To what extent is cyanoacrylate useful to prevent early wound infections in hernia surgery?

Abstract

Background: Prolene graft infection still occurs at an unacceptably high rate, despite many preventive measures with suggested effectiveness against infection. We assessed the efficacy of cyanoacrylate as a tissue adhesive and barrier against early and late contamination through the skin.

Method: Thirty-two Wistar albino rats weighing between 250 and 300 g were randomised into four groups with eight animals in each. Group I: N-butyl 2-cyanoacrylate and early local contamination; group II: N-butyl 2-cyanoacrylate and late local contamination; group III: prolene suture and early contamination; group IV: prolene suture and late contamination. Prolene graft material 1 x 0.5 cm was implanted in mice above the fascia. Local contamination with 75 x 10(6) cfu/ml Staphylococcus aureus ATCC 25923 was carried out in groups III and VI within a postoperative period of 24 h. On the seventh day, the animals were killed and the grafts were explanted. The microscopic, histological and microbiological evaluation of the graft material and the surrounding tissues were performed.

Results: All of the graft cultures from group III (8/8) were positive for S. aureus, whereas all of those from group I (0/8) were negative. This difference was significant (P < 0.001). Histological examination revealed denser inflammatory cell infiltration in group III than in group I. On the other hand, there was no difference between groups II and IV.

Conclusions: Maintaining skin integrity after closure is very significant, as contamination during the first few hours of the procedure may result in prolene graft infection. Cyanoacrylate appears to be a promising molecule within the first few hours of the operations for two reasons, namely, its bacteriostatic effects and ability to seal the barrier effectively and immediately.