Closure After Total Shoulder Arthroplasty: Subcuticular Closure With 2-Octyl Cyanoacrylate Versus 2-Octyl Cyanoacrylate With A Self-Adhering Mesh (Dermabond Prineo)
Phase: NA
Conditions: Shoulder Arthritis, Shoulder Arthropathy Associated With Other Conditions
Sponsor: Montefiore Medical Center

Title: 
Closure After Total Shoulder Arthroplasty: Subcuticular Closure with 2-Octyl 
Cyanoacrylate Versus 2-Octyl Cyanoacrylate With A Self-Adhering Mesh (Dermabond 
Prineo)
Authors:
Brandon Tauberg, MD; Konrad Gruson, MD; Brittany Schwartz, MD
Rationale and Context:
Despite the increasing incidence of total shoulder arthroplasty surgeries, including 
conventional and reverse arthroplasties, little has been published regarding adequate 
closure of the wounds, including acceptable scar formation. 
Background:
Shoulder arthroplasty, both conventional total shoulders and reverse total shoulders have 
been increasing in frequency in the United States. With over 2/3 of shoulder 
arthroplasties being performed in patients over the age of 65 and the FDA approval of the 
reverse shoulder in 2003, the number of shoulder arthroplasties has been growing faster 
than ever [1]. With amplified attention to shoulder arthroplasty, numerous advancements 
in prosthetics and surgical technique have recently been developed. However, very few 
studies have evaluated the process of total shoulder closure techniques and its 
relationship to quality of outcome regarding complications and aesthetics.
As newer methods of wound closure have been developed, the field of orthopaedic 
surgery has been slowly adapting, accepting alternative techniques in an attempt to 
improve cost and clinical outcomes such as decreased drainage, faster closures, and 
greater cosmetic appeal / patient satisfaction. Medical grade cyanoacrylates have been 
increasingly used for medical wound closures, such as 2-Octyl Cyanoacrylate (OCA), 
commonly referred to by its marketed name of Dermabond®. Orthopaedic surgery, 
plastic surgery, general surgery, etc. have been using this project over the past few years 
as an augment to wound closure. Numerous studies have looked at the use of dermabond 
in wound closure and have found benefits such as decreased surgical time, improved 
patient satisfaction, less wound drainage, and no difference in closing strength, scar 
appearance, or other complications [2-5]. Additionally, previous studies have 
demonstrated that Dermabond® has antimicrobial effects, being bactericidal to both gram 
positive and gram negative bacteria, including MRSA, E. coli, and S. epidermidis [6, 7]. 
As total shoulder arthroplasty procedures increase, the incidence of prosthetic joint 
infection has been rising as well, most recently at 0.8-1.46% of surgeries [8]. Closure 
with staples has been associated with a higher risk of wound infection, and currently, 
there is no standard closure for total shoulder arthroplasty, though a layered closure with 
OCA topical adhesive has been recommended [8]. In the orthopaedic literature, the use of 
IRB NUMBER: 2018-9370
IRB APPROVAL DATE: 06/11/2019
IRB NUMBER: 2018-9370
IRB APPROVAL DATE: 06/11/2019

OCA as an adjunct to wound closure has been more heavily evaluated in the joint 
reconstruction and trauma literature, especially for total knees and hips. When evaluating 
total knee arthroplasty utilizing OCA, Krebs et al showed it to be a faster technique of 
closure with no significant difference in length of stay or complications [9]. El Gazaar 
showed less wound drainage in total knees that used dermabond as an adjunct to wound 
closure with staples [10]. Total hip arthroplasty has also showed benefit when using OCA. 
Glennie et al showed than when using monocryl and dermabond versus staples for total 
hip closures, there was no significant difference in scar assessment, shorter time to 
closure, shorter hospital stay, and similar total cost [11]. Mudd et al looked at trauma 
patients after Kocher-Langenbach approaches closed with monocryl and dermabond 
versus staples, and found that the dermabond group had a shorter time until a dry incision, 
fewer post-op infections, and shorter time in the operating room that saved an average of 
$900 per surgery [12]. 
A new closure technique of OCA closure using a self-adhering mesh (Dermabond 
Prineo®) was developed that further decreased operative times and had similar outcomes. 
Parvizi et al showed benefits including that patients could shower immediately, could be 
removed easily with less pain after healing, forms a microbial barrier, provides even 
tension distribution across the wound, and reduced subcutaneous closure time compared 
to monocryl with steri strips [13]. Additionally, since the time in the operating room was 
less, the Prineo was found to be overall less expensive [13]. Richter et al also showed that 
while Prineo provided equivalent skin approximation compared to intradermal sutures, it 
was 4.5 times faster to apply and resulted with similar incision healing and cosmetic 
outcomes [14]. With positive results seen in the literature, Prineo dressings have been 
increasingly used in total hip and knee replacements. Holte et al evaluated a 2.5 year 
period with 360 consecutive primary total knees by one surgeon and showed that use of 
Prineo was successful for high tension total knee wounds, with no cases of wound 
dehiscence, operative intervention, or prosthetic joint infection [15]. Sutton evaluated the 
cost-effectiveness of Prineo compared to skin staples and found that Prineo was 
associated with a shorter length of stay, fewer discharges to rehab, and lower rates of all-
cause readmission [16]. 
The goal of this study is to compare conventional methods of wound closure after total 
shoulder arthroplasty, such as monocryl and dermabond, to a OCA mesh closure 
technique and evaluate its success. 
Objective and Hypothesis:
The objective is to compare two types of wound closure after total shoulder arthroplasty 
to determine which closure is faster, and subsequently if there are different outcomes 
between the two types of closures.
The objective of this study is to compare two types of wound closure after total shoulder 
arthroplasty procedures. A single fellowship trained shoulder surgeon will perform all 
procedures. We hypothesize that patients who undergo an OCA mesh closure will have a 
IRB NUMBER: 2018-9370
IRB APPROVAL DATE: 06/11/2019
IRB NUMBER: 2018-9370
IRB APPROVAL DATE: 06/11/2019

