In-vitro analysis for microbial barrier properties of 2-octyl cyanoacrylate-derived wound treatment films

Sutureless versus sutured circumcision: A comparative study

Introduction:

Today is the era of “wireless” in technology and here comes era of “sutureless” in the field of surgery. Every surgeon wishes for better wound healing with better cosmesis without complications and early back to routine activities. All this is possible by use of adhesive for wound edges of circumcision is shown by us in this study. In addition, other aim was to study the efficacy, safety, functional outcome, and cosmesis of isoamyl cyanoacrylate when used as adhesive for wound edges of pediatric circumcisions.

Materials and Methods:

Group A comprised 162 pediatric patients who underwent sutureless circumcisions and Group B comprised a similar number, i.e., 162 pediatric patients who had undergone circumcision by conventional method using absorbable interrupted sutures. Comparative analysis of both the groups was done based on various parameters such as bleeding, infection, foreign body reaction, excessive swelling, and wound dehiscence. In addition, visual analog pain scoring was done after 6 h and after 12 h postoperative.

Results:

Complications were more commonly seen in sutured Group B versus sutureless circumcision-Group A. In addition, postoperative pain and need of analgesics were seen more commonly in sutured Group B patients. Wound healing and final cosmesis were far better in Group A patients.

Conclusion:

Our results show that isoamyl cyanoacrylate is comparatively safe, efficient, has better functional outcome and good cosmesis when used as adhesive for wound edges of pediatric circumcisions. Sutureless circumcision technique is better than conventional sutured circumcision.

Effect on Microbial Growth of a New Skin Protectant Formulation

Objective: Evaluate the effect of a new investigational skin protectant formulation on the growth of various microorganisms in vitro. Approach: An in vitro laboratory assay with various species of gram-positive bacteria, gram-negative bacteria, and yeast grown on agar plates was used to verify that a new investigational product used for the management of incontinence-associated dermatitis (IAD) does not support microbial growth. Results: The investigational product did not support the growth of all organisms tested for 48 h in these assays. The results demonstrate the barrier properties of this investigational formulation against bacteria and yeast that are relevant to incontinent patients. Innovation: IAD accompanied by skin damage is difficult to manage with currently available products. A new skin protectant that can be applied as a liquid and polymerizes into a breathable film in situ even in the presence of exudate (as shown previously) has been developed and tested to ensure that it does not support microbial growth. Conclusion: This work verifies that this new product does not support microbial growth in vitro using organisms relevant for the intended application.

Evaluating the use of octyl-2-cyanoacrylate in unilateral cleft lip repair

Background:

Facial cosmetic results are one of the most concerning issues for the parents who get their children operated for cleft lip. Moreover, the postoperative care of the surgical site, the discomfort associated with the suture removal, and additional visit for suture removal are other reasons which encourages one to use any new technologies that may replace the need for suture placement. In this study, we used octyl-2-cyanoacrylate, a tissue adhesive which offers a viable alternative to traditional techniques without compromising optimal wound closure.

Objective:

To perform a comprehensive comparison of the outcomes from the use of Dermabond in patients undergoing primary repair of congenital cleft lip ± palate anomalies.

Materials and Methods:

Twenty patients, in the age group of 3–18 months were treated surgically for unilateral cleft lip deformity using Millard rotation-advancement flap. Pre- and post-operative photographs of the patients were taken at 1 week, 2 week, 1 month, 6 months, and 1 year postoperatively and were evaluated using Vancouver scar scale which was given by Sullivan in 1990. Paired t-test was used for statistical analysis.

Results:

Increased vascularity (hyperemia) was seen in the 1^st and 2^nd week in 35% and 30% patients, respectively which gradually reduced to normal in subsequent follow-ups. The scar was flat in 85% of patients in 1^st week, and the number decreased to 10% at the end of 1 year. No wound dehiscence was found in any patients. Statistical analysis showed that among all the follow-ups, only the difference between the first and second follow-ups. Comparison of the results of 1 week with all other follow-ups yielded no significant results.

Conclusion:

Octyl-2-cyanoacrylate can be used for cleft lip closure effectively. The procedure is relatively painless and quick. Added to this are benefits of protection from wound infection since the material is bacteriostatic.

