Influence of preoperative skin sealing with cyanoacrylate on microbial contamination of surgical wounds following trauma surgery: a prospective, blinded, controlled observational study

• Cyanoacrylate-based skin sealant (e.g. Integuseal®) have been proposed as an addition measure to prevent surgical site infection in the past. The intention of this measure is to block skin pores during the entire surgical procedure and to prevent intra-operative contamination of the sterile surgical site with endogenous skin organisms.
• The clinical evidence for the prophylactic use of cyanoacrylate based sealants to prevent SSI is discussed controversially. However, so far the sealant‘s barrier effect was studied mostly by measuring bacterial numbers at one location of the surgical site, or by comparing SSI rates in intervention and control groups.
• So far, the exact anatomic location where the sealant may support prevention of bacterial contamination was not ascertained microbiologically. In this study, we demonstrate that preoperative sealing has no microbiological effect at deeper sites of the surgical site. However, the measure can reduce microbial contamination on sutures during surgery while the overall wound contamination remained unchanged. Hence, prevention of the clinically more relevant deep SSIs may not be expected.

SummaryObjectiveIntraoperative bacterial contamination is a risk factor for surgical site infections (SSIs). This prospective, randomized, blinded, controlled trial (Reg. No. BB08/12) investigated the effect of a cyanoacrylate-based skin sealant (InteguSeal) on intraoperative wound contamination during trauma surgery.MethodsA total of 128 patients undergoing trauma surgery were assigned randomly to an intervention (n = 62) or a control group (n = 66). Surgical sites were investigated at three locations: maximum incision depth (base), wound margin prior to wound closure (margin), and the surgical sutures (suture). Colony-forming units (CFU) were counted after 48 h of incubation.ResultsOverall, significantly lower CFU counts were obtained for samples from the intervention group at all three sample sites compared to the control group. The difference, however, was only significant for the suture site (p = 0.040).ConclusionsPreoperative sealing reduced microbial contamination on sutures during surgery, while the overall wound contamination remained unchanged. Hence, prevention of the clinically more relevant deep SSIs may not be expected. However, this study was not designed to detect differences in the rate of SSI. The role of the reduction in suture contamination with regard to the prevention of SSI remains to be evaluated.