Aesthetic outcome of intermediate closure versus intermediate closure followed by 2-octyl cyanoacrylate: A randomized evaluator-blinded split-wound comparative effectiveness trial.

BACKGROUND: Dermatologic surgeons are increasingly using surgical adhesives in their practice. Studies comparing sutured wounds to those that utilize a combination of suturing and skin adhesive have not been previously conducted. OBJECTIVE: To compare the cosmetic outcome and patient wound care satisfaction of an intermediate suture closure with an intermediate suture closure followed by the application of 2-octyl cyanoacrylate (2-OCA). METHODS: Fifty patients were enrolled in a randomized, evaluator-blinded, split-scar study. Following intermediate sutured closure of a surgical defect, one side of the wound was randomized to receive an additional application of 2-OCA. After 3 months, the scar was assessed using the POSAS tool and patients reported wound care preferences. RESULTS: As the primary outcome measure, the mean sum of observer POSAS was 12.80 for sutured closure alone versus 12.40 for sutured closures followed by 2-OCA (P = .49). LIMITATIONS: Single-center study of a relatively homogenous population. CONCLUSION: Although there were no significant differences in scar cosmesis, both patients and observers tended to prefer the side with an additional application of 2-OCA in most POSAS components, in overall opinion, and in patient wound care satisfaction. Dermatologic surgeons may add this to their practice without sacrificing scar outcomes or patient satisfaction.

Comparison of 2-octyl cyanoacrylate with polyester mesh with standard suture and staples in total knee and hip arthroplasty.

OBJECTIVE: The use of 2-octyl cyanoacrylate with polyester mesh (OCA-M) has become common in total hip and knee arthroplasty (THA, TKA). We aimed to compare the safety and cosmetic outcomes between OCA-M and standard suture techniques and staples, and determine whether OCA-M can safely be used for TKA. METHOD: Inclusion criteria were patients who underwent THA or TKA from January 2010 to October 2011 (Suture group), November 2011 to August 2013 (Staple group), March 2017 to September 2018 (OCA-M group). Exclusion criteria was loss of imaging data. Complications during hospitalisation (early complication) and after discharge (late complication) were compared in groups. Plastic and orthopaedic surgeons performed cosmetic evaluations with the modified Vancouver Scar Scale (VSS) and Likert scale at three and six months postoperatively and compared in groups. RESULTS: A total of 249 arthroplasties (suture group=88 patients; staple group=94 patients; OCA-M group=67 patients) were included in the study. The OCA-M group had a significantly lower early complication rate than the suture group (p=0.015). For THA, the OCA-M group had a significantly lower total complication rate than the suture group (p=0.048). For TKA, there was no significant difference among the three groups. The complication rate in the OCA-M group showed no significant difference between THA/TKA. With regards to the VSS, the OCA-M group was significantly better for cosmetic qualities than the suture group (p=<0.001, p=0.021 at three and six months, respectively). For the Likert scale, the OCA-M group was also significantly better for cosmetic qualities than the suture group and staple group (suture-OCA-M, p=0.003 (three months), p=<0.001 (six months); staple-OCA-M, p=0.027 (three months)). CONCLUSION: In this study, the OCA-M complication rate was low compared to suturing and similar to stapling. Moreover, better cosmetic outcomes were achieved compared to suturing and stapling.

Allergic contact dermatitis due to the liquid skin adhesive Dermabond® predominantly occurs after the first exposure.

BACKGROUND: The clinical characteristics of patients with allergic contact dermatitis (ACD) due to a skin adhesive containing 2-octyl cyanoacrylate, Dermabond®, have not yet been elucidated. OBJECTIVE: To investigate the clinical characteristics of patients with ACD caused by Dermabond® application. METHODS: In this retrospective study, 577 patch tested patients were included. We identified patients with positive patch test results for Dermabond® and evaluated their results concerning (meth)acrylates and ethyl cyanoacrylate adhesive. RESULTS: Nine patients had positive patch test results to Dermabond®; six had developed secondary generalization.The mean time between Dermabond® application and ACD onset was 34 days (range, 27-44) in six patients with ACD after the first use, whereas, in the other three patients, it was 5.6 days (range, 4-8) after the second use. The time was significantly different between the two groups (P < .01). Positive reactions to ethyl cyanoacrylate adhesive (Aron Alpha) occurred in seven of nine patients, to ethyl cyanoacrylate 10% pet. in four of eight patients tested, and to 2-hydroxyethyl methacrylate in one of eight patients tested. CONCLUSIONS: Dermabond®-induced ACD is apparently characterized by a high prevalence of primary sensitization at first exposure to Dermabond®, secondary generalization is frequent, and most patients show cross-reactivity to ethyl cyanoacrylate.