The antibacterial effect of 2-octyl cyanoacrylate (Dermabond®) skin adhesive

Dermabond® is a tissue adhesive commonly used for wound or surgical incision closure. Its use has previously been associated with a reduction in wound infection, and it has been thought to act as a physical barrier to bacteria accessing the wound. This study aimed to establish whether the Dermabond® adhesive demonstrated any intrinsic antimicrobial properties. Solidified pellets of Dermabond® were placed on standardised Agar plates cultured with a variety of pathogens. Inhibition of growth was demonstrated against Gram-positive bacteria. Culture swabs taken from the inhibition rings demonstrated no growth, suggesting that Dermabond has a bactericidal mechanism of action. Based on the design of this study, the results suggest that Dermabond® demonstrates bactericidal properties against Gram-positive bacteria. Its use for wound closure following surgical intervention may reduce postoperative wound infection by Gram-positive organisms.

Microbial barriers

Barrier wound therapy is commonplace in the health care environment and functions to limit bacterial colonization and infection in both acute wounds and recalcitrant chronic wounds. This article reviews the nature of acute and chronic wounds and their available adjunctive barrier therapies.

Sutureless circumcision - An Indian experience

Context:

Traditionally, circumcision wounds are closed by absorbable sutures. However, certain alternative methods are also being utilized to overcome the shortcomings of the conventionally used method for circumcision wound closuring. In the current study, the use of tissue glue ((iso amyl 2-cyanoacrylate) has been compared with traditional suturing for the approximation of circumcision wounds. In our study, both the methods were found to be comparable with significantly less time consumed in glue group.

Aims:

The purpose of the present study has been to compare directly cyanoacrylate as a better alternative to conventional suture material in terms of cosmetic result, time consumed and incidence of infection (comparative study).

Materials and Methods:

The results of all the patients seen in outpatient department for circumcision were included in this study. The study was conducted from Aug 2009 to May 2010. The tissue glue (iso amyl 2-cyanoacrylate) was compared to sutures as a method of wound approximation in circumcision.

Results:

Tissue glue group has been observed to have less wound inflammation, bleeding or hematoma rate and was cosmetically superior as compared to suture group; however, none of these findings could reach statistically significant level. The mean time taken for circumcision was 14.2 min (SD 2.42), when tissue glue was used for wound approximation. However, it was 24.4 min (SD 5.06) in case of the use of sutures. This difference was found as highly significant (P value < 0.001). However, regarding postoperative pain no significant reduction was observed when glue was used.

Conclusions:

This study showed that the use of tissue glue in comparison to sutures is having the following advantages:

Cosmetically superior

Less time consuming

All other parameters measured were nearly the same and statically insignificant.

Phase 2 cross-over multicenter trial on the efficacy and safety of topical cyanoacrylates compared with topical silicone gel in the prevention of pathologic scars

BACKGROUND

Many clinical studies on scar therapy are reported in the literature, but only silicone gel sheeting and corticosteroid injections are supported by accurate prospective controlled studies. This prospective multicenter cross-over phase 2 study tested the effectiveness of a topical cyanoacrylate compared with silicone gel in improving postsurgical scars

METHODS

Patients presenting with symmetric breast scars after augmentation or reduction mammaplasty were enrolled in the study. From the same day as stitch removal, the cyanoacrylate was applied on one side every 3 to 5 days and the silicone gel on the other side twice a day for 3 months. Assessments of patients and external observers using a visual analog scale were recorded at scheduled visits during 1 year, and scars were photographed. Objective evaluations included measurements of scar width, length, and elevation. The statistical significance of objective parameter modifications was analyzed using the Wilcoxon test

RESULTS

Positive effects of both tested products were observed during the scar maturation process, and final scars of good quality were achieved without any major adverse effect. The topical cyanoacrylate proved to be more efficacious in preventing scar widening, and this result was statistically significant

CONCLUSIONS

The tested topical cyanoacrylate had a positive effect on the scar maturation process at least comparable with that of topical silicone gel.

Uso de 2-octil cianoacrilato em anastomose colônica: estudo experimental em ratos wistar

