A Prospective Analysis of the Use of Octylcyanoacrylate Tissue Adhesive for Wound Closure in Pediatric Neurosurgery

Abstract

Objective: Cyanoacrylate monomers have been developed for use as skin adhesives. Previous studies have demonstrated that using this skin adhesive for the closure of traumatic lacerations results in excellent cosmesis, decreased procedure-related pain and timesavings. Surgical Technique: Octylcyanoacrylate skin adhesive is applied after the placement of deep fascial sutures with close approximation of the skin edges. The adhesive is applied in liquid form and polymerizes rapidly to solid form. Multiple layers are applied forming a hard impenetrable barrier. Results: This technique was prospectively evaluated in the closure of 102 elective neurosurgical operations with 142 incisions: ventriculoperitoneal shunt insertion/revision (53%) and craniotomy for tumors (10%) were the commonest procedures. There were a total of 83 scalp, 36 abdominal, 8 neck, 6 chest and 6 lumbar incisions. The mean incision length was 5.1 cm (range 0.25–50 cm). Fifty-nine percent of the wounds had previous areas of operative incisions. Complications included 1 poor cosmetic result and 4 cerebrospinal fluid (CSF) leaks. Of the 4 patients with CSF leaks, 2 required operative wound revision, and 1 required ventriculoperitoneal shunting for hydrocephalus. Conclusion: Cyanoacrylate skin adhesive is a viable means of obtaining cosmetic wound closure. Its use requires attention to proper skin approximation and hemostasis. In our experience, propensity for CSF leakage especially in reoperative procedures is a relative contraindication.

Glue Instead of Stitches: A Minor Change of the Operative Technique with a Serious Impact on the Shunt Infection Rate

“…It is therefore particularly advantageous in such cases to close the upper layer of the skin with a tissue adhesive. This result contrasts with the previous recommendations from another prospective analysis of wound closure with octylcyanoacrylate tissue adhesive (9) in pediatric neurosurgical procedures (10). In sutured wounds, however, the fiber can act as a wick.…”

2-Octyl-cyanoacrylate for wound closure in cervical and lumbar spinal surgery

“…Wang et al have described the first clinical use of 2-octyl-cyanoacrylate for wound closure in neurosurgical procedures in paediatric neurosurgery [36]. …”

“…Since we limited our study to the use of 2-octyl-cyanoacrylate in spinal surgical procedures, we cannot make a statement on its use in other neurosurgical procedures. However, good results have been reported in paediatric neurosurgery and craniotomy or craniectomy [6, 36]. Further studies are needed to make clear statements on the use of 2-octyl-cyanoacrylate in cranial neurosurgical procedures compared to standard suture skin closure.…”

Use of skin glue versus traditional wound closure methods in brain surgery: A prospective, randomized, controlled study

“…9,10 CNA skin adhesive is increasingly being used in other surgical specialties such the trauma and emergency departments, as well as the pediatric, gynecology and general surgery departments. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] However, their use in neurosurgical wounds, where the thickness of the skin is greater, and where there has been a violation of the underlying structures (muscle, bone and dura mater), is a relatively new procedure. Our results, although limited because of the small number of patients involved in combination with the fact that only supratentorial wounds were considered, seem to demonstrate that the NCA used here is clinically effective and safe for the closure of cranial wounds.…”