European Spine Journal

, Volume 23, Issue 4, pp 854–862 | Cite as

Surgical site infection in spinal surgery: a comparative study between 2-octyl-cyanoacrylate and staples for wound closure

  • Muneharu AndoEmail author
  • Tetsuya Tamaki
  • Munehito Yoshida
  • Shunji Sasaki
  • Yasushi Toge
  • Takuji Matsumoto
  • Kazuhiro Maio
  • Ryosuke Sakata
  • Daisuke Fukui
  • Seiji Kanno
  • Yukihiro Nakagawa
  • Hiroshi Yamada
Original Article



Surgical site infection (SSI) after spinal surgery is a devastating complication. Various methods of skin closure are used in spinal surgery, but the optimal skin-closure method remains unclear. A recent report recommended against the use of metal staples for skin closure in orthopedic surgery. 2-Octyl-cyanoacrylate (Dermabond; Ethicon, NJ, USA) has been widely applied for wound closure in various surgeries. In this cohort study, we assessed the rate of SSI in spinal surgery using metal staples and 2-octyl-cyanoacrylate for wound closure.


This study enrolled 609 consecutive patients undergoing spinal surgery in our hospital. From April 2007 to March 2010 surgical wounds were closed with metal staples (group 1, n = 294). From April 2010 to February 2012 skin closure was performed using 2-octyl-cyanoacrylate (group 2, n = 315). We assessed the rate of SSI using these two different methods of wound closure. Prospective study of the time and cost evaluation of wound closure was performed between two groups.


Patients in the 2-octyl-cyanoacrylate group had more risk factors for SSI than those in the metal-staple group. Nonetheless, eight patients in the metal-staple group compared with none in the 2-octyl-cyanoacrylate group acquired SSIs (p < 0.01). The closure of the wound in length of 10 cm with 2-octyl-cyanoacrylate could save 28 s and $13.5.


This study reveals that in spinal surgery, wound closure using 2-octyl-cyanoacrylate was associated with a lower rate of SSI than wound closure with staples. Moreover, the use of 2-octyl-cyanoacrylate has a more time saving effect and cost-effectiveness than the use of staples in wound closure of 10 cm in length.


Surgical site infection Spinal surgery Wound closure 2-Octyl-cyanoacrylate Staples 


Conflict of interest

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.


