Type IV Hypersensitivity Reaction to Dermabond (2-Octyl Cyanoacrylate) in Plastic Surgical Patients: A Retrospective Study.

Background: The Dermabond (2-octyl cyanoacrylate) is a commonly used skin adhesive in plastic surgery. There are some reports in the literature regarding Dermabond associated contact dermatitis. In this retrospective cohort study, we evaluated the incidence and characteristics of contact dermatitis (type IV hypersensitivity reaction) post application of Dermabond (Trade name PRINEO manufactured by ETHICON) in patients who underwent plastic surgical breast procedures in our hospital. Methods: Sixty patients had undergone plastic surgical breast procedures (mastopexy and reduction mammoplasty) with Dermabond application over the period of last 3 years in our hospital. The records of these 60 patients were studied retrospectively. Results: Four patients (6.6%) out of the 60 patients taken for study had developed type IV hypersensitivity reaction to Dermabond. All of these patients presented with pruritus and skin rash in the second week of their post-operative period and none of them had any known past allergic history. Conclusion: We conclude that the incidence of type IV hypersensitivity allergic reaction post application of Dermabond (2-octyl cyanoacrylate) is significantly high and its possibility should be explained to the patients prior to its application.

Historique: Le Dermabond (2-octyl cyanoacrylate) est un adhésif cutané courant en plasturgie. Certaines publications traitent de la dermatite de contact associée au Dermabond. Dans cette étude rétrospective par cohorte, les auteurs ont évalué l'incidence et les caractéristiques de la dermatite de contact (réaction d'hypersensibilité de type IV) après l'application de Dermabond (marque de commerce PRINEO; fabriqué par ETHICON) chez des patientes qui ont subi des plasturgies mammaires à l'hôpital des chercheurs. Méthodologie: Les chercheurs ont fait l'examen rétrospectif des dossiers de 60 patientes qui ont subi des plasturgies mammaires (mammoplastie Mastopexy et Reduction) liées à l'application de Dermabond dans les trois années précédentes à l'hôpital des chercheurs. Résultats: Quatre patientes (6,6%) sur les 60 à l'étude ont fait une réaction d'hypersensibilité de type IV au Dermabond. Elles ont toutes présenté un prurit et une éruption dans la deuxième semaine suivant leur opération; aucune n'avait d'antécédents d'allergie connus. Conclusion: Les chercheurs concluent que l'incidence de réaction allergique d'hypersensibilité de type IV après l'application de Dermabond (2-octyl cyanoacrylate) est assez élevée et qu'il faut en expliquer la possibilité aux patientes avant de l'utiliser.

Evaluation of transversus abdominis plane (TAP) block in lipoabdominoplasty surgical procedure: a comparative study.

BACKGROUND: The transversus abdominis plane (TAP) block is a well-known regional nerve block, used for the pain control in various surgeries. There are only few studies in the literature, which have evaluated analgesic efficacy of TAP block in Abdominoplasty; A surgery in which post-operative pain is of major concern for both patient and operating surgeon. OBJECTIVES: We conducted randomized control trial, to assess the efficacy of ultrasound-guided bilateral TAP block in Abdominoplasty patients for controlling post-operative pain. METHODS: Sixty patients planned for lipoabdominoplasty were randomly assigned to two groups A and B, with thirty Patients in each group. The ultrasound guided TAP block was administered in group A patients whereas no block was administered to group B. The patients in two groups were compared for demographic characteristics, pain intensity on mobilization, opioid consumption, time to first rescue analgesic dosage and nausea- vomiting incidences. RESULTS: The demographic characteristics were similar in both groups. The Group A Patients required significantly smaller mean dose of opioids and had significantly longer mean time of first request for analgesic medication. The Median VAS score on mobilization in Group A was significantly lower than Group B. Only few patients in group A experienced nausea-vomiting compared to group B. CONCLUSIONS: The ultrasound guided TAP block provides effective analgesia after Lipoabdominoplasty, which allows more convenient early post-operative mobilization and decreases opioid requirement as well as its related side-effects. Hence we suggest that ultrasound guided TAP block should be considered in most lipoabdominoplasty cases for better patient experience.

Silicone Foley's catheter as an effective alternative to Hunter's rod in staged flexor tendon reconstruction of the hand.

CONTEXT: Staged flexor tendon reconstruction is most suitable treatment method for extensive zone II tendon injuries. The Hunter's rod used in this procedure is costly and not easily available, which adds to the miseries of both patients as well as treating surgeon. AIMS: The aim of this study is to evaluate the results of staged zone II flexor tendon repair using silicone Foley's catheter as a cheaper and readily available alternative to Hunter's rod. SETTINGS AND DESIGN: This was a prospective study. MATERIALS AND METHODS: Seventy digits in 35 patients were treated by the staged flexor tendon reconstruction using silicone Foley's catheter in place of Hunter's rod, and the patients were followed for an average period of 18 months. Early controlled motion exercise protocol was instituted in all cases. RESULTS: As per the Strickland scale, total active motion obtained was excellent in 70%, good in 20%, fair in 7.1% and poor in 2.9% of patients. CONCLUSIONS: Silicone Foley's catheter is cheaper, easily available and an effective alternative to Hunter's rod in staged flexor tendon reconstruction procedure, yielding high rates of excellent and good results with fewer complications.