Faculty Opinions recommendation of Using Dermabond for wound closure in lumbar and cervical neurosurgical procedures.

Abstract Objective and Importance: Carcinoma of the adnexal structures of the skin is a rare malignancy, and is even more unusual in the scalp. We report an unusual case of scalp adnexal carcinoma of eccrine origin that went untreated for years, resulting in a giant tumor with extension through the cranium. The tumor resection and reconstruction of the cranium and scalp defects posed unique challenges. Clinical Presentation: A 54-year-old woman experienced a large recurrence of her scalp adnexal carcinoma after an incomplete wide local excision, which invaded through the cranium. Intervention: The entire vertex of the scalp and cranium were removed en bloc. After cranioplasty, a free vascularized muscle flap was used for soft tissue coverage, but failed owing to poor vascular inflow. A large area of dura was left open, using a vacuum-assisted wound closure device to generate granulation tissue by secondary intention. Another split thickness skin graft was used to provide a cosmetically acceptable outcome. Conclusion: Scalp adnexal tumors of eccrine origin rarely metastasize and can be resected for cure with complete removal. Reconstruction options for large scalp and cranial tumors may be limited, and allowing the dura to granulate by secondary intention has been very rarely described. The novel use of a vacuum-assisted wound closure device was a very useful adjunct in this situation, and may be beneficial in the reconstruction of other patients with large scalp and cranial defects after neurosurgical procedures. It should be used with caution, since it may risk injury to a major venous sinus, especially when used in the midline, or cerebrospinal fluid leakage.

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Using Dermabond for Wound Closure in Lumbar and Cervical Neurosurgical Procedures

Operative Neurosurgery ◽

10.1227/01.neu.0000144170.39436.52 ◽

2005 ◽

Vol 56 (suppl_1) ◽

pp. ONS-147-ONS-150 ◽

Cited By ~ 19

Author(s):

Lance T. Hall ◽

Julian E. Bailes

Keyword(s):

Wound Closure ◽

Senior Author ◽

Anterior Cervical Discectomy ◽

Neurosurgical Procedures ◽

Superficial Wound Infection ◽

Cervical Discectomy ◽

Surgical Incisions ◽

Superficial Wound ◽

Patient Responses

Abstract 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.

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Effect of Preoperative Shampoos with Chlorhexidine or lodophor on Emergence of Resident Scalp Flora in Neurosurgery

Infection Control and Hospital Epidemiology ◽

10.1086/645726 ◽

1988 ◽

Vol 9 (1) ◽

pp. 8-12 ◽

Cited By ~ 9

Author(s):

Jeanne M. Leclair ◽

Ken R. Winston ◽

Bernadette F. Sullivan ◽

Janet M. O'Connell ◽

Stella M. Harrington ◽

...

Keyword(s):

Wound Closure ◽

Study Groups ◽

Neurosurgical Procedures ◽

Wound Contamination ◽

Skin Flora ◽

Group A ◽

Surgical Preparation ◽

Group B ◽

Group D ◽

Closure Group

AbstractWound contamination with endogenous bacterial scalp flora plays an important role in the pathogenesis of postoperative neurosurgical infections. To assess the effect of preoperative antiseptic shampoos on the emergence of resident scalp flora during surgery and subsequent wound contamination, we randomized 151 neurosurgical procedures into four study groups: group A—preoperative shampoos with chlorhexidine, surgical scalp preparation with chlorhexidine; group B-no shampoos, surgical preparation with chlorhexidine; group C-shampoos with iodophor, surgical preparation with iodophor; group D-no shampoos, surgical preparation with iodophor. Quantitative cultures of the scalp were obtained preoperatively and at the end of surgery, and qualitative wound cultures were taken prior to wound closure. Group A had the lowest concentration of bacteria on the scalp both preoperatively and postoperatively (median range = 30 [0-5.7 × 105] and 0 [0-2.5 x 103] respectively). Group A also had significantly fewer positive postoperative scalp cultures (29%) than groups B (51%), C (58%), and D (53%) (P<0.05), as well as fewer positive wound cultures (20% v 25%, 42%, and 30% respectively). A density of bacteria on the scalp of > 102/4cm2 best predicted the presence of bacteria in the wound. Repeated preoperative shampoos with chlorhexidine reduce intraoperative emergence of resident skin flora and subsequent contamination of the wound.

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Association of Surgical Overlap during Wound Closure with Patient Outcomes among Neurological Surgery Patients at a Large Academic Medical Center

Neurosurgery ◽

10.1093/neuros/nyz142 ◽

2019 ◽

Vol 85 (5) ◽

pp. E882-E888 ◽

Cited By ~ 3

Author(s):

Gregory Glauser ◽

Prateek Agarwal ◽

Ashwin G Ramayya ◽

H Isaac Chen ◽

John Y K Lee ◽

...

Keyword(s):

Patient Outcomes ◽

Wound Closure ◽

Medical Center ◽

Academic Medical Center ◽

Length Of Hospital Stay ◽

Neurosurgical Procedures ◽

Readmission Rates ◽

Surgical Time ◽

Academic Medical ◽

Neurological Surgery

Abstract BACKGROUND Several studies have explored the effect of overlapping surgery on patient outcomes, but impact of surgical overlap during wound closure has not been studied. OBJECTIVE To examine the association of overlap during wound closure and suture time overlap (STO) with patient outcomes in a heterogeneous neurosurgical population. METHODS Over 4 yr (7/2013-7/2017), 1 7689 neurosurgical procedures were retrospectively reviewed at a single, multihospital academic medical center. STO was defined as all surgeries for which an overlapping surgery occurred, exclusively, during wound closure of the index case being studied. We excluded nonelective cases and overlapping surgeries that involved overlap during surgical portions of the case other than wound closure. Tests of independence and Wilcoxon tests were used for statistical analysis. RESULTS Patients with STO had a shortened length of hospital stay (100.6 vs 135.1 h; P < .0001), reduced deaths in follow-up (1.59% vs 5.45%; P = .0004), and lower 30- to 90-d readmission rates (3.64% vs 7.47%; P = .0026). Patients with STO had no increase in revision surgery. Patients with STO had longer wound closure times (26.5 vs 23.9 min; P < .0001) but shorter total surgical times (nonclosure surgical time 101.8 vs 133.3 min; P < .0001; and total surgical time 128.3 vs 157.1 min; P < .0001). CONCLUSION Surgical overlap during wound closure (STO) is associated with improved or at least noninferior patient outcomes, as it pertains to readmissions and wound revisions.

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