  1. 1.
    Pull ter Gunne AF, van Laarhoven CJ, Cohen DB (2010) Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk. Eur Spine J 19:982–988PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Calderone RR, Garland DE, Capen DA, Oster H (1996) Cost of medical care for postoperative spinal infections. Orthop Clin North Am 27:171–182PubMedGoogle Scholar
  3. 3.
    Rubinstein E, Findler G, Amit P, Shaked I (1994) Perioperative prophylactic cefazolin in spinal surgery. A double-blind placebo-controlled trial. J Bone Jt Surg 76-B:99–102Google Scholar
  4. 4.
    Wimmer C, Gluch H, Franzreb M, Ogon M (1998) Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures. J Spinal Disord 11:124–128PubMedGoogle Scholar
  5. 5.
    Weinstein MA, McCabe JP, Cammisa FP Jr (2000) Postoperative spinal wound infection: a review of 2,391 consecutive index procedures. J Spinal Disord 13:422–426PubMedCrossRefGoogle Scholar
  6. 6.
    Blam OG, Vaccaro AR, Vanichkachorn JS, Albert TJ, Hilibrand AS, Minnich JM, Murphey SA (2003) Risk factors for surgical site infection in the patient with spinal injury. Spine 28:1475–1480PubMedGoogle Scholar
  7. 7.
    Olsen MA, Mayfield J, Lauryssen C, Polish LB, Jones M, Vest J, Fraser VJ (2003) Risk factors for surgical site infection in spinal surgery. J Neurosurg 98(2 Suppl):149–155PubMedGoogle Scholar
  8. 8.
    Fang A, Hu SS, Endres N, Bradford DS (2005) Risk factors for infection after spinal surgery. Spine 30:1460–1465PubMedCrossRefGoogle Scholar
  9. 9.
    Demura S, Kawahara N, Murakami H, Nambu K, Kato S, Yoshioka K, Okayama T, Tomita K (2009) Surgical site infection in spinal metastasis: risk factors and countermeasures. Spine 34:635–639PubMedCrossRefGoogle Scholar
  10. 10.
    Tofuku K, Koga H, Yanase M, Komiya S (2012) The use of antibiotic-impregnated fibrin sealant for the prevention of surgical site infection associated with spinal instrumentation. Eur Spine J 21:2027–2033PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Singh B, Mowbray MAS, Nunn G, Mearns S (2006) Closure of hip wound, clips or subcuticular sutures: does it make a difference? Eur J Orthop Surg Traumatol 16:124–129CrossRefGoogle Scholar
  12. 12.
    Singhal AK, Hussain A (2006) Skin closure with automatic stapling in total hip and knee arthroplasty. JK Practit 13:142–143Google Scholar
  13. 13.
    Smith TO, Sexton D, Mann C, Donell S (2010) Sutures versus staples for skin closure in orthopaedic surgery: meta-analysis. BMJ 340:c1199PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Quinn JV, Drzewiecki A, Li MM, Stiell IG, Sutcliffe T, Elmslie TJ, Wood WE (1993) A randomized, controlled trial comparing a tissue adhesive with suturing in the repair of pediatric facial lacerations. Ann Emerg Med 22:1130–1135PubMedCrossRefGoogle Scholar
  15. 15.
    Ikada Y (1997) Tissue adhesives. In: Chu CC, Greisler HP, Von Fraunhofer JA (eds) Wound closure biomaterials and devices. CRC Press, Boca Raton, pp 317–346Google Scholar
  16. 16.
    Farion K, Osmond MH, Hartling L, Russell K, Klassen T, Crumley E, Wiebe N (2002) Tissue adhesives for traumatic lacerations in children and adults. Cochr Datab Sys Rev 3:CD003326Google Scholar
  17. 17.
    Liebelt EL (1997) Current concepts in laceration repair. Curr Opin Pediatr 9:459–464PubMedCrossRefGoogle Scholar
  18. 18.
    Collin TW, Blyth K, Hodgkinson PD (2009) Cleft lip repair without suture removal. J Plast Reconstr Aesthet Surg 62:1161–1165PubMedCrossRefGoogle Scholar
  19. 19.
    Cho J, Harrop J, Veznadaroglu E, Andrews DW (2003) Concomitant use of computer image guidance, linear or sigmoid incisions after minimal shave, and liquid wound dressing with 2-octyl cyanoacrylate for tumor craniotomy or craniectomy: analysis of 225 consecutive surgical cases with antecedent historical control at one institution. Neurosurgery 52:832–840PubMedCrossRefGoogle Scholar
