Glue instead of stitches: a minor change of the operative technique with a serious impact on the shunt infection rate.
BACKGROUND
Shunt infections are still one of the most important complications of shunt surgery. We observed shunt infections coming from wound breakdown due to minimal CSF leakage from subcutaneous CSF accumulation, which is often unavoidable in babies over the borehole, along the fibers of stitches that close the superficial skin. Whether such secondary shunt infections might be overcome by avoiding stitches has been studied.


METHODS
We examined 90 children experiencing their first shunt insertion between September 1998 and April 2008. We divided the children into two groups. Wound closure was performed with absorbable subcutaneous one-on-one sutures with counter-sunk knots in both groups. In one group, octylcyanoacrylate tissue adhesive was used for the final layer closure of the skin (44 children); in the other group, non-absorbable one-on-one single skin sutures were used (46 children).


RESULTS
Using the glue, we reduced the wound dehiscence rate from 24% to 2% and the infection rate from 17% to 0%.


CONCLUSIONS
A minimal change of operative technique substantially affects the shunt infection rate due to the extermination of the "wick-effect" along filaments used to close the skin. Furthermore, Dermabond itself has a bactericidal effect.
Eymann
Regina
R
Department of Neurosurgery, Medical School, Saarland University, Homburg-Saar, Saarland, Germany. Regina.Eymann@uks.eu
Kiefer
Michael
M
D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003487:Cyanoacrylates / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018709:Statistics, Nonparametric; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000517:prevention & control*; D013536:Suture Techniques; D014014:Tissue Adhesives / Q000008:administration & dosage*
D003487:Cyanoacrylates; D014014:Tissue Adhesives; C119247:octylcyanoacrylate