2-Octyl Cyanoacrylate Topical Adhesive as an Alternative to Subcuticular Suture for Skin Closure After Total Knee Arthroplasty: A Randomized Controlled Trial in the Same Patient.

BACKGROUND: The 2-octyl cyanoacrylate topical adhesive with flexible self-adhesive polyester mesh (Dermabond Prineo) is becoming widely used in many surgical fields. However, no prior studies have tested the efficacy and safety of this topical adhesive compared with subcuticular suture in the same patient. The purpose of this study was to compare the efficacy and safety between Dermabond Prineo and subcuticular suture for skin closure in patients undergoing same-day bilateral total knee arthroplasties (TKAs). MATERIALS AND METHODS: A prospective, double-blind randomized controlled trial was performed in 51 patients scheduled to undergo same-day bilateral TKAs. One knee was randomly assigned to the Dermabond Prineo and the other knee was allocated to the subcuticular suture. As primary outcomes, Vancouver scar scale was evaluated at 6 months and Patient and Observer Scar Assessment Scale was evaluated at 2 weeks, 6 weeks, 3 months, and 6 months. Secondary outcomes included cosmesis efficacy (Hollander wound evaluation scale [HWES] and cosmesis visual analog scale [VAS]), time and pain efficiency (skin suture time, stitch out time, and stitch out pain VAS), and safety (wound complications during the 6-month follow-up period). The primary and secondary outcome measures were compared between groups. RESULTS: There were no significant differences in Vancouver scar scale and Patient and Observer Scar Assessment Scale at 6 months. Although there were no significant differences in HWES at 2 weeks, the Dermabond Prineo group showed better step-off border item of HWES. There was also no difference in cosmesis VAS at 6 months. The Dermabond Prineo group showed superior results in terms of time (suture time: Dermabond Prineo = 191 second (sec) ± 60.1 sec, subcuticular suture = 356.8 sec ± 92.3 sec; stitch out time: Dermabond Prineo = 4 sec ± 1.3 sec, subcuticular suture = 26.6 sec ± 4.2 sec, all P < .001) without significant differences in pain scale (P = .823) or wound complications (all P > .05). CONCLUSION: Comparing cosmetic efficacy, time efficiency, and safety, Dermabond Prineo provided quicker wound closure, shorter stitch out time, and better wound margin coaptation in the early postoperative period but similar cosmetic efficacy compared with subcuticular suture. Based on our study, Dermabond Prineo is a useful alternative to subcuticular suture in patients undergoing TKA. LEVEL OF EVIDENCE: Therapeutic level 1.

Skin closure with 2-octyl cyanoacrylate and polyester mesh after primary total knee arthroplasty offers superior cosmetic outcomes and patient satisfaction compared to staples: a prospective trial.

INTRODUCTION: The goals of this study were to compare patient satisfaction and wound-related complications in patients receiving 2-octyl cyanoacrylate (glue) and polyester mesh for skin closure after primary total knee arthroplasty (TKA) versus staples. METHODS: A total of 60 knees in 54 patients undergoing TKA were enrolled in a prospective trial and randomized to receive either skin closure with glue and polyester mesh (n = 30) or a control group closed with staples (n = 30). Hollander wound cosmesis score (measured on a scale of 0-5, with 0 being the best) and visual analog scale (VAS) scores (range 0-100 mm) for patient satisfaction with wound cosmesis, as well as wound-related readmission, reoperation, and complications, including superficial surgical site infection, wound dehiscence, wound hematoma, stitch abscess, and wound discharge, were assessed at 6 weeks and 90 days after TKA. Baseline characteristics were not statistically significantly different between the groups (p > 0.05). RESULTS: At 6 weeks and 90 days, the Hollander wound cosmesis score was significantly lower (p < 0.01) in the glue and polyester mesh groups. Similarly, at 6 weeks and 90 days, the VAS for patient satisfaction with wound cosmesis was significantly higher (p < 0.01) in the glue and polyester mesh groups. The rate of superficial surgical site infection was 1/30 (3%) in glue and polyester mesh groups versus zero in the control group (p = 1.00). The rate of wound dehiscence was 1/30 (3%) in glue and polyester mesh groups versus zero in the control group (p = 1.00). CONCLUSION: These results suggest that glue and polyester mesh closure may offer superior cosmetic outcomes to staples for skin closure in TKA.

