Type IV hypersensitivity reactions following Dermabond adhesive utilization in knee surgery: A Report of Three Cases

Abstract

​We retrospectively reviewed the records of 3 patients (3 knees) with a delayed type hypersensitivity reaction following Dermabond exposure after an orthopaedic knee procedure. Delayed hypersensitivity reactions are mediated by CD4+ helper T cells. The use of skin adhesives in place of traditional sutures is increasing in popularity given Dermabond's potential benefits of decreased wound infection rate and better wound approximation. However, hypersensitivity reactions to the cyanoacrylate material in Dermabond have been described. Differentiating hypersensitivity reactions from post-operative infections is important as septic arthritis is a potentially devastating complication. This case series presents the challenge of properly diagnosing and managing hypersensitivity reactions. Consultation with allergists and dermatologists may be appropriate for ascertaining the nature of the surgical site complication and proper management. The recommended management of hypersensitivity-type reactions is a course of topical steroids and infection work up if needed.

Association of Surgical Adhesive and Glue System With Incidence of Allergic Dermatitis Post Unilateral and Staged Bilateral Total Knee Arthroplasty

“…Type IV hypersensitivity reactions are cell-mediated by CD4+ and CD8+ T cells, macrophages, and inflammatory cytokines. This results in direct tissue damage by T cells or indirectly by the release of enzymes [ 14 ]. Thus, upon re-exposure to the antigen during the second TKA or primary exposure in the presence of cross-reactivity in the case of the first knee, the immunologic memory is reactivated and a type IV hypersensitivity reaction occurs explaining the higher incidence of adverse reactions after the second TKA.…”

Hot Glue Gun Releasing Biocompatible Tissue Adhesive

“…An ideal bioadhesive should be liquid for ease of application but solidify quickly after administration . It should also maintain both adhesion and cohesion strength, biodegradability, elasticity, and biocompatibility . Here, we develop a medical glue gun concept in which a cylindrical bioadhesive polymer stick is inserted into a commercially available hot melt device.…”