Allergic Contact Dermatitis to Dermabond Prineo After Elective Orthopedic Surgery

Abstract

The Dermabond Prineo skin closure system (Ethicon, Somerville, New Jersey) is a wound closure device that combines a 2-octyl cyanoacrylate liquid adhesive and a self-adhesive polyester mesh. Although cyanoacrylates traditionally have been associated with low rates of sensitization, allergic contact dermatitis (ACD) to Dermabond products is being increasingly reported after orthopedic surgery. The authors describe the first case series of ACD to Dermabond Prineo where patch testing confirmed the diagnosis in all patients. Six patients who had suspected Dermabond Prineo ACD after lower limb orthopedic surgery were assessed. Of these patients, 5 had itching within 4 days of surgery and rash within 5 days. All 5 of these patients reported previous exposure to Dermabond products. All patients had removal of the adhesive and mesh earlier than planned and were treated with corticosteroids. In addition, 4 patients received systemic antibiotics; however, only 1 had a microbiologically confirmed superficial skin infection. In all patients, the dermatitis resolved within 2 weeks of dressing removal, with no adverse effect on the orthopedic outcome. Patch testing showed positive reactions to Dermabond Prineo glue for all patients. Orthopedic surgeons should be aware of the potential for ACD to Dermabond Prineo, especially among patients with previous exposure to Dermabond products. The authors discuss the risk factors for ACD to Dermabond Prineo in the orthopedic cohort and provide recommendations for prevention and management. [ Orthopedics . 2020;43(6):e515–e522.]

Comparison of 2-octyl cyanoacrylate skin adhesive and interrupted polypropylene sutures for wound closure in total ankle arthroplasty

“…However, it has been frequently reported that the constituents of Dermabond Prineo induce allergic reactions. These can lead to ACD or wound dehiscence and can cause critical complications such as deep SSI [ 10 , 25 , 27 – 29 , 34 – 37 , 39 – 42 ]. ACD is more likely to develop when the skin is in prolonged contact with the allergen or when the amount of allergen is high [ 36 , 37 , 39 ].…”

“…There is still no established method for the prophylaxis of ACD after the use of Dermabond Prineo. According to previous reports, patch testing for Dermabond Prineo glue or polyester mesh has been known to be useful to identify the patient who may have allergenic reactions postoperatively [ 29 ]. Bulky occlusive dressings after TAA can increase the absorption of allergens, and water or a humid environment can cause depolymerization to create a strong sensitizer, a monomer.…”

“…The wound complications were subdivided into allergic contact dermatitis (ACD), wound dehiscence, and surgical site infection (SSI). The appearance of an eczematous eruption or blister at the suture area or the area where the skin adhesive mesh was attached was classified as ACD [ 29 ]. The wound dehiscence is defined as a partial or total separation of previously approximated wound edges due to a failure of proper wound healing [ 30 ].…”

“…Despite these advantages and convenience in use, several recent studies have reported complications associated with its use; these are being increasingly reported as the use of the material has steadily increased. Most of these studies have highlighted concerns like allergic reactions following the use of Dermabond Prineo [ 10 , 24 – 29 ]. This reaction is similar to postoperative infection and is difficult to distinguish; additionally, reaction symptoms are known to vary from mild to severe.…”

Post‐operative rashes in the orthopaedic ward caused by allergic contact dermatitis to Dermabond Prineo

“…We recently reported a case series of ACD to Dermabond ® Prineo ® from Perth, where all six cases were patch tested, confirming the diagnosis of ACD to Dermabond Prineo ® . 3 Four had prior exposure to Dermabond ® Prineo ® , one to Dermabond ® liquid adhesive and one had no known exposure to Dermabond ® products. In our series, ACD sometimes caused prolonged hospitalization It is imperative to convey to all healthcare professionals using Dermabond ® Prineo ® that development of ACD may occur following its use, particularly in patients who have been exposed to it before.…”