faster closure time, lower cost, non-inferior complication rate, and non-inferior patient 
satisfaction scores with respect to their postoperative follow up and scar appearance. 
Patients in the OCA mesh cohort will be compared to patients who have a closure with a 
running monocryl suture and dermabond. This investigation seeks to determine if OCA 
closure mesh closure is non-inferior to monocryl suture and dermabond in terms of 
operative time, cost, complications, and aesthetic appearance.
If the hypothesis is confirmed, this study will suggest that a OCA mesh closure may be 
used for total shoulder arthroplasty surgeries as an alternative to current conventional 
closures and may provide a cost benefit.
Specific Goal:
1) To specifically be able to make a recommendation of total shoulder wound 
closure based on complications, aesthetic result, time to closure, and cost
Specific Aims:
1) To compare the timing of total shoulder closure between OCA mesh and 
monocryl/dermabond closure
2) To compare the costs of the OCA mesh closure versus monocryl/dermabond
3) To compare the complications the OCA mesh closure versus 
monocryl/dermabond closure
4) To compare the healing and patient satisfaction of wounds between the OCA 
mesh closure versus monocryl/dermabond closure
Study Plan:
The study will be implemented at the Wakefield Campus of Montefiore medical center 
by randomizing patients undergoing total shoulder arthroplasty to receiving closure with 
monocryl and dermabond versus dermabond with self-adhering mesh. Participants will be 
subsequently followed for 3 months to evaluate wound healing and monitor for 
complications.
Methods:

Design – Prospective randomized intervention

Setting  - Wakefield Hospital of Montefiore Medical Center

Participants – Patients who agree to participate in the study undergoing total 
shoulder arthroplasty

Study Period 
o
Sample size – 22 patients

Determine using a standard between-groups sample size 
calculation with a type 1 error rate of 5% and 80% power to detect 
a moderate effect size (0.5 standard deviation)
o
Inclusion

Total shoulder arthroplasty

Reverse total shoulder arthroplasty
IRB NUMBER: 2018-9370
IRB APPROVAL DATE: 06/11/2019
IRB NUMBER: 2018-9370
IRB APPROVAL DATE: 06/11/2019


Age 18-100

Single Surgeon
o
Exclusion

Previous shoulder surgery

Known wound healing complications

DM, chronic steroid use, vascular insufficiency, morbid 
obesity (BMI>40), ESRD, family hx of pathologic scars

Patients on blood thinners (ASA 81mg ok)

Connective tissue disease

Allergy to skin adhesive

Mentally unable to complete questionnaires

Previous wound over planned incision

Measures
o
Time for closure
o
Cost of closure (time in OR, materials)
o
Wound cosmesis

Patient and Observer Scar Assessment Scale (POSAS) 
o
Wound complications (i.e. dehiscence)
o
Wound drainage
o
Infection (superficial vs. deep)
o
Length of stay in hospital

Endpoints
o
Primary endpoint is to determine which method of closure is faster
o
Secondary endpoints will include cost of closure, difference in wound 
complications, aesthetic differences, and difference in patient satisfaction

Independent Variables
o
Age
o
BMI
o
Race
o
Gender
o
Length of Incision
o
Depth of Incision
o
Prealbumin
o
Albumin
o
Glucose

Randomization and blinding
o
A random number generator will be used to assign patients to the study 
and control groups. Patients will not be notified which group they had 
been assigned to, though they may be able to determine which group they 
are in after looking at their wound. 
Study Protocol:
20 total shoulder replacement patients presenting to Wakefield Medical Center will be 
screened for eligibility according to the inclusion and exclusion criteria by study 
personnel. Medical history and demographic data will be collected and assessed to ensure 
IRB NUMBER: 2018-9370
IRB APPROVAL DATE: 06/11/2019
IRB NUMBER: 2018-9370
IRB APPROVAL DATE: 06/11/2019

that patients meet the inclusion and exclusion criteria. Eligible subjects will be enrolled 
after informed consent is obtained. 

