Medical Adhesive-Related Skin Injury Associated with Surgical Wound Dressing among Spinal Surgery Patients: A Cross-Sectional Study

Abstract

The aim of this cross-sectional study was to determine the incidence, types, and factors associated with medical adhesive-related skin injuries (MARSIs) among spinal surgery patients. Adult patients who underwent planned spinal surgery under general anesthesia at a tertiary hospital in Seoul, Korea were enrolled. Data were collected from March through April 2019. Skins under surgical wound dressings were evaluated for MARSI once every morning until discharge. Skin injuries lasting for 30 min or more were considered as MARSIs. Logistic regression was performed to identify factors associated with MARSI. The incidence of MARSIs in surgical areas was 36.4% and the rate per 100 medical adhesives was 9.8%. All MARSIs occurred on postoperative day 1 or 2. A history of contact dermatitis (OR = 10.517, 95% CI = 3.540–31.241, p < 0.001) and late ambulation (OR = 1.053, 95% CI = 1.012–1.095, p = 0.010) were identified as risk factors for MARSI. Spinal surgery patients were at high risk of MARSIs associated with surgical wound dressings. Patients with a history of contact dermatitis or prolonged bed rest periods need more active skin assessment and more careful skin care to prevent MARSIs after spinal surgery.

The Science of Skin: Measuring Damage and Assessing Risk

“…Finally, a history of contact dermatitis and longer time to ambulation after surgery are also factors affecting the risk for MARSI. 11 …”

“… Examples of reported prevalence or incidence of MARSI in the literature, in percent of patients affected. Sources (from top to bottom ): Wang et al 10 ; Kim and Shin 11 ; Schwartz Sellaeg et al 12 ; Zhao et al 13 ; Alcantara et al, 14 ; Polatsch et al 15 ; Zhao et al, 16 ; de Oliveira Marcatto et al 17 ; White et al 18 ; Konya et al 19 ; McLane et al 20 ; Farris et al 21 ; Jester et al 22 ; Gao et al 23 ; Ratliff 24 ; Koyano et al 25 ; Sanada et al 26 MARSI, medical adhesive-related skin injury. …”

A Novel No Foil-to-Skin Contact Technique for Vacuum-assisted Wound Closure in Patients with Sensitive Skin

“…Particular attention is paid to the proper risk evaluation before the use of adhesives and skin protection. 9–11…”

“…Particular attention is paid to the proper risk evaluation before the use of adhesives and skin protection. [9][10][11] In patients undergoing vacuum-assisted wound therapy, MARSI occurs because of at least two reasons: (1) skin contact to the adhesive substances of the fixation films and (2) excessive accumulation of fluids under the adhesive films. The adhesive drapes contain often acrylic or silicone compounds, which can cause allergic/irritative skin reactions.…”

“…When adhesive drapes are removed, superficial cutaneous lesions may occur. 8,10,12 There are several strategies for the prevention of MARSI. The guidelines for primary and secondary prevention include selection of suitable patients and appropriate wound products, the use of skin barriers and means for harmless removal of the adhesive drapes, adequate education of health-care professionals and patients, etc.…”