Commentary on JPOSNA® paper, “Dermatitis after spine fusion caused by liquid adhesive (2-octyl cyanoacrylate)”
Year: 2024
Type: editorial
Abstract: Liquid 2-octyl cyanoacrylate (Derma-Bond) is a UV curing skin adhesive that can be implemented for a variety of wound closures including in spinal surgery.Acrylates rapidly polymerize into solid chains, leading to rapid, durable wound closure, without the need for dedicated removal required of sutures and staples.However, cyanoacrylates can trigger allergic contact dermatitis (ACD), complicating recovery from surgery.In this May 2024 issue of JPOSNA®, Miller et al. report 2 cases of ACD from 2-octyl cyanoacrylate adhesive.This paper highlights an uncommon but treatable complication following surgical repair using liquid adhesives.Early recognition of ACD and treatment are critical aspects of this Quality Improvement Case Series report for the pediatric orthopaedic community.ACD is a delayed, T-cell mediated hypersensitivity reaction that will recur with each subsequent exposure.Studies reporting ACD from the use of liquid adhesives containing acrylates in orthopaedic surgery collectively report an incidence of 0.5% to 2.7% [1-3], suggesting that alternative wound closures may not be necessary for most patients given the benefits reported for liquid adhesive closures in orthopaedic surgery.ACD typically manifests with well demarcated, pruritic patches and vesiculated plaques that align with the application of the liquid skin adhesive and usually occurs within the first 2 weeks after exposure.Importantly, many patients with ACD to 2-octyl cyanoacrylate are not previously sensitized and may develop ACD after the first exposure, reacting up to 30 days after exposure [4].ACD to 2-octyl cyanoacrylate could be confused with an early would infection, but the prominent itching suggests allergy over infection.In uncertain cases, culture can be helpful early on, but persistent dermatitis can also lead to secondary infection due to a broken skin barrier.Most cases of Dermabond ACD should be relatively straightforward to diagnose, but if in question patch testing may be done to confirm allergy.Patch testing with the TRUE system will miss ACD to 2-octyl
Authors: Lisa M. Arkin, Margo Reeder
Institution: University of Wisconsin–Madison
Language: English
Subfield: Dermatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,500
OpenAlex ID: W4393999983