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Periorbital infections after Dermabond closure of traumatic lacerations in three children
Ruth H Yeilding1, Denis M O'Day, Chun Li
1Vanderbilt Eye Institute, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-8808, USA.
Insights
Periorbital infections, including cellulitis and necrotizing fasciitis, occurred in 3 young children after using 2-octyl cyanoacrylate (Dermabond) for laceration repair. A meta-analysis suggests tissue adhesive closure may increase wound infection rates.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Wound Healing
Background:
- Periorbital lacerations are common in children.
- Tissue adhesives offer a convenient alternative for wound closure.
- The safety and efficacy of tissue adhesives in pediatric periorbital wounds require careful consideration.
Observation:
- Three pediatric cases of periorbital infection (cellulitis, necrotizing fasciitis) are reported following 2-octyl cyanoacrylate (Dermabond) application.
- Infections developed within 24 hours of wound closure in children under 3 years old.
- Two cases required surgical intervention, and Streptococcus pyogenes was identified in cultures.
Findings:
- A meta-analysis indicated a higher infection rate (1.8%) with tissue adhesive closure compared to standard closure (0.3%).
- The odds ratio for infection with tissue adhesives was 6.0, though not statistically significant (P=0.06).
- Prompt intravenous antibiotic therapy was initiated in all reported cases.
Implications:
- Physicians should be vigilant for periorbital infections after using Dermabond for laceration repair.
- Consideration of wound sterilization techniques prior to adhesive application is crucial.
- Further research is warranted to confirm the association between tissue adhesives and increased infection risk in pediatric periorbital wounds.
Purpose:
To report the occurrence of periorbital infections in 3 children treated with the tissue adhesive 2-octyl cyanoacrylate (Dermabond) after traumatic periorbital laceration.
Methods:
We retrospectively reviewed the records of consecutive patients referred to Vanderbilt Children's Hospital for the treatment of periorbital infections to identify cases associated with the use of Dermabond. The clinical features and outcomes of each case were reviewed. We performed a meta-analysis of published cases to identify any association of tissue adhesive with wound infection rate.
Results:
The review identified 3 patients, all of whom were younger than 3 years of age and developed cellulitis within 24 hours of wound closure. Broad-spectrum intravenous antibiotic therapy was started in less than 3 hours in all cases. Cultures were obtained in 2 of the 3 cases; both grew Streptococcus pyogenes. Two cases required surgical intervention, including one with necrotizing fasciitis. In the meta-analysis, the wound infection rate was 1.8% in tissue adhesive closure and 0.3% in standard wound closure (odds ratio 6.0; 95% confidence interval 0.7-50.3, P = 0.06).
Conclusions:
The development of periorbital cellulitis after the closure of periorbital lacerations with Dermabond should alert the physician to the possibility of periorbital infection, including necrotizing fasciitis. The literature review suggests a trend toward an increased infection rate with tissue adhesive closure. We propose that ineffective wound sterilization before tissue adhesive wound closure may be a contributing factor.
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