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Shirin Towfigh, MD; William G. Cheadle, MD; Stephen F. Lowry, MD; Mark A. Malangoni, MD; Samuel E. Wilson, MD

Arch Surg. 2008;143(9):885-891.

Hypothesis  Application of skin sealant prior to incision reduces microbial contamination of the wound.

Design  Prospective, randomized, multicenter clinical trial.

Setting  Six teaching hospitals.

Patients  A total of 177 adult patients undergoing elective open inguinal hernia repair were randomized to either standard skin preparation with 10% povidone-iodine or skin preparation followed by cyanoacrylate-based liquid microbial sealant.

Interventions  Wound contamination was assessed during surgery by microbial sampling inside the wound at initiation of skin incision and prior to skin closure.

Main Outcome Measures  The primary outcome measures were the safety and effectiveness of cyanoacrylate-based microbial sealant to reduce bacterial contamination during surgery. The secondary outcome measure was reduction of postoperative surgical site infections using microbial sealant.

Results  Demographics were similar. Patients treated with sealant were more likely to have no bacterial cells found in the wound than control participants (47% vs 31%; P = .04). Three patients developed surgical site infections; all were in the control group (P = .25). Independent factors that reduced wound contamination were use of microbial sealant (odds ratio, 0.45; confidence interval, 0.23-0.88; P = .02) and perioperative antibiotics (odds ratio, 0.24; confidence interval, 0.10-0.58; P = .001).

Conclusion  Cyanoacrylate-based microbial sealant may be an important tool to reduce wound contamination and potentially prevent surgical site infections.

Author Affiliations: Department of Surgery at Cedars-Sinai Medical Center, Los Angeles, California (Dr Towfigh); Veterans Affairs Medical Center, Louisville, Kentucky (Dr Cheadle); Robert Wood Johnson Medical School, New Brunswick, New Jersey (Dr Lowry); MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio (Dr Malangoni); and Veterans Affairs Long Beach Healthcare System, Long Beach, California (Dr Wilson).

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