Economic and clinical comparison of 2-octyl cyanoacrylate/polymer mesh tape with skin staples in total knee replacement.

OBJECTIVE: To compare economic and clinical outcomes between skin staples and 2-octyl cyanoacrylate plus polymer mesh tape, Dermabond Prineo skin closure system, (SCS) among patients undergoing total knee replacement (TKR). METHOD: Retrospective, observational study using the Premier Healthcare Database, which comprises hospital administrative and billing data for over 700 hospitals in the US. Patients selected for study had an elective hospital admission, with discharge occurring between January 2012 and September 2015, carrying primary ICD-9-CM procedure and diagnosis codes for TKR and osteoarthritis. Patients were classified into two mutually-exclusive groups based on billing records during the index admission: those with billing record(s) for the skin closure system (SCS group); and those with billing record(s) for skin staples (staple group). Primary outcomes were index admission's length of stay (LOS), total hospital costs, and discharge status (skilled nursing facility (SNF)/other versus home/home health-care); exploratory outcomes included operating room time (ORT) during index admission and 30, 60, and 90-day readmissions. The SCS and staple groups were propensity score matched (1:1/nearest neighbour/caliper=0.10) on patient, hospital, and provider characteristics. Multivariable regressions accounting for hospital-level clustering after matching were used to compare outcomes between study groups. RESULTS: Each group comprised 971 patients (1942 total patients; mean age: 65.3 years; female: 63.5%). The groups were generally well-balanced on matching covariates: mean standardised difference calculated across 49 covariates=0.049. Compared with the staple group, the SCS group had statistically significant shorter LOS (2.8 days versus 3.2 days, p=0.002), lower rate of discharge to SNF/other versus home/home health-care (26.4% versus 38.5%, p=0.011), and lower rate of 30, 60, and 90-day readmissions (30-day, 1.8% versus 4.4%, p=0.006; 60-day, 3.0% versus 5.4%, p<0.001; 90-day, 5.4% versus 7.4%, p=0.016). Differences between the groups for other outcomes were not statistically significant. CONCLUSION: Among patients undergoing TKR, use of the SCS was associated with shorter LOS, less resource intensive discharge status, and lower rates of all-cause readmission as compared with skin staples.

Friction Blisters on the Hands Treated Successfully Using 2-Octyl Cyanoacrylate: A Case Report.

BACKGROUND: Friction blisters on the hand are challenging to treat as conventional dressings are prone to saturation, contamination, and loosening with active hand use and other mechanical stresses. Alternative methods and materials for dressing hand blisters warrant exploration. CASE SUMMARY: A 48-year-old male surgeon presented with friction blisters over his bilateral thumbs. The patient complained of significant difficulty in keeping his dressings clean and dry, significant pain with hand hygiene, and functional limitations at work. The patient's blisters were dressed with 2-octyl cyanoacrylate (Dermabond; Ethicon US LLC, Somerville, New Jersey), applied directly onto the wound bed. The patient was able to perform his normal duties immediately, without the need for additional intervention. Six days postapplication, the Dermabond sloughed off, revealing an epithelialized surface. CONCLUSION: Dermabond is a promising agent for dressing unroofed blisters of the hand, as it provides a barrier to moisture and contamination, while allowing the wound to epithelialize, without functional cost.

PEG-Biscyanoacrylate Crosslinker for Octyl Cyanoacrylate Bioadhesive.

