Spinal Wound Closure using a self-adhering mesh system and polymeric glue (2-OCA)
Introduction: Meticulous wound closure following lumbar surgery is essential for antisepsis, haemostasis, cosmesis and containment of any incidental cerebrospinal fluid leak. We hereby report our early experience using the Ethicon Dermabond® Prineo® wound closure system in elective lumbar spinal surgery. This system, which incorporates a self-adhering mesh and 2-octyl cyanoacrylate (2-OCA), a polymeric glue-like substance, seeks to significantly reduce operating time during wound closure. Previously it has been shown to possess good skin holding strength and establish a robust antimicrobial barrier in vitro; clinically it has been associated with fewer readmission rates following surgery. Methods: We prospectively collected data including total time taken to close thoracolumbar fascia and superficial layers in all patients undergoing elective lumbar surgery. Fascial layers were closed using the Ethicon Stratafix knotless barbed suture and superficial layers were closed using Prineo in accordance with manufacturer recommendations. Results: Prineo was used for skin closure in eight cases (3 lumbar microdiscectomies, 4 lumbar decompressions and 1 decompression and stabilisation). Wound closure time was short with mean time 6 minutes 36 seconds (range 4:23 to 10:43). Patient, surgeon and nursing staff satisfaction was reported as high for all cases. In one case intraoperative bleeding precluded the use of the device and closure was performed using our usual technique of deep dermal and subcuticular sutures. One case required a pressure dressing post-operatively to reduce bleeding. One patient developed wound dehiscence within 48 hours requiring a return to theatre for washout and primary closure under general anaesthetic. Subsequent to this complication we have discontinued our study and no longer use Prineo along for skin closure in spinal surgery. Conclusion: We do not recommend its routine use in the absence of deep dermal and/or subcutaneous/subcuticular sutures.
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