  20. 20.
    Lee KW, Sherwin T, Won DJ (1999) An alternate technique to close neurosurgical incisions using octyl cyanoacrylate tissue adhesive. Pediatr Neurosurg 31:110–114PubMedCrossRefGoogle Scholar
  21. 21.
    Wang MY, Levy ML, Mittler MA, Liu CY, Johnston S, McComb JG (1999) A prospective analysis of the use of octyl cyanoacrylate tissue adhesive for wound closure in pediatric neurosurgery. Pediatr Neurosurg 30:186–188PubMedCrossRefGoogle Scholar
  22. 22.
    Leung GY, Peponis V, Varnell ED, Lam DS, Kaufman HE (2005) Preliminary in vitro evaluation of 2-octyl cyanoacrylate (Dermabond) to seal corneal incisions. Cornea 24:998–999PubMedCrossRefGoogle Scholar
  23. 23.
    Lee J, Singletary R, Schmader K, Anderson DJ, Bolognesi M, Kaye KS (2006) Surgical site infection in the elderly following orthopaedic surgery. Risk factors and outcomes. J Bone Jt Surg 88-A:1705–1712CrossRefGoogle Scholar
  24. 24.
    Scott GR, Carson CL, Borah GL (2007) Dermabond skin closures for bilateral reduction mammaplasties: a review of 255 consecutive cases. Plast Reconstr Surg 120:1460–1465PubMedCrossRefGoogle Scholar
  25. 25.
    Hall LT, Bailes JE (2005) Using Dermabond for wound closure in lumbar and cervical neurosurgical procedures. Neurosurgery 56(1 Suppl):147–150PubMedCrossRefGoogle Scholar
  26. 26.
    Wachter D, Brückel A, Stein M, Oertel MF, Christophis P, Böker DK (2010) 2-Octyl-cyanoacrylate for wound closure in cervical and lumbar spinal surgery. Neurosurg Rev 33:483–489PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Inf Cont Hosp Epidemiol 13:606–608CrossRefGoogle Scholar
  28. 28.
    Stockley I, Elson RA (1987) Skin closure using staples and nylon sutures: a comparison of results. Ann R Coll Surg Engl 69:76–78PubMedCentralPubMedGoogle Scholar
  29. 29.
    Shetty AA, Kumar VS, Morgan-Hough C, Georgeu GA, James KD, Nicholl JE (2004) Comparing wound complication rates following closure of hip wounds with metallic skin staples or subcuticular vicryl suture: a prospective randomised trial. J Orthop Surg 12:191–193Google Scholar
  30. 30.
    Singh B, Mowbray MAS, Nunn G, Mearns S (2006) Closure of hip wound, clips or subcuticular sutures: does it make a difference? Eur J Ortop Surg Traumatol 16:124–129Google Scholar
  31. 31.
    Gatt D, Quick CR, Owen-Smith MS (1985) Staples for wound closure: a controlled trial. Ann R Coll Surg Engl 67:318–320PubMedCentralPubMedGoogle Scholar
  32. 32.
    Murphy M, Prendergast P, Rice J (2004) Comparison of clips versus sutures in orthopedic wound closure. Eur J Ortop Surg Traumatol 14:16–18Google Scholar
  33. 33.
    Saleh K, Olson M, Resig S, Bershadsky B, Kuskowski M, Gioe T, Robinson H, Schmidt R, McElfresh E (2002) Predictors of wound infection in hip and knee joint replacement: results from a 20 year surveillance program. J Orthop Res 20:506–515PubMedCrossRefGoogle Scholar
  34. 34.
    Quinn JV, Osmond MH, Yurack JA, Moir PJ (1995) N-2 butyl cyanoacrylate: risk of bacterial contamination with an appraisal of its antimicrobial effects. J Emerg Med 13:581–585PubMedCrossRefGoogle Scholar
  35. 35.
    Bhende S, Rothenburger S, Spangler DJ, Dito M (2002) In vitro assessment of microbial barrier properties of Dermabond topical skin adhesive. Surg Inf (Larchmt) 3:251–257CrossRefGoogle Scholar
  36. 36.
    Schimmel JJ, Horsting PP, de Kleuver M, Wonders G, van Limbeek J (2010) Risk factors for deep surgical site infections after spinal fusion. Eur Spine J 19:1711–1719PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    McPhee IB, Williams RP, Swanson CE (1998) Factors influencing wound healing after surgery for metastatic disease of the spine. Spine 23:726–732PubMedCrossRefGoogle Scholar
  38. 38.
