Glue Instead of Stitches: A Minor Change of the Operative Technique with a Serious Impact on the Shunt Infection Rate
Shunt infections are still one of the most important complications of shunt surgery. We observed shunt infections coming from wound breakdown due to minimal CSF leakage from subcutaneous CSF accumulation, which is often unavoidable in babies over the bore
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Abstract Introduction Shunt infections are still one of the most important complications of shunt surgery. We observed shunt infections coming from wound breakdown due to minimal CSF leakage from subcutaneous CSF accumulation, which is often unavoidable in babies over the borehole, along the fibers of stitches that close the superficial skin. Whether such secondary shunt infections might be overcome by avoiding stitches has been studied. Materials and Methods We examined 90 children experiencing their first shunt insertion between September 1998 and April 2008. We divided the children into two groups. Wound closure was performed with absorbable subcutaneous one-onone sutures with counter-sunk knots in both groups. In one group, octylcyanoacrylate tissue adhesive was used for the final layer closure of the skin (44 children); in the other group, non-absorbable one-on-one single skin sutures were used (46 children). Results Using the glue, we reduced the wound dehiscence rate from 24% to 2% and the infection rate from 17% to 0%. Conclusion A minimal change of operative technique substantially affects the shunt infection rate due to the extermination of the “wick-effect” along filaments used to close the skin. Furthermore, Dermabond® itself has a bactericidal effect. Keywords Hydrocephalus • shunts • children • octylcyanoacrylate tissue adhesive • shunt infection • wound dehiscence • complications
Introduction Shunt infections are still one of the most important complications of shunt surgery (2), On closer inspection they have to be separated into primary and secondary infections. The latter are caused by wound dehiscence and/or cerebral spinal fluid (CSF) leakage from subcutaneous CSF accumulation along the fibers of sutures. Additionally, sutures may introduce bacteria from the skin into the wound via punctures of the skin that generate a migration path through the skin along which common skin bacteria can migrate (4). Like every foreign material brought into human tissue (e.g., shunt catheters), the surface of the suture material can serve as an opportunistic site for bacterial colonization and potential biofilm cultivation. Shunted patients present optimal conditions for infections, regarding the fact having two foreign materials closely together. Shunt catheter and sutures, which are eventually in direct contact with each other in the subcutaneous tissue, exponentially increase the risks of a shunt infection. The development of 2-octylcyanoacrylate (Dermabond®, Ethicon, Summerville, NJ, USA) was a new advancement in the wound closure field. This tissue adhesive was introduced in the summer of 1998, and it appears to prevent skin sutures from contacting both CSF accumulations around shunt catheter and the catheter itself. The aim of the prospective study was to find out whether wound closure with octylcyanoacrylate tissue adhesive (ota) is an appropriate method for preventing secondary shunt infections in children.
Materials and Methods R. Eymann (*) Department of Neurosurgery, Medical School, Saarland Uni
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