e.g., skin moisture). Applied by clinician to approximate skin edges of minor wounds. Acts as a topical barrier/sealant to hold wound edges together during healing. Benefits include non-invasive wound closure and ease of application.

Clinical Evidence

Bench testing only. Testing performed in accordance with FDA's Class II Special Controls Guidance Document for Tissue Adhesive for the Topical Approximation of Skin. Metrics included tensile strength (ASTM F2458-05), polymerization time, viscosity, and GC chemical analysis.

Technological Characteristics

n-butyl-2-cyanoacrylate monomer; liquid form; polymerizes on contact with moisture. Supplied in 0.5 ml plastic ampoules. Tensile strength testing per ASTM F2458-05. No electronic or software components.

Indications for Use

Indicated for topical closure of minimum-tension wounds, including clean surgical incisions and simple, thoroughly cleansed, trauma-induced lacerations. May be used as an adjunct to dermal sutures.

Regulatory Classification

Identification

A tissue adhesive for the topical approximation of skin is a device intended for topical closure of surgical incisions, including laparoscopic incisions, and simple traumatic lacerations that have easily approximated skin edges. Tissue adhesives for the topical approximation of skin may be used in conjunction with, but not in place of, deep dermal stitches.

Special Controls

*Classification.* Class II (special controls). The special control for this device is FDA's “Class II Special Controls Guidance Document: “Tissue Adhesive for the Topical Approximation of Skin.” See § 878.1(e) of this chapter for the availability of this guidance document.(b) *Tissue adhesive for non-topical use* —(1)*Identification.* A tissue adhesive for non-topical use, including adhesives intended for use in the embolization of brain arteriovenous malformation or for use in ophthalmic surgery, is a device used for adhesion of internal tissues and vessels.(2) *Classification.* Class III (premarket approval). As of May 28, 1976, an approval under section 515 of the act is required before this device may be commercially distributed. See § 878.3 of this chapter.

Predicate Devices

• Histoacryl and Histoacryl Blue Topical Skin Adhesive, Tissue Seal LLC (P050013)

Submission Summary (Full Text)

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FEB - 6 2012

arket Notification

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KIII 459

Histoacryl and Histoacryl Blue

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# 510(k) SUMMARY (as required by 21 CFR 807.92)

(K) SChildren - Propical Skin Adhesive Topical Skin Adhesive
Aesculap Histoacryl and Histoacryl Blue Topical Skin Adhesive
Topical Skin Address July 7, 2011 July 7, 2011

MPANY:

Aesculap, Inc. 3773 Corporate Parkway Center Valley, PA 18034 Center Valley, PA 16654
Establishment Registration Number: 2916714

CONTACT:

Kathy A. Racosky 610-984-9291 (phone) 610-791-6882 (fax) [e-mail]

Aesculap Histoacryl and Histoacryl Blue TRADE NAME:

Topical Skin Adhesive COMMON NAME:

CLASSIFICATION NAME: Tissue adhesive

Regulation Number: 878.4010

MPN PRODUCT CODE:

### DEVICE DESCRIPTION

DEVICE DESCRIPTION
Histoacryl and Histoacryl Blue are sterile liquid topical skin adhesives composed of n-Histoacryl and Histoacryl Blue are sterile liquid toplaars are different in only one respect:
butyl-2-cyanoacrylate monomer. The two products are different in only one respe Histoachy and History of the two products are different in only one the dye
Histoacryl is provided as a ooloress liquid, and Histoacry Blue is colored with a bith a oyal as a colorless liquid, and filstoachyr black on the device during application.
Histoacryl is provided as a colorless liqualization of the device during and Fistoachy is provised in athesives are supplied in 0.5 ml single patient
D&C Violet #2 with intent to ease visualization of the extent of the D&C Tiber in This Market of the Supplied in ols of supplied in one of the extern of the extern of the extern of the extern of the extern of the extent of the lead History and Richard Justices remain liquid until exposed to water
use plastic ampoules . Each tissue adhesives remain liquid until exposed to water
ampoule can remain steries use, passes ampediation in the . Both tissue, after which it cures (polyments)
ampoule can remain sterile, Both tissue, after which it cures (polymerizes) and
or water-cont or water-containing substantees into

### INDICATIONS FOR USE

INDICATIONS FOR USE
Histoacryl and Histoacryl Blue topical skin adhesives are intended for topicalion Histoacryl and Histoacryl Blue topical skin edges of minimum-tension wounds from clean
to hold closed easily approximated skin edges of minimum-induced lacerations. to hold closed easily approximated skin edges of trauma-induced lacerations.
surgical incisions and simple, thoroughly cleansed, trauma-induced in place to her besting and simple, thoroughly cleansed, trauna industrial with, but not in place of, dermal sutures.

