Interest of 2-octyl-cyanoacrylate (Dermabond®) in Closing Surgical Incisions in Children Before Acquisition of Continence

Interest of 2-octyl-cyanoacrylate (Dermabond®) in Closing Surgical Incisions in Children Before Acquisition of Continence

Interest of 2-octyl-cyanoacrylate (Dermabond®) in Closing Surgical Incisions in Children Before Acquisition of Continence. Randomised, Prospective, Non-inferiority Study.

Fondation Lenval, Centre Hospitalier Régional Universitaire Montpellier, Assistance Publique Hopitaux De Marseille

Inguinal incisions are the most frequent incisions used in children before the acquisition of continence (180 incisions per year for the Pediatric Surgery Department in Nice CHU). However, healing of those wounds can be made hard because of soiling induced by urine and/or stool, which is unavoidable in case of wearing nappies. Nowadays, in order to overcome a possible contamination of the surgical wound, post-surgery wound dressing is protected by the application of a waterproof band aid (like Tegaderm®) during wound-healing (evaluated to a mean of 7 days). When the band aid is soiled, a nurse changes it, causing unpleasantness in low age children (whose epidermal fragility is well known), and sometimes parents worry. Moreover, those occlusive wound dressings avoid any control of the surgical wound during healing phase. At the end of the wound-healing time, wound dressings are removed, causing discomfort for children and necessity of a qualified nurse staff at visit times. Cutaneous use glues, introduced in surgery more than 10 years ago, allow making waterproof and transparent sutures, with a firmness equivalent to a 2/0 string suture (cutaneous suture in children is made with 5/0) and has its own local antiseptic properties. It does not need to be covered by any wound dressing during wound-healing phase. Moreover, cosmetic results for the 2-octyl-cyanoacrylate in the adult and children series (without any precise age distinction) seem to be equivalent to conventional sutures. Finally, its application goes with time saving (in preoperative and during wound-healing phase) and increases comfort for patients. The aim of this study is to evaluate the efficiency of cutaneous use glue Dermabond® (2-octyl-cyanoacrylate) in surgical inguinal incisions sutures in children before the acquisition of continence, by a non-inferiority randomized multicentric prospective study. Two patient groups will be studied, the sutures of one control group will be made with a conventional technique (intradermic surjet surgical suture), and one patient group will be sutured with 2-octyl-cyanoacrylate. The principal evaluation criteria is the suture quality (short- and long-term cosmetic aspect) evaluated by the surgeon. Two secondary criteria will be studied : Parental satisfaction Ease of clinical nursing management Each studied criteria will be evaluated by a numeric score.

Adequate or suboptimal wound-healing rate defined by a HOLLANDER cosmetic score higher or equal to 5 at the end of the initial wound-healing period.

Inclusion Criteria: Children less than 24 months old Continuous nappies wearing for non-acquisition of continence Need of a surgical intervention which entry way is an inguinal incision in the inguinal fold (POTTS incision) for the following indications: inguinal hernia testicular ectopy hydrocele chord cyst Surgical incision smaller than 5 cm Informed consent form signed by both parents or by the legal representative Patient affiliated to French national health and pensions organization Exclusion Criteria: Chronic or acute dermatological affection that can hamper wound-healing (atopic pathology, infectious pathology…) General affection that can hamper wound-healing (chronic denutrition) Cutaneous infection at the incision site Scar in the concerned region Medical history of wound-healing trouble Digestive pathology causing chronic or acute diarrhea Allergy to one of the used compounds (glue, string, wound dressing) Operative indication set in emergency with immediate surgery Non-acceptance of the protocol, refusal to participate to the study by one of the parents or the legal representative Impossibility of doing the follow up of the child, in accordance with the pre-established rules of the protocol