Characterizing the Diagnosis and Treatment of Allergic Contact Dermatitis to 2-Octyl Cyanoacrylate Used for Skin Closure in Elective Orthopedic Surgery

Background: While studies have shown that postoperative wound complications can predispose to deep infection following orthopedic surgery, the best form of skin closure has not been elucidated. Furthermore, the unique risks and benefits of each type of wound closure have not been studied. The goal of this study is to present the diagnosis and treatment of patients with allergic contact dermatitis (ACD) from 2-octyl cyanoacrylate, a skin adhesive commonly used in wound closure. Methods: Twenty-nine patients with ACD to 2-octyl cyanoacrylate (Prineo, Ethicon, NJ) following elective orthopedic surgeries from 2013 to 2016 were retrospectively reviewed; this occurred in 29 of 6088 units of Prineo used at our institution, for an estimated incidence of 0.5%. Nineteen patients (66%) had knee operations. Mean age was 55 years (range, 15-92 years). We classified patients by symptom severity and treatment requirements into mild, moderate, and severe reactions. Results: Most reactions were moderate (48%) or severe (38%) reactions. Mean time from surgery to diagnosis was 11.8 days (range, 2-42 days). All patients underwent removal of the Prineo dressing and daily dressing changes with a specific protocol. Twenty patients (69%) received oral antihistamines, 16 patients (55%) required topical corticosteroids, and 5 patients (17%) required oral corticosteroids. All cases of ACD ultimately resolved at a mean of 22 days (range, 13-56 days) postoperatively. Conclusion: 2-Octyl cyanoacrylate skin adhesive occurs in an estimated 0.5% of cases and can lead to severe postoperative ACD when used following orthopedic operations. However, with early recognition and appropriate treatment, patients' symptoms resolve without a significant impact on wound healing. (C) 2017 Elsevier Inc. All rights reserved.