0003

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### KIII959

Histoacryl and Histoacryl Blue

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### ANTIAL EQUIVALENCE

SUBSINANIA Believes that the Histoacryl and Histoacryl Blue Topical Skin Adhesive is
Aliana Mather Maddiet Medictions of and Histocoryl Blue Topical Skin Adhesive, Tissue ുട്ടേയ്മ്മ, lnc. believes that the Histoacryl and Histoachyl Blue Topical Skin Adhesive, Tissue
reubstantially equivalent to Histoacryl and Histoacryl Blue Topical Skin Adhe ally equivalent (0 ... The only difference is the packaging.

R

## PUPPOSE FOR PREMARKET NOTIFICATION

and if
The purpose of this submission is to gain marketing clearance for Histoacryl and The purpose of Topical Skin Adhesive.

## TECHNOLIGICAL CHARACTERISTICS(compared to Predicate(s)}

The Aesculap Histoacryl and Histoacryl Blue Topical Skin Adhesive is equivalent in The Aesculap Histoacryl and Filstoacryl and Histoacryl Blue Topical Skin Adhesive,
performance to the predicate device Histoacryl and Histoaryl ond Histoary/ Blue performance to the predicate Gevice Pinstoury and Histoacyl and Histoacyl Blue
Tissue Seal LLC (P050013). The main difference between Histoacryl Blue I Issue Seal LLO (r 0500 10). The main amore within an aluminum pouch.

### PERFORMANCE DATA

Testing was performed in accordance to FDA's Class II Special Control Cuidance Testing was penomied in accordance to T brical Approximation of Skin to demonstrally Document for Tissue Adnesive for the Topical Skin Adhesive is substantially that the Aesoulap I hotodory. and inst. The following testing was performed:

- Tensile strength (ASTM F2458-05) .
- Set (polymerization) time .
- Viscositv .
- GC Chemical Analysis ●

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Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized eagle with its wings spread, and the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" are arranged in a circle around the eagle. The eagle is black, and the text is also black. The logo is simple and recognizable.

#### Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room -WO66-G609 Silver Spring, MD 20993-0002

FEB - 6 2012

Aesculap, Inc. % Ms. Kathy A. Racosky 3773 Corporate Parkway Center Valley, Pennsylvania 18034

Re: K111959

Trade/Device Name: Aesculap Histoacryl and Histoacryl Blue Topical Skin Adhesive Regulation Number: 21 CFR 878.4010 Regulation Name: Tissue adhesive Regulatory Class: Class II Product Code: MPN Dated: February 02, 2012 Received: February 03, 2012

Dear Ms. Racosky:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you; however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must

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comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address

http://www.fda.gov/MedicalDevices/Resourcesfor You/Industry/default.htm.

Sincerely yours,

Mark N. Melkerson

Director Division of Surgical, Orthopedic and Restorative Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure .

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### KIII959

Histoacryl and Histoacryl Blue

Page 1 of 1

### INDICATIONS FOR USE STATEMENT

KIII959 510(k) Number:_

harket Notification

## Defice Name: Aesculap Histoacryl and Histoacryl Blue Topical Skin Adhesive

Histoacryl and Histoacryl Blue topical skin adhesives are intended for topical application Histoacryi and filefoury. Dias toploskin edges of minimum-tension wounds from clean to nota olders only of thoroughly cleansed, trauma-induced lacerations. surglour including to the may be used in conjunction with, but not in place of, dermal sutures.

X Prescription Use

(per 21 CFR 801.109)

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED) Concurrence of CDRH, Office of Device Evaluation (ODE)

Daniel Keane In Nixon

(Division Sign-Off) Division of Surgical, Orthopedic, and Restorative Devices

510(k) Number K111959