O2085: Dermabond®, Friend or Foe? A Retrospective Review of Dermabond® Sensitivity in Pediatric Patients

Background: Dermabond® is a skin adhesive popularized in adult surgery for its low rates of skin sensitivity. As Dermabond® becomes increasingly common in pediatric surgery, differences in pediatric skin sensitivities and wound healing are relatively unknown. Few studies have examined outcomes of Dermabond® exposure in children. The purpose of this study is two-fold: to estimate the rate of skin reactions following Dermabond® exposure in pediatric orthopedic surgery, and to investigate potential risk factors associated with Dermabond® sensitivity.

Methods: This was a retrospective chart review of a level one pediatric trauma center. All elective and orthopedic traumatic surgeries in 2019 were screened for Dermabond® application. We employed a convenience sample of 3 surgeons with the highest rates of Dermabond® application to define our cohort. There were 2990 surgeries in 2019, and the 3 surgeons performed 495. Of those 495, 234 patients had Dermabond® applied. Patients were assessed for postoperative skin reactions and repeat Dermabond® exposure. Subjects with known allergies to Dermabond® or cyanoacrylate skin adhesives were excluded. Reactions were defined by localized discoloration or irritation, as well as wound dehiscence or discharge. Significant differences in skin reactions between patients with repeat Dermabond® exposure and those without were determined using Chi-squared analysis. Associations between patient and surgical characteristics and skin sensitivity were determined using logistic regression analysis. P-values less than 0.05 were considered significant.

Results: 234 patients were included for analysis. The mean age at surgery was 12.5 years (SD, 6.05) and 39% of the cohort was male (Table 1). 32 patients (14%) experienced skin reactions during the study period (95%CI=7-19%). Reactions most frequently included erythema (31%) and itchiness (31%) (Table 2). Reactions were most frequently treated with oral antibiotics, Benadryl®, or a dressing change. One patient required surgery. Of 144 patients with a primary Dermabond® exposure, 17 (12%) experienced skin reactions (95%CI=7-18%). Of 128 patients with a repeat Dermabond® exposure, 32 (25%) experienced skin reactions (95%CI=18-32%, p=0.004). Age, surgical procedure, and surgical location were not associated with a variable rate of skin sensitivity.

Conclusion: Skin sensitivity to Dermabond® after pediatric orthopedic surgery occurs at a higher rate than seen in adults. As Dermabond’s® popularity increases in pediatric surgery, providers must be aware of increased sensitivity rates. In this study, patients with multiple Dermabond® exposures experienced significantly greater sensitivity than patients at their first exposure, suggesting that providers should be aware of prior Dermabond® exposure. Larger, multi-center study on this topic is needed to identify other risk factors associated with skin sensitivity after Dermabond® application. Dermabond® and other skin adhesives used in pediatric orthopedic surgery are associated with a moderate risk of skin sensitivity. Increased provider awareness of this potential complication is needed to help justify its application in pediatric orthopedics.