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.

Revision anterior cruciate ligament reconstruction: a midterm patient assessment

Twenty patients who underwent revision anterior cruciate reconstruction were retrospectively reviewed. Before revision surgery all patients reported functional instability with daily and or sporting activities. The causes of primary graft failure have been identified. Four different types of graft were used for the revision reconstruction. A comprehensive knee analysis was used to assess the graft performance both subjectively and objectively at an arranged follow-up visit. In general our study shows that although there is residual antero-posterior laxity on clinical assessment and KT-1000 instrumentation after revision surgery, the majority of patients thought the results were subjectively good or excellent. The study highlights the well-recognised technical failures of primary anterior cruciate ligament reconstruction and confirms good subjective results. The poor correlation between the physical examination (objective) and the patient's perception (subjective) of the revision surgery is discussed.

Surgical treatment of a tomaculous neuropathy

Compressive neuropathy of the ulnar nerve at the elbow is the second most common nerve entrapment in the upper limb. Eight possible anatomical points of constriction have been identified. The most common constriction being the intermuscular septum proximally or between the two heads of the flexor carpi ulnaris in the cubital canal distally. Surgical release is successful in 80-90% of cases. Certain rare genetic conditions can predispose susceptible peripheral nerves to similar compressive neuropathies but there is no literature on surgical treatment of such patients. We present a case of hereditary neuropathy with liability to pressure palsy (HNPP) often known as 'tomaculous' neuropathy, in a patient with ulnar nerve symptoms who underwent a surgical release.

Osseous metaplasia as a cause of loss of extension after anterior cruciate ligament reconstruction

We report a case of osseous metaplasia of an autologous anterior cruciate ligament (ACL) reconstruction that was implicated in blocking extension of the knee. Nonoperative treatment was unsuccessful. Arthroscopic excision of the ACL and osseous metaplasia abolished the fixed flexion deformity. The osseous metaplasia was an additional factor in causing the block to extension along with an anteriorly placed femoral tunnel, raising the question that nonisometry of the graft may be involved in the pathogenesis of the osseous metaplasia.