OBJETIVO: Comparar os resultados das anastomoses colônicas realizadas com o adesivo 2-octil cianoacrilato e as feitas com fio de polipropileno 5.0. MÉTODOS: Selecionaram-se 32 ratos Wistar machos distruibuidos em quatro grupos de oito animais tendo em conta o tipo de sutura - polipropileno ou aplicação de cianoacrilato -, e os dias para eutanásia - terceiro ou sétimo do pós-operatório. Nos animais dos grupos controle, as anastomoses foram realizadas em plano único com fio de polipropileno 5.0. Nos dos grupos com adesivo, elas foram executadas com 2-octil cianoacrilato. Avaliaram-se o tempo operatório, a integridade, o aspecto macroscópico das anastomoses, a pressão de ruptura à distensão, obstrução intestinal, formação de aderências e histologicamente o processo cicatricial e inflamatório. RESULTADOS: O tempo operatório foi significativamente maior nos grupos em que se aplicou adesivo tanto no terceiro quanto no sétimo dias (p=0,004). A formação de aderências foi mais extensa no grupo 2-octil cianoacrilato estudado no sétimo dia de pós-operatório em comparação com o grupo polipropileno (p=0,007). Os valores obtidos no estudo tensiométrico da anastomose, no sétimo dia de pós-operatório, mostraram-se menores no grupo 2-octil cianoacrilato (p=0,002). A frequência de obstrução intestinal parcial foi maior no grupo em que se aplicou adesivo quando avaliado no sétimo dia (0,029). O processo cicatricial e inflamatório não diferiu entre os grupos, seja no terceiro ou sétimo dias (p>0,05). CONCLUSÃO: Em condições experimentais, o uso do 2-octil cianoacrilato, avaliado no sétimo dia revelou-se deletério, levando a intensa formação de aderências, obstrução parcial da luz colônica, e menor resistência mecânica da anastomose.

A mouse model to evaluate the interface between skin and a percutaneous device

Percutaneous medical devices are integral in the management and treatment of disease. The space created between the skin and the device becomes a haven for bacterial invasion and biofilm formation and results in infection. We hypothesize that sealing this space via integration of the skin into the device will create a barrier against bacterial invasion. The purpose of this study was to develop an animal model in which the interaction between skin and biomaterials can be evaluated. Porous poly(2-hydroxyethyl methacrylate) [poly(HEMA)] rods were implanted for 7 days in the dorsal skin of C57 BL/6 mice. The porous poly(HEMA) rods were surface-modified with carbonyldiimidazole (CDI) or CDI plus laminin 5; unmodified rods served as control. Implant sites were sealed with 2-octyl cyanoacrylate; corn pads and adhesive dressings were tested for stabilization of implants. All rods remained intact for the duration of the study. There was histological evidence of both epidermal and dermal integration into all poly(HEMA) rods regardless of treatment. This in vivo model permits examination of the implant/skin interface and will be useful for future studies designed to facilitate skin cell attachment where percutaneous devices penetrate the skin.

Fermeture cutanée par colle à base d'octylcyanoacrylate (Dermabond®) en chirurgie cervicofaciale programmée : étude longitudinale prospective

OBJECTIVES

A prospective non-randomised evaluation of the octyl-2-cyanoacrylate (Dermabond) for skin closure in head and neck surgery.

MATERIALS AND METHODS

An inception cohort of 52 patients managed by six otorhinolaryngologists head and neck surgeons at a single institution (university teaching and tertiary referral center) during the months of May-July 2004. The length of the skin incision varied from 3 to 30 cm (mean: 7 cm). Morbidity evaluation, longitudinal analysis of the evolution of the scar, and analysis of the degree of satisfaction.

RESULTS

Postoperative death was not encountered. The overall morbidity rate was 3.8% (2/52). There was no instances of wound dehiscence's. A subcutaneous abscess was noted in one patient. From an aesthetic point of view, the scar appearance was considered to be slightly retracted during the first postoperative month and to be very good 2 to 4 months from initial surgery. Only one patient developed a minimal cheloid scar. Among the 47 patients who expressed an opinion postoperatively regarding the use of the octyl-2-cyanoacrylate (Dermabond) for skin closure, the degree of satisfaction was very high due to the ability to take an early shower (40 patients) followed by the lack of skin sutures (5 patients) and the lack of any allergic skin reaction (2 patients).

CONCLUSION

At our department, the octyl-2-cyanoacrylate (Dermabond) for skin closure at the time of head and neck surgery is becoming more and more utilized due to the completion of a solid and aesthetic suture, the ability to take an early shower and the high degree of satisfaction expressed by the patients.

Cyanoacrylates for Skin Closure

Cyanoacrylates (CAs) were not widely adopted for medical use until recently because of lingering concerns regarding the initial tissue toxicities of the short-chain CAs. The medium-chain CAs, primarily butyl-cyanoacrylate, have been widely used in Europe and Canada for several decades and have gone a long way in dispelling any lingering concerns about tissue toxicity. The newer, longer chain CA, octyl-2-cyanoacrylate (2-OCA), now has been approved for multiple uses in the United States and has achieved widespread acceptance by the medical and lay communities. The current authors believe that this is probably only the beginning of the use of 2-OCA and other CAs in cutaneous medicine. This article discusses the use of CAs in their original cutaneous use as glues for the repair of lacerations and incisions and in their more recent use as dressings for the treatment of abrasions and wounds.