Avoiding Wound Site Dermatitis After Spine Surgery

Why do some wound closure systems cause uncomfortable dermatitis after surgery, and what can surgeons do to avoid this complication?

Recovering from spine surgery is challenging for anyone, but for a select few kids, it’s even more difficult. That’s because in rare instances, the wound closure systems many surgeons use as alternatives to staples and sutures can cause allergic dermatitis, an immune response that leads to mild, but aggressive, rashes.

Sumeet Garg, MD, recently wrote a retrospective study on a liquid adhesive wound closure system which combines 2-octyl cyanoacrylate and a self-adhesive polyester mesh. This type of wound closure helps lessen the appearance of scars and reduces the risk of infection, but for Dr. Garg, the rates of dermatitis were too high to continue using it.

“You’re recovering from your surgery and then maybe you feel good from the actual surgery after a couple weeks. That’s a time where you should be starting to walk more and do more things, and instead you are dealing with this uncomfortable, painful rash,” Dr. Garg says.

He stopped using the adhesive several years ago because in a small percentage of patients, it caused significant dermatitis along the surgical site — often a large portion of the back. Instead, his team pivoted to using a similar system that still allows for cosmetic improvements and decreased risk of infection, but without the concern of dermatitis.

“Now I use this silver mesh on the incision that helps with infection and is antibacterial,” Dr. Garg explains. “Then, I use a silicone-based, soft adhesive dressing, and patients have liked it. You can shower with it on, and it is low management for the patient. We want to make it easy.”

Because the 2-octyl cyanoacrylate wound closure system remains a popular choice, Dr. Garg’s study aims to give doctors who still use it a playbook on how to treat dermatitis should the concern arise. His team recommends topical application of medium-potency corticosteroids with antipruritic and vasoconstrictive properties. Additionally, Dr. Garg says doctors should consider using mupirocin ointment on the rash up to three times a day to prevent infection.

Above all though, Dr. Garg urges doctors to share potential risks of the closure system with patients and consider more skin-friendly alternatives, as surgical dressing options are always improving and advancing.

Citations

1. Miller, Florian, et al. “Dermatitis after spine fusion caused by liquid adhesive (2-Octyl cyanoacrylate).” Journal of the Pediatric Orthopaedic Society of North America, Volume 7, 2024, 100045, ISSN 2768-2765, jposna.2024.100045.