A prospective analysis of the use of octylcyanoacrylate tissue adhesive for wound closure in pediatric neurosurgery

Objective: Cyanoacrylate monomers have been developed for use as skin adhes ives. Previous studies have demonstrated that using this skin adhesive for the closure of traumatic lacerations results in excellent cosmesis, decreas ed procedure-related pain and timesavings. Surgical Technique: Octylcyanoac rylate skin adhesive is applied after the placement of deep fascial sutures with close approximation of the skin edges. The adhesive is applied in liq uid form and polymerizes rapidly to solid form. Multiple layers are applied forming a hard impenetrable barrier. Results: This technique was prospecti vely evaluated in the closure of 102 elective neurosurgical operations with 142 incisions: ventriculoperitoneal shunt insertion/revision (53%) and cra niotomy for tumors (10%) were the commonest procedures. There were a total of 83 scalp, 36 abdominal, 8 neck, 6 chest and 6 lumbar incisions. The mean incision length was 5.1 cm (range 0.25-50 cm). Fifty-nine percent of the w ounds had previous areas of operative incisions. Complications included 1 p oor cosmetic result and 4 cerebrospinal fluid (CSF) leaks. Of the 4 patient s with CSF leaks, 2 required operative wound revision, and 1 required ventr iculoperitoneal shunting for hydrocephalus. Conclusion: Cyanoacrylate skin adhesive is a viable means of obtaining cosmetic wound closure. Its use req uires attention to proper skin approximation and hemostasis. In our experie nce, propensity for CSF leakage especially in reoperative procedures is a r elative contraindication.