PEG400 (polyethylene glycol, MW 400) biscyanoacrylate is synthesized and copolymerized with 2-octyl cyanoacrylate for potential use as bioadhesive. PEG400 biscyanoacrylate is synthesized from the esterification of anthracenyl cyanoacrylic acid where the anthracene unit serves as vinyl-protecting group. Copolymerization increases the plasticity, mechanical strength, and resilience of the resulted polymer as determined by dynamic mechanical analysis. Peeling test confirms its superior bioadhesive properties. Surface morphology is characterized by SEM imaging. The formulations are cytocompatible and safe. This cyanoacrylate composition may provide improved bioadhesive cyanoacrylates.

Introduction of 2-octyl cyanoacrylate (Dermabond®) for incisional hernia mesh repair.

PURPOSE: We developed a new technique, sutureless mesh fixation, using 2-octyl cyanoacrylate (Dermabond®, a surgical tissue adhesive) for incisional hernia repair. The objective of this article is to introduce the new technique and to examine whether the technique provides sufficient resistance to abdominal pressure. METHODS: We conducted two tests using a porcine model, a traction experiment and artificial pneumoperitoneum test. In the traction experiment, the adherence properties of Dermabond® with mesh and peritoneum were examined using a tissue fragment from a pig. In the artificial pneumoperitoneum test, which used an incisional hernia porcine model, mesh was implanted on the peritoneum in the abdominal cavity with Dermabond®. It was then determined whether sutureless mesh fixation could bear artificial abdominal air pressure. RESULTS: In the traction experiment, Dermabond®, which bonded the mesh to the peritoneum, tolerated pressure up to 2.45 × 103 mmHg. In the artificial pneumoperitoneum test, the mesh was strongly fastened to the peritoneum by means of only Dermabond®, and there was little air circulation even without closing the wound over the mesh. CONCLUSIONS: Sutureless mesh fixation with Dermabond® is technically feasible and promises to provide sufficient resistance to abdominal pressure.

Systematic review of cyanoacrylate embolization for refractory gastrointestinal fistulae: a promising therapy.

BACKGROUND: Surgical management of gastrointestinal fistulae has been reported to carry a 30-day morbidity rate up to 82% and a mortality rate ranging from 2% to 4.8%; thus nonoperative alternatives are required. The aim of the present study was to assess the current experience on the use of cyanoacrylates in the management of these fistulae. METHODS: A systematic review was carried out on Medline, Embase, The Cochrane database, Academic Search Complete, MedicLatina, and SciELO for English, Spanish, and Portuguese articles dealing with refractory fistulae by means of cyanoacrylate embolization therapy. Publication dates were restricted from 1969 to present. Outcome parameters were study design, number of participants, etiology of the fistula, approach, material used, success rate, complications, and mortality. RESULTS: Electronic search yielded a total of 377 articles. After a meticulous screening, only 14 studies dealing with foregut/midgut fistulae and 6 addressing hindgut fistulae were included. All the included articles were prospective and retrospective case series. Cumulative success rate was 81% (range 0% to 100%) and 3 out of 203 patients (1%) developed minor complications. CONCLUSION: Cyanoacrylate embolization of nearly all types of refractory gastrointestinal fistulae is a feasible and harmless technique. Prospective controlled studies are required to support the available evidence.

A comparison of 2-octyl cyanoacrylate with nylon for wound closure of knee arthroscopy portals.

OBJECTIVE: To compare the cosmetic results, complications and patient satisfaction of 2-octyl cyanoacrylate (Dermabond, Ethicon Inc. Somerville, NJ, USA), a liquid bonding agent, with 3-0 nylon sutures (Ethilon, Ethicon Inc) skin closure in two groups of patients undergoing elective knee arthroscopy at 6 weeks. METHOD: The retrospective clinical audit recruited patients undergoing knee surgery for the first time between October 2010 and August 2011. The patients were either treated with the liquid bonding agent or nylon sutures. The patients in the bonding agent group were allowed to shower as normal on postoperative day one, while patients in the suture group kept their wounds dry for 2 weeks. RESULTS: Between the two groups (40 patients per group) there was no difference in the cosmetic outcome (p=0.285), patient satisfaction (p=0.29), pain scores (p=0.44) or wound complication rate (p<0.05). Patient satisfaction was high in both groups. Furthermore, 83.75% of all patients indicated they would prefer the liquid bonding closure over nylon sutures if undergoing the same procedure in the future as they could shower the next day and avoid suture removal. CONCLUSION: 2-octyl cyanoacrylate is safe to use in the short term in knee arthroscopy providing comparable results to nylon suture closure. Allowing patients to shower the next day appears to cause no adverse effects. DECLARATION OF INTEREST: The authors would like to state that they do not have any economic or social interest in any of the products used or mentioned. No grant or finance was received for this study, nor any input from other sources.

