Therefore, it is very important to obtain meticulous intraoperative bleeding control and to eliminate dead space using subcutaneous sutures. This decreases the likelihood of wound infection and wound tension, and facilitates skin-edge eversion. If an unwanted seroma or hematoma develops, it is difficult to evacuate them by removing 1 or 2 stitches and widening the incision. Generally, it is recommended that surgeons do not completely cover the wound with the cyanoacrylate tissue adhesive in cases where hemostasis is an issue. In these cases, a single suture is placed at the end of an incision without adhesive coverage, allowing for the discharge from a seroma or hematoma.¹

   The tissue adhesive usually remains on the wound for 7 to 14 days after its application, and then sloughs off with the desquamating epidermis.¹

   Two limitations must be considered in relation to this study. Despite the many advantages of adhesive use, there was no improvement in cosmetic outcomes in this study. An improvement in cosmetic outcome has only been noted in studies with a larger number of patients. The second limitation to the adoption of cyanoacrylate tissue adhesive application was the cost. Although the cyanoacrylate tissue adhesive costs 50 times as much as the 5-0 nylon suture material, the tissue adhesive sutured patients paid 2.5–7.0 times as much as 5-0 nylon-sutured patients. However, if one compares the total medical cost rather than the individual patient payment, the difference was reduced to 1.7–4.7 times (Table 2). In addition, considering the indirect social costs including economic loss or transportation costs not counted in this calculation, it is expected that a difference in expenditures between the two methods might be much less than estimated. Additionally, patients’ paradigm shift is the principal reason why most patients want to use the tissue adhesive regardless of cost. Recently, patients’ desire for improved quality of life has increased rapidly, and many patients want a comfortable and pleasant medical treatment. Korean national health insurance also reduces individual patient payment, which makes the tissue adhesive an attractive option.

   The risk of contact dermatitis is an important consideration for clinicians. Contact dermatitis or hypersensitivity is rare. In their study, Cohen and Kaufmann⁹ ascribed contact dermatitis to common medical acrylics, such as commonly used bone and dental cement, to 1.6% of patients with suspected contact dermatitis. Also, in contrast to the toxic reaction in vitro, there is no evidence of histotoxicity in in-vivo studies on animals after correct adaptation of the wound edge.⁵

Conclusion

   Dermabond tissue adhesive provides a means of closure of preauricular fistulectomy wound closure equivalent to traditional suture closure. The use of a tissue adhesive is preferable for children who undergo a preauricular fistulectomy, considering children frequently contaminate the wound dressing, find it is too stressful to change the dressing or undergo suture removal, and find it difficult to shower, bathe, or wash hair with a gauze dressing. Its use is suitable for the busy professional who does not have time for a hospital visit, and young women who dislike unseemly gauze dressing.

From the Department of Otolaryngology–Head and Neck Surgery, The Catholic University of Korea, Seoul, Korea