• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • 0 CME Hours
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
#Grand Rounds

Does Tissue Adhesive Decrease Cesarean Wound Infection?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • A tissue adhesive using 2-octyl cyanoacrylate inhibits bacterial growth for up to 10 days and appears to have bactericidal qualities
  • Braginsky et al. (Obstetrics & Gynecology, 2019) compared risk of wound infection following use of tissue adhesive vs sterile strips for Pfannenstiel incision closure at cesarean section

METHODS:

  • Multicenter randomized controlled trial (RCT)
  • Participants
    • Cesarean delivery
    • Pfannenstiel skin incision
  • Infection prophylaxis best practices including
    • Chlorhexidine skin prep | Pre-op antibiotics before skink incision | suture if subQ >2cm | skin closed with subcuticular
  • Groups (randomized)
    • Tissue adhesive (2-octyl cyanoacrylate)
    • Sterile strips
  • Primary outcome: A composite of wound complications
    • Drainage | Cellulitis | Abscess | Seroma | Hematoma | Isolated wound separation
    • Occurring within 8 weeks of delivery
  • Secondary outcomes
    • Operative time
    • Readmission
    • Office or emergency department visits
    • Antibiotic use for wound complications
    • Patient satisfaction with the cesarean scar
  • Statistical analysis
    • With 80% power and a 95% CI, a sample size of 432 per group (n=864) was required to detect a 50% reduction in the primary outcome
    • Planned interim analysis was performed after 500 patients

RESULTS:

  • At interim analysis point in the study
    • Tissue adhesive group: 238 | Sterile strips group: 241
  • Wound complications
    • Tissue adhesive group: 7.5%
    • Sterile strips group: 7.9%
    • Relative risk: 0.96 (95% CI, 0.51 to 1.78)
  • There were no significant differences identified for the following
    • Types of wound complications
    • Operative time
    • Readmission or office or emergency department visits
    • Antibiotics prescribed for wound complications
    • Patient scar assessment scores of pain, stiffness, and irregularity
  • Tissue adhesive performed slightly better in regard to itchiness of scar and overall scar satisfaction
  • Based on above data at interim analysis, using conditional power analysis
    • Probability of showing a benefit with tissue adhesive was extremely low (6.2%)
    • Study was halted due to futility

CONCLUSION:

  • Authors suggest that the reason tissue adhesive may work better to prevent infection in non-OB cases is that while it may be effective against skin microbes, it may not work as well against microorganisms arising from the genital tract
  • Limitations include the fact that the trial was unmasked and the incidence of wound complication was lower than anticipated (7.7% vs 10%)
  • Tissue adhesive with 2-octyl cyanoacrylate is unlikely to reduce risk of wound complications when used to close a cesarean Pfannenstiel incision

Learn More – Primary Sources:

Tissue Adhesive Compared With Sterile Strips After Cesarean Delivery – A Randomized Controlled Trial

Now You Can Get ObG Clinical Research Summaries Direct to Your Phone, with ObGFirst

Learn More »

image_pdfFavoriteLoadingFavorite
< Previous
All #Grand Rounds Posts
Next >

Related ObG Topics:

Can Evidence-Based Interventions Reduce C-section Complications?
Does Changing Gloves Decrease Cesarean Wound Infection?
Chlorhexidine or Iodine Based Skin Prep for Cesarean Sections?

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • #Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

ObG Library

  • Hysteroscopy
  • Fertility
  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Log In to ObG First

Please log in to access OBGFirst and the 2T Ultrasound Atlas

Password Trouble?

Sign Up for ObGFirst

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!

ObG First Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site