Concomitant use of computer image guidance, linear or sigmoid incisions after minimal shave, and liquid wound dressing with 2-octyl cyanoacrylate for tumor craniotomy or craniectomy: analysis of 225 consecutive surgical cases with antecedent historical control at one institution

Surgical site infection in spinal surgery: a comparative study between 2-octyl-cyanoacrylate and staples for wound closure

BACKGROUND

Surgical site infection (SSI) after spinal surgery is a devastating complication. Various methods of skin closure are used in spinal surgery, but the optimal skin-closure method remains unclear. A recent report recommended against the use of metal staples for skin closure in orthopedic surgery. 2-Octyl-cyanoacrylate (Dermabond; Ethicon, NJ, USA) has been widely applied for wound closure in various surgeries. In this cohort study, we assessed the rate of SSI in spinal surgery using metal staples and 2-octyl-cyanoacrylate for wound closure.

METHODS

This study enrolled 609 consecutive patients undergoing spinal surgery in our hospital. From April 2007 to March 2010 surgical wounds were closed with metal staples (group 1, n = 294). From April 2010 to February 2012 skin closure was performed using 2-octyl-cyanoacrylate (group 2, n = 315). We assessed the rate of SSI using these two different methods of wound closure. Prospective study of the time and cost evaluation of wound closure was performed between two groups.

RESULTS

Patients in the 2-octyl-cyanoacrylate group had more risk factors for SSI than those in the metal-staple group. Nonetheless, eight patients in the metal-staple group compared with none in the 2-octyl-cyanoacrylate group acquired SSIs (p < 0.01). The closure of the wound in length of 10 cm with 2-octyl-cyanoacrylate could save 28 s and $13.5.

CONCLUSIONS

This study reveals that in spinal surgery, wound closure using 2-octyl-cyanoacrylate was associated with a lower rate of SSI than wound closure with staples. Moreover, the use of 2-octyl-cyanoacrylate has a more time saving effect and cost-effectiveness than the use of staples in wound closure of 10 cm in length.

Skin closure in vascular neurosurgery: A prospective study on absorbable intradermal suture versus nonabsorbable suture

Background:

The craniotomy performed with minimal hair removal and closure with intradermal suture alone is an option in neurosurgical procedures, which can help faster psychological recovery of the patient, as it allows a better cosmetic result. This study is aimed at evaluating if such method is safe and effective, compared with continuous skin sutures with 2-0 nylon.

Methods:

We analyzed the sutures in 117 patients undergoing craniotomies for cerebral aneurysm clipping. In the case group (n = 49), closure of the scalp was performed only with intradermal absorbable sutures using wire Monocryl^® 2-0. In the control group (n = 68), closure was performed with continuous suture using 2-0 nylon.

Results:

The case group was composed of 49 patients in whom just intradermal suture was performed. One (2.2%) patient developed wound infection and was given proper medical treatment. No cases of dehiscence or cerebrospinal fluid leaks were observed. The control group was composed of 68 patients in whom the skin was closed with 2-0 nylon continuous suture. Three (5.3%) patients developed wound infection and were given proper medical treatment. There were no cases of wound dehiscence. The overall infection rate in the control group was 4%. There was no statistically significant difference in the number of wound infections between the two groups (P = 0.73).

Conclusion:

The closure with intradermal suture alone in craniotomies is as safe as the traditional skin closure with nylon sutures, besides eliminating the need for suture removal and providing a cosmetic advantage.

