title: Periorbital infections after Dermabond closure of traumatic lacerations in three children.
abstract: OBJECTIVE
  To report the occurrence of periorbital infections in 3 children treated with the tissue adhesive 2-octyl cyanoacrylate (Dermabond) after traumatic periorbital laceration.
  
  
  METHODS
  We retrospectively reviewed the records of consecutive patients referred to Vanderbilt Children's Hospital for the treatment of periorbital infections to identify cases associated with the use of Dermabond. The clinical features and outcomes of each case were reviewed. We performed a meta-analysis of published cases to identify any association of tissue adhesive with wound infection rate.
  
  
  RESULTS
  The review identified 3 patients, all of whom were younger than 3 years of age and developed cellulitis within 24 hours of wound closure. Broad-spectrum intravenous antibiotic therapy was started in less than 3 hours in all cases. Cultures were obtained in 2 of the 3 cases; both grew Streptococcus pyogenes. Two cases required surgical intervention, including one with necrotizing fasciitis. In the meta-analysis, the wound infection rate was 1.8% in tissue adhesive closure and 0.3% in standard wound closure (odds ratio 6.0; 95% confidence interval 0.7-50.3, P = 0.06).
  
  
  CONCLUSIONS
  The development of periorbital cellulitis after the closure of periorbital lacerations with Dermabond should alert the physician to the possibility of periorbital infection, including necrotizing fasciitis. The literature review suggests a trend toward an increased infection rate with tissue adhesive closure. We propose that ineffective wound sterilization before tissue adhesive wound closure may be a contributing factor.
authors.affiliation: Vanderbilt Eye Institute, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8808, USA.
authors.forename: Ruth H
authors.initials: RH
authors.lastname: Yeilding
authors.forename: Denis M
authors.initials: DM
authors.lastname: O'Day
authors.forename: Chun
authors.initials: C
authors.lastname: Li
authors.forename: Pauline T
authors.initials: PT
authors.lastname: Alexander
authors.forename: Louise A
authors.initials: LA
authors.lastname: Mawn
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003487:Cyanoacrylates / Q000627:therapeutic use*; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D015807:Eye Injuries, Penetrating / Q000188:drug therapy* / Q000382:microbiology; D005138:Eyebrows; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D005260:Female; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D022125:Lacerations / Q000188:drug therapy; D008297:Male; D013508:Ophthalmologic Surgical Procedures; D054517:Orbital Cellulitis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D013297:Streptococcus pyogenes / Q000302:isolation & purification*; D014014:Tissue Adhesives / Q000627:therapeutic use; D014946:Wound Infection / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents; D003487:Cyanoacrylates; D014014:Tissue Adhesives; C100832:octyl 2-cyanoacrylate