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

Discussion

Since its development in 1949, cyanoacrylate compounds have been used nonmedically as instant adhesives for rubber, metal, glass, plastics, and cosmetics (e.g., nail, hair, and eyelash glues). For many surgeons, the use of cyanoacrylate glues has become routine along incisions given their intrinsic bactericidal properties, watertight nature, added wound/incisional strength, and possible improved aesthetics.[1–5,28–39] Nonetheless, multiple case reports have emerged describing glue-associated dermatitis.[10,40–44] Degradation products of Dermabond (e.g., formaldehyde and cyanoacetate) can induce inflammation and/or a reaction, particularly in areas of thin skin or open wounds (i.e., incisions).[6,22]

In 2018, Nakagawa et al. retrospectively examined 100 patients who underwent breast reconstructions with cyanoacrylate application for skin closure, predominantly of the abdomen.[25] They found that seven patients (7 percent) developed contact dermatitis after exposure. Three of these patients (43 percent) developed contact dermatitis after their first exposure and four (57 percent) developed contact dermatitis following their second exposure.[25] Unlike this study, our study does not include abdominal incisions. It is possible the abdominal skin is less susceptible to allergic reaction, perhaps because of its thicker nature.[22] One might also consider cultural differences between the Nakagawa et al. study population and our study population regarding previous exposure.

This is the first prospective study documenting the prevalence of glue reaction and confirming the diagnosis by scratch testing. Scratch testing was chosen over patch testing because it more closely replicates the surgical incision.[18] Scratch testing also ruled out other possible causes of irritation and dermatitis in the surgical setting, including reaction to the surgical preparation solution, postoperative cleansers, elastic or fabric components of dressings and garments, and infection.

Multiple studies and case reports suggest that prior exposure to cyanoacrylates produces sensitization.[6,25,27,45] However, the exact role of prior glue/adhesive exposures and preexisting allergies remains unclear.[9,11,12,14,15,17,18,21,23,40–44,46–48] To further explore the hypothesis that cyanoacrylates are producing sensitization, we examined repeated exposure to cyanoacrylate as a predictor of reaction. Although our study does not demonstrate any clear correlation, further research is warranted to clarify.

Our study is limited by the use of self-reported patient data in the form of a questionnaire. In addition to our own documented repeated exposures, we asked patients to report previous glue/adhesive exposures. It is possible that not all patients remember or were aware of previous exposures, especially because many exposures may have been in a nonmedical context. Of note, many of our patients had either classic two-stage reconstructions with either tissue expanders followed by permanent implant or direct-to-implant reconstructions following nipple delay procedures. Both situations were also sometimes followed by fat grafting and/or other revisions; this led to more exposures to cyanoacrylate compared with other typical surgical patients.

Our incidence of 14 percent is notably higher than that previously reported. We believe cyanoacrylate glue use warrants a general reconsideration by surgeons and other physicians given patient morbidity including discomfort, anxiety, additional medical treatment, and potential wound healing complications associated with these dermatitides.[12] We infer that our findings are generalizable to all cyanoacrylate glues because all patients reacted to both Dermabond and LiquiBand scratch tests. These findings have changed the senior author's practice.

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