    Chen S, Anderson MV, Cheng WK, Wongworawat MD (2009) Diabetes associated with increased surgical site infections in spinal arthrodesis. Clin Orthop Relat Res 467:1670–1673PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    Koutsoumbelis S, Hughes AP, Girardi FP, Cammisa FP Jr, Finerty EA, Nguyen JT, Gausden E, Sama AA (2011) Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis. J Bone Jt Surg 93-A:1627–1633Google Scholar
  40. 40.
    Schwarzkopf R, Chung C, Park JJ, Walsh M, Spivak JM, Steiger D (2010) Effects of perioperative blood product use on surgical site infection following thoracic and lumbar spinal surgery. Spine 35:340–346PubMedCrossRefGoogle Scholar
  41. 41.
    Veeravagu A, Patil CG, Lad SP, Boakye M (2009) Risk factors for postoperative spinal wound infections after spinal decompression and fusion surgeries. Spine 34:1869–1872PubMedCrossRefGoogle Scholar
  42. 42.
    Abdul-Jabbar A, Takemoto S, Weber MH, Hu SS, Mummaneni PV, Deviren V, Ames CP, Chou D, Weinstein PR, Burch S, Berven SH (2012) Surgical site infection in spinal surgery: description of surgical and patient-based risk factors for postoperative infection using administrative claims data. Spine 37:1340–1345PubMedCrossRefGoogle Scholar
  43. 43.
    Boston KM, Baraniuk S, O’Heron S, Murray KO (2009) Risk factors for spinal surgical site infection, Houston, Texas. Inf Cont Hosp Epidemiol 30:884–889CrossRefGoogle Scholar
  44. 44.
    Chopra T, Zhao JJ, Alangaden G, Wood MH, Kaye KS (2010) Preventing surgical site infections after bariatric surgery: value of perioperative antibiotic regimens. Exp Rev Pharmacoecon Outcom Res 10:317–328CrossRefGoogle Scholar
  45. 45.
    Kang BU, Lee SH, Ahn Y, Choi WC, Choi YG (2010) Surgical site infection in spinal surgery: detection and management based on serial C-reactive protein measurements. J Neurosurg Spine 13:158–164PubMedCrossRefGoogle Scholar
  46. 46.
    Abdul-Jabbar A, Berven SH, Hu SS, Chou D, Mummaneni PV, Takemoto S, Ames C, Deviren V, Tay B, Weinstein P, Burch S, Liu C (2013) Surgical site infections in spine surgery: identification of microbiologic and surgical characteristics in 239 cases. Spine 38:E1425–E1431PubMedCrossRefGoogle Scholar
  47. 47.
    Al-Nammari SS, Lucas JD, Lam KS (2007) Hematogenous methicillin-resistant Staphylococcus aureus spondylodiscitis. Spine 32:2480–2486PubMedCrossRefGoogle Scholar
  48. 48.
    Meredith DS, Kepler CK, Huang RC, Brause BD, Boachie-Adjei O (2012) Postoperative infections of the lumbar spine: presentation and management. Int Orthop 36:439–444PubMedCentralPubMedCrossRefGoogle Scholar
  49. 49.
    Pappou IP, Papadopoulos EC, Sama AA, Girardi FP, Cammisa FP (2006) Postoperative infections in interbody fusion for degenerative spinal disease. Clin Orthop Relat Res 444:120–128PubMedCrossRefGoogle Scholar
  50. 50.
    Dipaola CP, Saravanja DD, Boriani L, Zhang H, Boyd MC, Kwon BK, Paquette SJ, Dvorak MF, Fisher CG, Street JT (2012) Postoperative infection treatment score for the spine (PITSS): construction and validation of a predictive model to define need for single versus multiple irrigation and debridement for spinal surgical site infection. Spine J 12:218–230PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Muneharu Ando
    • 1
    Email author
  • Tetsuya Tamaki
    • 1
  • Munehito Yoshida
    • 2
  • Shunji Sasaki
    • 1
  • Yasushi Toge
    • 1
  • Takuji Matsumoto
    • 1
  • Kazuhiro Maio
    • 1
  • Ryosuke Sakata
    • 1
  • Daisuke Fukui
    • 1
  • Seiji Kanno
    • 3
  • Yukihiro Nakagawa
    • 2
  • Hiroshi Yamada
    • 2
  1. 1.Department of Orthopedic SurgeryWakayama Rosai HospitalWakayamaJapan
  2. 2.Department of Orthopedic SurgeryWakayama Medical UniversityWakayamaJapan
  3. 3.Department of Orthopedic SurgeryThe Cancer Institute Hospital of JFCRTokyoJapan

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