Sutureless circumcision; gentamicin-collagen implants; gentamicin prophylaxis; benefits of smoking cessation

AORN Journal,  May, 2005  by George Allen

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Use of tissue glue in circumcision

Pediatric Surgery International

October 2004

Circumcision is a common surgical procedure that involves surgical removal of the foreskin that covers the tip of the penis. Techniques for circumcision vary from excision without suturing to wound approximation with sutures and the use of tissue glue. The purpose of this prospective randomized study was to evaluate the advantages of glue versus sutures for circumcision in children. (1)

One hundred fifty-two boys scheduled for circumcision were randomly assigned to one of two groups. For participants in the suture group (n = 72), the mucosal cuff and the outer skin were approximated with interrupted sutures. For participants in the glue group (n = 80), similar approximation was achieved with single circumferential application of tissue glue. The time to approximation was recorded. Postoperatively, wound healing and comesis, scab formation, pain, and comfort level were assessed weekly by an independent observer and at two weeks after the surgery by the respective surgeon. Statistical procedures, including chi square and t tests, were used to analyze differences between the groups.

Findings. The mean time to wound approximation was significantly shorter for participants in the glue group (0.54 minutes; range 0.2-4.56) compared to participants in the suture group (3.34 minutes; range 2-11.5, P < .001). Additionally, pain duration and pain scores, as reported by the patients' parents, were significantly lower for participants in the glue group (P < .001). There were no allergic reactions to the tissue glue.

Clinical implications. This study revealed that operating time was significantly reduced when glue was used as opposed to sutures during circumcision, and patients experienced less pain. Use of tissue glue for circumcision most likely will increase. Perioperative nurses should be prepared to stock adequate supplies and assist surgeons using this technique.

Gentamicin-collagen implants

Journal of Hospital Injection

February 2005

Sternal wound infection after cardiac surgery continues to be one of the most serious postoperative complications because it invariably results in increased morbidity and mortality, prolonged hospital stay, and increased health care costs. The purpose of this randomized, controlled study was to determine the effects of locally administered gentamicin in preventing sternal wound infections after coronary artery bypass grafting (CABG) surgical procedures. (2)

During a 14-month period, 542 patients undergoing elective CABG procedures at a university hospital in Finland were randomly assigned to one of two groups. Participants in the study group (n = 272) received a 10 cm by 10 cm gentamicin-collagen implant containing 130 mg gentamicin and 280 mg collagen beneath the sternum before the incision was closed. For participants in the control group (n = 270), the incision was closed in a routine manner with steel wires and without a gentamicin-collagen implant. All patients received routine IV antimicrobial prophylaxis with cefuroxime. Patients who were hospitalized for three or more days before the surgical procedure received vancomycin in addition to antimicrobial prophylaxis with cefuroxime.

Patient characteristics, including age, gender, body mass index, underlying disease, duration of surgery, number of bypasses, and aortic cross-clamp time, were recorded. Patients were monitored daily for fever, wound discharge, and other evidence of sternal wound infection during their hospital stay and at three months after discharge. Diagnosis of sternal wound infection was established using criteria from the Centers for Disease Control and Prevention. Common statistical techniques, including logistic analysis techniques, were used to analyze differences between the groups.

Findings. Patient characteristics were comparable between the two groups. The sternal wound infection rate was not significantly different in the two groups (P = .470). Eleven patients (4%) who had the gentamicin-collagen implant and 16 patients (5.9%) in the control group developed sternal wound infections. No side effects related to the gentamicin-collagen implant were reported.

Clinical implications. This study suggests that gentamicin-collagen implants are safe, easy to use, and may be effective in preventing surgical site infections. The sternal wound infection rate was reduced slightly in patients who received the gentamicin-collagen implant compared to patients in the control group.

The authors note that this is the first study on the use of a gentamicin-collagen implant as prophylaxis in cardiac surgery and that additional studies with larger populations are warranted before conclusions can be drawn. Consequently, perioperative nurses should be prepared to assist in evaluating the use of gentamicin-collagen implants for preventing sternal wound infections after cardiac surgery.

Gentamicin prophytaxis in cardiac surgery

The Annals of Thoracic Surgery