Impact of Two-Octyl Cyanoacrylate on Surgical Site Infections After Lower-Extremity Dermatologic Procedures: A 10-Year Retrospective Study

BACKGROUND Surgical site infections after lower extremity dermatologic procedures increase morbidity, recovery time, and health care costs. This study examined whether the introduction of a skin adhesive closure method influenced infection rates and antibiotic use over a 10-year period. PATIENTS AND METHODS The authors performed a single-center retrospective cohort analysis of adult patients undergoing lower-leg dermatologic surgery between 2013 and 2023. The 3 cohorts were procedures before adhesive availability closed with sutures only, after adhesive availability closed with sutures, and after adhesive availability closed with the adhesive material. The primary outcome was occurrence of surgical site infection within 30 days, confirmed by culture or clinical signs. Secondary outcomes included incidence of prophylactic and postoperative antibiotic prescriptions, wound closure length, and Mohs micrographic stages. RESULTS Introduction of adhesive was associated with a decrease in confirmed surgical site infections from 4.78% to 1.94% ( p = .0156) and clinically suspected infections from 7.96% to 3.16% ( p = .0008). Prophylactic antibiotic use dropped from 86.31% to 77.40% ( p = .0011), and postoperative antibiotics from 7.96% to 3.04% ( p = .0005). Closure length decreased from 6.59 cm to 5.07 cm ( p = .003), and Mohs stages decreased by 0.13 stages ( p < .001). CONCLUSION Skin adhesive correlated with reduced infection rates, antibiotic use, and more efficient procedures in lower-extremity dermatologic surgery.