Should We Stick With Surgical Glues?

The Incidence of Dermatitis after 2-Octyl Cyanoacrylate Exposure in 102 Consecutive Breast Cases

Lauren C. Nigro, M.D.; Jamie Parkerson, B.F.A., M.S.; Julia Nunley, M.D.; Nadia Blanchet, M.D.

Disclosures

Plast Reconstr Surg. 2020;145(1):32-37. 

In This Article

Abstract and Introduction

Abstract

Summary: Skin adhesives have become standard in wound closure as alternatives to traditional sutures or as sterile occlusive dressings after surgery of all types. The literature is replete with case reports of contact dermatitis following exposure to cyanoacrylate-based adhesives, such as 2-octyl cyanoacrylate. Nonetheless, it has been the impression of the senior author and others that the incidence of allergic and/or contact dermatitis is much higher than commonly considered. The authors prospectively studied 102 consecutive patients who underwent breast surgery performed by the senior author with 2-octyl cyanoacrylate placed over incisions as an occlusive dressing. Two patients with a known glue allergy did not receive cyanoacrylate at surgery but were scratch tested to confirm the diagnosis. All patients were followed postoperatively. Twelve patients went on to develop significant dermatitis postoperatively after glue placement. Cyanoacrylate was confirmed as the cause of all rashes by allergy scratch testing for a total incidence of 14 percent (14 patients). Given the popularity of cyanoacrylate products across emergency rooms, clinics, and operating rooms, awareness of the true incidence of these reactions may caution against their use in the future.

Clinical Question/Level Of Evidence: Therapeutic, IV.

Introduction

Cyanoacrylate glues are often used as dressings or as alternatives to traditional sutures in wound closure. These glues are reported to improve wound strength, provide an antibacterial barrier to skin pathogens, decrease operative time, negate the need for suture removal, and improve scar aesthetics.[1–5] Nonetheless, they are not without risk. Reactions to commonly used surgical adhesives have been previously described in numerous case reports, often presenting as erythematous, pruritic dermatitis occasionally lasting up to several months following surgery.[6–24] Recent studies found an incidence of contact dermatitis as high as 7 percent among patients exposed to Dermabond (Ethicon, Inc., Somerville, N.J). We hypothesized that the incidence of surgical adhesive reactions is higher than previously reported, particularly among patients with prior exposures.[10,14,25]

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