2-Octyl-cyanoacrylate for wound closure in cervical and lumbar spinal surgery

It is claimed that wound closure with 2-octyl-cyanoacrylate has the advantages that band-aids are not needed in the postoperative period, that the wound can get in contact with water and that removal of stitches is not required. This would substantially enhance patient comfort, especially in times of reduced in-hospital stays. Postoperative wound infection is a well-known complication in spinal surgery. The reported infection rates range between 0% and 12.7%. The question arises if the advantages of wound closure with 2-octyl-cyanoacrylate in spinal surgery are not surpassed by an increase in infection rate. This study has been conducted to identify the infection rate of spinal surgery if wound closure was done with 2-octyl-cyanoacrylate. A total of 235 patients with one- or two-level surgery at the cervical or lumbar spine were included in this prospective study. Their pre- and postoperative course was evaluated. Analysis included age, sex, body mass index, duration and level of operation, blood examinations, 6-week follow-up and analysis of preoperative risk factors. The data were compared to infection rates of similar surgeries found in a literature research and to a historical group of 503 patients who underwent wound closure with standard skin sutures after spine surgery. With the use of 2-octyl-cyanoacrylate, only one patient suffered from postoperative wound infection which accounts for a total infection rate of 0.43%. In the literature addressing infection rate after spine surgery, an average rate of 3.2% is reported. Infection rate was 2.2% in the historical control group. No risk factor could be identified which limited the usage of 2-octyl-cyanoacrylate. 2-Octyl-cyanoacrylate provides sufficient wound closure in spinal surgery and is associated with a low risk of postoperative wound infection.

Current neurosurgical management of brain metastases

Brain metastases occur in a third of patients diagnosed with cancer; without any intervention, the prognosis is quite poor with a median survival of 1 month. Because of the constraints of the blood-brain barrier, chemotherapy is not effective and treatment options include surgery, whole brain radiation, or stereotactic radiation. This chapter is devoted to a review of the current management options for treatment of brain metastases.

Absorbable Intradermal Closure of Elective Craniotomy Wounds

Objective:

More and more commonly, craniotomies are being performed with minimal hair shaving to improve cosmesis and facilitate return to a normal life. In such patients, traditional sutures or metal staples are used for scalp closure. This practice requires suture removal, often perceived as a cause of discomfort by the patient. We investigate the safety and efficacy of intradermal sutures in a large, consecutive series of patients undergoing elective craniotomy.

Methods:

Wound healing complications were investigated in a consecutive series of 208 patients who underwent elective craniotomy during a 2-year period. In all patients, minimal shaving, performed by shaving a small strip of hair along the planned wound, was used. Scalp closure was achieved with only absorbable intradermal running sutures. All wounds were covered with sterile adhesive strips, which were kept in place for 24 hours postoperatively. Patients were followed for a mean follow-up period of 10.6 months (range, 1–23 mo).

Results:

All patients except two had satisfactory wound healing. One patient (0.48%) developed cerebrospinal fluid leakage, which responded to bed rest and lumbar drainage. Another patient (0.48%) had a superficial skin infection, which was successfully treated with topical wound care and oral antibiotics.

Conclusion:

The closure method described is safe and effective. The absence of visible sutures in the postoperative course reinforces the cosmetic advantage of no shaving and decreases discomfort associated with the removal of sutures or staples.

A NOVEL, INEXPENSIVE METHOD OF IMAGE COREGISTRATION FOR APPLICATIONS IN IMAGE-GUIDED SURGERY USING AUGMENTED REALITY

OBJECTIVE

Augmented reality (AR) is a technique in which an overlay of a virtual image to a live picture is performed to create a new image in which both original images coexist as a single image. This results in the visualization of internal structures through overlying tissues. The objective was to describe an easy, inexpensive, and successful method to coregister with AR in an image-guided surgery setting using the resources at hand.

METHODS

Cortical information was obtained with a volumetric acquisition of 200 0.8-mm thick, cerebral magnetic resonance imaging scans in an axial T1-weighted sequence. For the venous anatomy, a contrast phase at 7 mm/s velocity was used. This data was reconstructed in a three-dimensional fashion using MRIcro software (v. 1.37, freeware, courtesy of Chris Rorden) and was overlaid to a digital image of the cerebral cortex either pre- or intraoperatively.

