Wound complications associated with the use of bovine serum albumin-glutaraldehyde surgical adhesive in pediatric patients

OBJECTIVE: The use of dural sealants has become common in neurosurgery. Ten patients in whom a bovine albumin-glutaralclehyde combination (BioGlue; Cryolife, Inc., GA) was implanted have had wound complications. The clinical experience Kennesaw, of these patients is presented along with recommendations regarding the use of BioGlue. METHODS: All clinical information was reviewed for the patients who had wound complications after implantation of BioGlue. Data collected included diagnosis, type of original surgery, clinical presentation of the wound complication, culture results, and management. RESULTS: BioGlue was implanted in 75 patients during 77 procedures. Ten patients (13%) had wound complications. There were six boys and four girls with an average age of 5.2 years (range, 11 mo-16 yr). Three had undergone spinal procedures for detethering of the spinal cord and seven underwent craniotomies (five infratentorial, two supratentorial). Six patients presented with purulent drainage, two had periorbital cellulites, and two had swelling and fluctuance without drainage. All patients were managed operatively by washout, debridement, and removal of the BioGlue followed by a course of intravenous antibiotics. The average interval between the implantation and the debridement was 12.5 weeks (range, 2.5-28 wk). All patients had purulence around the BioGlue. Positive cultures were obtained in seven patients (Staphylococcus species in six and Streptococcus pneumoniae in one), including five who presented with wound drainage. CONCLUSION: We have found a strong association between the use of BioGlue and postoperative wound complications in our pediatric neurosurgical practice and, thus, discourage its future use. BioGlue triggers an intense acute pyogenic and chronic granulomatous inflammatory response, which is an ideal environment for bacterial growth. The bacteria may arise from the BioGlue or other foreign bodies or, more likely, from the skin if the inflammation breaches the skin surface.