title: Cyanoacrylate-sealed Donati suture for wound closure after cardiac surgery in obese patients.
abstract: The majority of wound infections after median sternotomy in obese patients are triggered by the breakdown of skin suture and subsequent seepage of skin flora into the deeper tissue layers. In a prospective study, 90 patients (body mass index ≥30) who had cardiac surgery via median sternotomy were enrolled. In 45 patients, skin closure was performed according to the Donati technique (vertical interrupted mattress suture) and sealed with octylcyanoacrylate (group A). In 45 patients, intracutaneous running technique without sealed was performed (group B). The endpoint was wound infection within 90 days. Degree of obesity and other risk factors for wound infection were equally distributed between groups A and B (all P>0.05). In group A only two superficial infections occurred, whereas in group B there were nine wound infections including two deep infections (P=0.026). In 10 of 11 infections (both groups) coagulase-negative staphylococci were isolated. In eight of 11 wound infections the caudal third of the incision was affected. Intertrigo in inframammary skin folds was found in 20.0% (18/90) of all patients but in 63.6% (seven of 11) of cases with infection. We conclude, that cyanoacrylate-sealed Donati suture is superior to intracutaneous suture technique since it offers tension-resistant closure with immediate microbial barrier properties.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany. grauhan@dhzb.de
authors.forename: Onnen
authors.initials: O
authors.lastname: Grauhan
authors.forename: Artashes
authors.initials: A
authors.lastname: Navasardyan
authors.forename: Michael
authors.initials: M
authors.lastname: Hofmann
authors.forename: Peter
authors.initials: P
authors.lastname: Müller
authors.forename: Manfred
authors.initials: M
authors.lastname: Hummel
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D003487:Cyanoacrylates / Q000627:therapeutic use*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000209:etiology / Q000517:prevention & control*; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D056346:Sternotomy; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D013536:Suture Techniques / Q000009:adverse effects; D013997:Time Factors; D014014:Tissue Adhesives / Q000627:therapeutic use*; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D003487:Cyanoacrylates; D014014:Tissue Adhesives; C119247:octylcyanoacrylate