Patient Satisfaction With a Tissue Adhesive in Preauricular Fistulectomy

Jae-Hyun Seo, MD; Dong-Hee Lee, MD

Address correspondence to:
Dong-Hee Lee, MD
Department of Otolaryngology-Head and Neck Surgery
Uijeongbu, St. Mary’s Hospital, The Catholic University of Korea
#65-1 Gumoh-dong, Uijeongbu City, Gyeonggi-do
480-717, Korea
Phone: 82-31-820-3564

Abstract: Objective. To evaluate the usefulness of Dermabond® (octyl-2-cyanoacrylate) tissue adhesive, and to provide advice on its use for patients undergoing preauricular fistulectomy. Study design. A retrospective, IRB-approved, case-control study. Methods. This study reviewed the medical records of patients who underwent preauricular fistulectomy by one otologist at a single institution. Patient satisfaction was assessed by a questionnaire and the cosmetic result was assessed using the Hollander Wound Evaluation Scale (HWES). Results. There were 2 cases of wound dehiscence; a stitch abscess was noted in 2 patients. Aesthetically, scar appearance was considered very good. Among 33 patients who expressed an opinion postoperatively regarding the use of the tissue adhesive for skin closure, the degree of satisfaction was considerably high because patients were able to wash their face and bathe/shower (28 patients) soon after the procedure, followed by the lack of any dressing or wound care (21 patients), and the lack of skin sutures (19 patients). Conclusion. The tissue adhesive offered equivalent wound closure as traditional suture for preauricular fistulectomy. Tissue adhesive is a safe method for closing wounds in preauricular fistulectomy and has many advantages, especially in young children and young women.

     There is an increasing demand for office-based outpatient procedures performed by otolaryngologists. For patients who undergo office-based outpatient procedures or are discharged from the hospital prior to stitch removal, the dressing and care of the surgical wound are not only important, but often troublesome to both patients and surgeons.

   The goals of skin closure are to provide a favorable cosmetic and functional surgical result. It is also important to protect the surgical wound from infection. Meticulous approximation of subcutaneous tissues is an important prerequisite for a favorable outcome. Properly placed subcutaneous sutures aim to maximize skin-edge eversion and relieve tension on the wound.1 The authors have previously used 5-0 nylon suture material for epidermal closure in the face, and usually left it in place for 5 to 7 days.

   Preauricular sinuses or fistulae are common congenital malformations. Once infection occurs, the likelihood of recurrent acute exacerbations is high, and preauricular fistulectomy is inevitable.2 Since a time gap exists between operation (for an outpatient) or discharge (for an inpatient) and suture removal, frequent re-dressing of the surgical wound is required over the subsequent 4–5 days. Dressing care can be bothersome, especially for patients who live far from the hospital and do not have an otolaryngology clinic nearby. Additionally, suture removal can produce anxiety, particularly in children or women.3 Due to these concerns, the authors began using Dermabond® tissue adhesive (octyl-2-cyanoacrylate; Ethicon Inc, Somerville, NJ) for more than 1 year.

   The goal of this study was to examine the efficacy and advantages of the tissue adhesive in skin closure of a preauricular fistulectomy from the viewpoint of the patient.

Patients and Methods

   Patient selection. This retrospective, institutional review board-approved study reviewed the medical records of patients who underwent a preauricular fistulectomy (complete extirpation of the sinuses) at the otolaryngology head and neck surgery department of a University-based and secondary referral hospital over a 3-year period.


1. Toriumi DM, Bagal AA. Cyanoacrylate tissue adhesives for skin closure in the outpatient setting. Otolaryngol Clin North Am. 2002;35(1):103–118.
2. Yeo SW, Jun BC, Park SN, et al. The preauricular sinus: factors contributing to recurrence after surgery. Am J Otolaryngol. 2006;27(6):396–400.
3. Liu RW, Mehta P, Fortuna S, et al. A randomized prospective study of music therapy for reducing anxiety during cast room procedures. J Pediatr Orthop. 2007;27(7):831–833.
4. Hollander JE, Singer AJ, Valentine S, Henry MC. Wound registry: development and validation. Ann Emerg Med. 1995;25(5):675–685.
5. Nitsch A, Pabyk A, Honig JF, Verheggen R, Merten HA. Cellular, histomorphologic, and clinical characteristics of a new octyl-2-cyanoacrylate skin adhesive. Aesthetic Plast Surg. 2005;29(1):53–58.
6. Handschel JG, Depprich RA, Dirksen D, Runte C, Zimmermann A, Kübler NR. A prospective comparison of octyl-2-cyanoacrylate and suture in standardized facial wounds. Int J Oral Maxillofac Surg. 2006;35(4):318–323.
7. Silvestri A, Brandi C, Grimaldi L, et al. Octyl-2-cyanoacrylate adhesive for skin closure and prevention of infection in plastic surgery. Aesthetic Plast Surg. 2006;30(6):695–699.
8. Knott PD, Zins JE, Banbury J, Djohan R, Yetman RJ, Papay F. A comparison of dermabond tissue adhesive and sutures in the primary repair of the congenital cleft lip. Ann Plast Surg. 2007;58(2):121–125.
9. Cohen DE, Kaufmann JM. Hypersensitivity reactions to products and devices in plastic surgery. Facial Plast Surg Clin North Am. 2003;11(2):253–265.

Post new comment

  • Lines and paragraphs break automatically.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Use to create page breaks.

More information about formatting options

Enter the characters shown in the image.