Histological effects of occlusive dressing on healing of incisional skin wounds.

Occlusive dressing is widely accepted and used to manage skin ulcers. However, with respect to its application to incisional wounds, most studies have been conducted about the clinical effects on incisional healing of surgical sites. Studies of the histological effects of occlusive dressing for incisional wounds have been few. The aim of this study was to clarify the histological effects of occlusive dressings on healing of incisional skin wounds. Rat dorsal skin was incised down to the panniculus and sutured immediately. Dressing types included 2-octyl cyanoacrylate and hydrocolloid materials as occlusive dressings and no-dressing as the open therapy. Histological examination and dermoscopic observation were performed 1, 2, 4 and 7 days after surgery. The findings from each dressing type were compared. In the open therapy group, the upper portion of the edge of incision was necrosed minimally and finally healed with wide scar formation. However, in the occlusive dressing groups, micronecrosis of the incision edge seen in the no-dressing group was not observed, healing was more rapid and the remaining scar was finer. Occlusive dressing can prevent micronecrosis of the incision edge, resulting in rapid and excellent healing. This study shows that the efficacy of and supports the use of occlusive dressing in incisional wound management.

A Comparison between 2-Octyl Cyanoacrylate and Conventional Suturing for the Closure of Epiblepharon Incision Wounds in Children: A Retrospective Case-Control Study.

Background: Tissue adhesive has been widely used in ophthalmic surgery for various procedures, proving both effective and safe. However, no studies have compared the surgical efficacy of the tissue adhesive 2-octyl cyanoacrylate (SurgiSeal®) to that of traditional suture closure in Asian children undergoing surgery for lower lid epiblepharon. Methods: This is a single-center retrospective case-control study. Surgical correction for epiblepharon was performed on 22 patients from November 2019 to May 2023. A total of 20 patients who were followed up for at least 1 month were included for analysis. After standardized epiblepharon surgery, group A underwent wound closure with a subcuticular suture and 2-octyl cyanoacrylate, and group B underwent closure with a 6-O fast-absorbing surgical gut suture. Patients were followed up at 1, 4, and 12 weeks post-surgery. Results: A total of 10 patients (20 eyes) underwent skin closure with tissue adhesives (group A), and 10 patients (18 eyes) underwent wound closure using conventional suture material (group B). No significant differences in the sex ratio, mean age at operation, pre- and postoperative best-corrected visual acuity (BCVA), or average surgical time were observed between groups. Both groups exhibited improved postoperative BCVA, with symptom relief and a significant decrease in the severity of keratopathy after surgery. Neither recurrence nor complications were reported during follow-up. The aesthetic results were similar between groups, while caregivers of children in the tissue adhesive group expressed high satisfaction regarding the ease of postoperative care. Conclusions: Successful closure of lower lid epiblepharon surgery wounds in children can be performed using 2-octyl cyanoacrylate (SurgiSeal®). This method is simple, safe, and effective when compared to conventional sutures.

An in Vitro Evaluation of the 14-Day Microbial Barrier Property of Exofin High Viscosity Topical Skin Adhesive.

