Chlorhexidine Gluconate and Hypersensitivity From 2-Octyl Cyanoacrylate Mesh Dressings

Both 2-octyl cyanoacrylate mesh dressings and chlorhexidine gluconate are independently associated with hypersensitivity. Residual chlorhexidine antiseptic trapped under an impermeable mesh dressing may synergistically contribute to skin reactions. We hypothesized that an enhanced washing protocol before dressing application would reduce the incidence of hypersensitivity. We secondarily compared delayed wound healing, infection, and sensitization from prior exposure with mesh dressings.

This retrospective study reviewed 214 hip and knee arthroplasty patients receiving 2% chlorhexidine gluconate/70% isopropyl alcohol skin paint and a 2-octyl cyanoacrylate mesh dressing. The standard wash protocol (n = 138) informally wiped the skin prep with saline. The enhanced wash protocol (n = 76) thoroughly removed the skin prep with an isopropyl alcohol-soaked sponge followed by a saline soaked sponge. The chart was reviewed for hypersensitivity, wound healing, infection, and prior exposure.

The enhanced wash protocol was associated with a notable decrease in the rate of hypersensitivity from 14.5 to 2.6% (OR 0.16, 95% CI, [0.04-0.70]). The two reactions in the enhanced protocol occurred immediately and both subsequently revealed a history of adhesive allergy. More folliculitis was observed in the enhanced group (3.9 vs. 0%, P = 0.04). No differences were observed in delayed wound healing, superficial infection, or deep infection (P = 0.75, 0.53, and 1, respectively). Prior mesh exposure had no effect on hypersensitivity.

We observed that thorough removal of durable chlorhexidine paint was associated with a lower incidence of hypersensitivity after application of impermeable mesh dressings. The study findings support efforts to reduce chlorhexidine concentration on the skin before the application of dressings. In the absence of a prospective study, we recommend making this inexpensive and simple protocol change before application of a 2-octyl cyanoacrylate mesh dressing to surgical wounds.