Use of 2-octyl cyanoacrylate for skin closure of sternal incisions in cardiac surgery: observations of microbial barrier effects.
BACKGROUND
The systematic use of 2-octyl cyanoacrylate (2-OCA) became routine in our cardiac unit in 2000. This topical skin adhesive has been used in conjunction with conventional suturing for skin closure and prevention of postoperative wound infections by means of its performance as a microbial barrier to exogenous bacteria. It is, therefore, important to validate its effectiveness in the reduction of infection rates and, consequently, in the length of postoperative hospital stays.


OBJECTIVE
To evaluate the impact of the use of 2-OCA as an add-on measure in the closure of sternotomy incision wounds by comparing postoperative infection rates and length of hospital stays before and after this procedural change.


METHODS
We reviewed the records of 680 patients whose cardiovascular surgery performed between 2000 and 2004 included the use of 2-OCA and an equal number of patients who did not receive the topical skin adhesive (surgeries performed between 1995 and 1999), used as a control group.


RESULTS
From 1995 to 1999 (without the topical skin adhesive) the infection rate was 4.9%. This rate was reduced to 2.1% after the systematic use of the topical skin adhesive (p < 0.001). Superficial and deep infection rates decreased from 4.3% and 0.6% to 2.1% and 0%, respectively. Postoperative hospital stays were also significantly reduced, decreasing from a median of 13 days to 9 days (p < 0.001).


CONCLUSIONS
From the patient records reviewed in this study, it was found that the routine use of 2-octyl cyanoacrylate as an add-on measure to conventional sutures was associated with a significant reduction in infection rates for cardiovascular surgery patients.
Cardiovascular Surgery Department, Hospital Beneficiência Portuguesa - São Paulo, Brazil. institutozerbini@uol.com.br
E C
EC
Souza
R B
RB
Fitaroni
D M
DM
Januzelli
H M S
HM
Macruz
J C A
JC
Camacho
M R C
MR
Souza
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003487:Cyanoacrylates / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012867:Skin / Q000187:drug effects; D013249:Sternum / Q000187:drug effects / Q000601:surgery; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014014:Tissue Adhesives / Q000627:therapeutic use*; D016896:Treatment Outcome
D003487:Cyanoacrylates; D014014:Tissue Adhesives; C100832:octyl 2-cyanoacrylate