Background: Wound closure is a critical aspect of medical care, and the choice of closure methods plays a pivotal role in preventing infections. Traditional sutures and staples can introduce foreign material into the wound, increasing the risk of infection. Adhesives offer a potential alternative by providing a physical barrier against microorganisms. Objective: To assess the microbial barrier properties of Exofin High Viscosity Topical Skin Adhesive (HVTSA), a novel adhesive system, against a range of challenge organisms. Methods: This study, conducted by the independent research organization NAMSA (North American Science Associates, LLC), aimed to evaluate the effectiveness of Exofin HVTSA as a microbial barrier. This study was carried out by an independent research organization NAMSA. Challenge organisms, including Staphylococcus aureus, Staphylococcus epidermidis, methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Escherichia coli, Candida albicans, and Aspergillus brasiliensis, were used to evaluate the adhesive's effectiveness. Inocula of each organism were placed on cured Exofin HVTSA test articles and observed for 14 days. Positive and negative control plates were included to validate the effectiveness of the challenge organisms and assess the absence of contamination. Results: Exofin HVTSA demonstrated effective microbial barrier properties against all challenge organisms, except Pseudomonas aeruginosa. No growth or color change was observed for Staphylococcus aureus, Staphylococcus epidermidis, MRSA, Escherichia coli, Candida albicans, and Aspergillus brasiliensis over the 14-day observation period. Pseudomonas aeruginosa exhibited no growth, but showed a color change in two out of five replicates on day 14. Conclusion: Exofin HVTSA demonstrated effective microbial barrier properties for 14 days against a range of common wound pathogens, suggesting its potential as a safe and effective alternative to traditional wound closure methods. Further research is warranted to investigate its efficacy in clinical settings.

Pediatric tongue laceration repair using 2-octyl cyanoacrylate (dermabond(®)).

BACKGROUND: Tongue lacerations provide a challenge for emergency physicians, especially in the case of pediatric patients. Traditional wound closure typically involves local anesthesia or procedural sedation in children, which is time consuming and often anxiety provoking for providers, patients, and parents. 2-Octyl cyanoacrylate (Dermabond(®); Ethicon, Inc., Sommerville, NJ) has been used in the context of the emergency department for successful repair of lacerations, however, is not marketed for use on mucosal or intraoral surfaces. This case report describes an alternative manner of tongue laceration repair by the use of 2-octyl cyanoacrylate. OBJECTIVE: 2-Octyl cyanoacrylate is generally not indicated for intraoral use. Our case demonstrates a situation in which it was used safely and effectively to repair a tongue laceration. CASE REPORT: A 7-year-old boy presented to the emergency department after sustaining a large tongue laceration requiring repair. The boy's parent refused traditional wound repair with suturing due to concerns regarding the pain of local anesthesia administration, as well as risks posed by procedural sedation. The wound was repaired using the tissue adhesive 2-octyl cyanoacrylate. The patient tolerated the procedure well and there were no complications in the patient's course. Good cosmetic results were achieved using this method. CONCLUSIONS: Tongue lacerations and other intraoral lacerations are challenging to repair, especially in pediatric patients. The use of tissue adhesives such as 2-octyl cyanoacrylate is very likely safe and may provide an expedient manner in which to repair such lesions with good cosmetic results.

Antimicrobial Activity and Cytotoxicity of Prepolymer Allyl 2-cyanoacrylate and 2-Octyl Cyanoacrylate Mixture Adhesives for Topical Wound Closure.

The development of a new skin adhesive that can be used inside and outside the body, which prevents infection and has fewer scars and less side effects, is currently attracting attention from the scientific community. To improve biocompatibility, prepolymer allyl 2-cyanoacrylate (PAC) and 2-octyl cyanoacrylate (OC) were mixed in various proportions and tested for their therapeutic potential as skin adhesives. A series of skin adhesive samples prepared by mixing PAC, OC, and additives with % (w/w) ratios of 100:0:0, 0:100:0, 70:0:30, 40:30:30, and 30:40:30 were tested to determine their antimicrobial activity, cell cytotoxicity, and formaldehyde release. The additives include myristic acid and dibutyl sebacate as plasticizers and butylated hydroxyanisole as an antioxidant. It was observed that the samples containing 70% PAC (PAC7) or 40% PAC (PAC4) with 30% additives had the highest antimicrobial activities against various microbial cells and no cytotoxicity regarding in vitro fibroblast cell growth. In addition, these formulations of adhesive samples released formaldehyde within the levels permitted for medical devices. Taken together, the mixture of PAC and OC as a topical skin adhesive for wound closure was found to be biocompatible, mechanically stable and safe, as well as effective for wound healing.