RESULTS

Eight patients were studied. There was an adequate coregistration in seven of the patients as confirmed by intraoperative ultrasound, frame-based stereotaxy, or obvious anatomic homology between the three-dimensional magnetic resonance imaging scan virtual reconstruction and the live image obtained during surgery. AR was not possible in one case of a cerebellar lesion.

CONCLUSION

AR coregistration capabilities are adequate when revised by other intraoperative guidance devices. When performed with "freeware" software and conventional digital cameras, it is relatively inexpensive, which makes it a potential tool for surgical planning and noncontinuous intraoperative guidance in neurosurgery. Its largest drawbacks are the inability to function in deep-seated lesions and its lack of tracking devices, which gives it a noncontinuous coregistration nature.

Fermeture cutanée par colle à base d'octylcyanoacrylate (Dermabond®) en chirurgie cervicofaciale programmée : étude longitudinale prospective

OBJECTIVES

A prospective non-randomised evaluation of the octyl-2-cyanoacrylate (Dermabond) for skin closure in head and neck surgery.

MATERIALS AND METHODS

An inception cohort of 52 patients managed by six otorhinolaryngologists head and neck surgeons at a single institution (university teaching and tertiary referral center) during the months of May-July 2004. The length of the skin incision varied from 3 to 30 cm (mean: 7 cm). Morbidity evaluation, longitudinal analysis of the evolution of the scar, and analysis of the degree of satisfaction.

RESULTS

Postoperative death was not encountered. The overall morbidity rate was 3.8% (2/52). There was no instances of wound dehiscence's. A subcutaneous abscess was noted in one patient. From an aesthetic point of view, the scar appearance was considered to be slightly retracted during the first postoperative month and to be very good 2 to 4 months from initial surgery. Only one patient developed a minimal cheloid scar. Among the 47 patients who expressed an opinion postoperatively regarding the use of the octyl-2-cyanoacrylate (Dermabond) for skin closure, the degree of satisfaction was very high due to the ability to take an early shower (40 patients) followed by the lack of skin sutures (5 patients) and the lack of any allergic skin reaction (2 patients).

CONCLUSION

At our department, the octyl-2-cyanoacrylate (Dermabond) for skin closure at the time of head and neck surgery is becoming more and more utilized due to the completion of a solid and aesthetic suture, the ability to take an early shower and the high degree of satisfaction expressed by the patients.

Using Dermabond for Wound Closure in Lumbar and Cervical Neurosurgical Procedures

OBJECTIVE:

2-Octylcyanoacrylate (Dermabond; Ethicon, Inc., Somerville, NJ) is a liquid adhesive being used with increasing frequency for the closure of lacerations and surgical incisions. Dermabond provides excellent cosmetic closure, and recent studies have demonstrated very low infection risks when it is properly applied. There are no published studies using Dermabond on lumbar or cervical procedures. This study was undertaken to determine whether Dermabond is safe and efficacious to use in these common neurosurgical procedures.

METHODS:

Records of 200 consecutive patients with Dermabond closure after anterior cervical discectomy, microlumbar discectomy, or lumbar laminectomy by the senior author (JEB) with a mean follow-up time of 5.42 months were retrospectively reviewed. Suspected infections with or without confirmatory cultures, erythema, and incisional drainage were documented.

RESULTS:

Of 200 patients, 85 underwent microlumbar discectomy, 22 lumbar laminectomy, and 93 anterior cervical discectomy. There was only 1 definitive infection, which was a culture-proven discitis in a microlumbar discectomy patient. Of the remaining 85 microlumbar discectomies, there was 1 transient incisional erythema. Of the 22 lumbar laminectomies, there was 1 patient with clinical superficial wound infection with negative cultures and 4 patients with transient incisional drainage without infection. Of the 93 anterior cervical discectomies, 2 had transient incisional drainage without infection.

CONCLUSION:

This study demonstrates that Dermabond is safe to use in neurosurgery patients undergoing lumbar or cervical procedures, with only 1 patient of 200 having a proven infection. Patients are able to shower and do not have sutures or staples to remove. Patient responses are overwhelmingly positive.