Prospective Randomized Design
o
After determining a patients’ eligibility for inclusion, they will be 
randomized to the OCA mesh group or monocryl with dermabond group. 
After surgery, both groups will be seen at their 2 week, 6 week, and 3 
month appointment.

Surveys
o
At the 6 week, and 3 month follow up appointment both groups and the 
same surgeon will complete a patient observer and scar assessment scale 
survey
o
The Patient Observer and Scar Assessment Scale validated instrument 
created to measure patients and physician overall satisfaction with surgical 
wound appearance / healing [17]

Data Collection
o
For each enrolled subject, we will collect data from hospital presentation 
to discharge on standard demographics, routine laboratory results, clinical 
information, past medical history and hospital course data (length of stay, 
mobilization status, associated inpatient procedures and complications). 
Major complications are defined as: all-cause re-hospitalization, re-
hospitalization relating to index surgery, DVT, PE, deep wound infection, 
dislocation, fracture, death.  Minor complications include: UTI, delayed 
wound healing, superficial wound infection.  Complications resulting from 
the surgery will be distinguished from those resulting from pre-existing 
conditions and comorbid states.
o
All the data will be recorded and stored in a password-protected Excel 
spreadsheet on study personnel password-protected work computers.

Statistical Considerations
o
Power Analysis

Power Power analysis (IBM SPSS 21) was performed before the 
study at a level of 0.05 alpha error and 0.8 beta error. Looking at 
closure time of total shoulder arthroplasty wounds, looking for an 
effect size of 13 minutes between closure groups determined that a 
sample size of 2 patients in each group was adequate to detect 
significant differences in closure times between groups. Increasing 
group size to 5 patients in each group resulted in a power of 88% at 
an alpha of 0.05 and using 10 patients in each group resulted in 
100% power at an alpha of 0.05. 
Measures to address study aims:
To address specific aim 1: We will first measure the length of the incision and depth of 
the wound with a intraoperative flexible ruler prior to closure. We will assess the timing 
of closure in the operating room by the surgeon announcing the start of closure. At this 
time, the circulating nurse will start monitoring time with a stopwatch. Once the 
dressings are completely on, the surgeon will announce to end time and the circulating 
nurse will stop the stopwatch. The timing of closure will be recorded.
IRB NUMBER: 2018-9370
IRB APPROVAL DATE: 06/11/2019
IRB NUMBER: 2018-9370
IRB APPROVAL DATE: 06/11/2019

To address specific aim 2: We will compare the costs of the two closure methods by 
determining the cost of the medical supplies used for closure, as well as calculating the 
cost of the operating room time that was required for each closure. The sum of these costs 
will be the total cost of closure. 
To address specific aim 3: We will compare complications, including drainage and 
infection, between the groups over a 3 month period.
 
To address specific aim 4: We will compare POSAS scores between the study group and 
control group at the 6-week postoperative follow up visit and 3 month postoperative 
follow-up visit. 
Informed Consent
Informed consent procedure will take place during the preoperative consultation in the 
clinic setting or at any point during the hospital admission where the procedure is to be 
performed. This consent process will occur prior to the day of surgery. Study personnel 
including Dr. Brandon M. Tauberg, Dr. Konrad Gruson, or Dr. Brittany Schwartz will 
approach patients in a manner, time, and location that insure participant privacy. 
Information about the study will be conveyed to the participant in simple understandable 
English. The information that will be provided to prospective subjects will include the 
studies purpose, the risks associated with the study, the potential benefits of the study, 
study requirements, and a request for compliance with study procedures.
Ample time and opportunity for patients to consider all options and ask questions will be 
given before signing the informed consent form. All participants’ questions will be 
answered. Verbal confirmation that the participant has comprehended the information 
and options provided will be obtained through Talk Back technique.
Upon agreeing to participate in the study, patients will provide written consent using an 
IRB-approved informed consent document. Enrolled subjects will be provided with 
copies of signed consent documents. Efforts will be made to continue to provide 
information and options as the participant or research requires.
Safety Considerations
Total joint arthroplasty closure techniques vary widely based on surgeon preference and 
practices. In shoulder arthroplasty, closure with monocryl suture, dermabond, nylon 
suture, and staples have all been used. In total joint arthroplasty, OCA mesh closure is 
also used. Safety risks of the OCA mesh may include wound dehiscence, drainage, 
infection and need for re-operation. However, these risks are minimal and should not be 
significantly different in the control and study groups. If there is any concern that the 
OCA mesh is leading to increased complications, the study will be abandoned. 
Additionally, if there are indications of wound complications that need alternative 
treatment, including revision closure, the study will be abandoned. Pregnancy testing will 
be done as part of the normal preoperative labs in women of child-bearing age. 
IRB NUMBER: 2018-9370
IRB APPROVAL DATE: 06/11/2019
IRB NUMBER: 2018-9370
IRB APPROVAL DATE: 06/11/2019

Confidentiality of Research Records
Confidentiality will be protected by assigning a unique masked ID that will be linked to 
subjects’ identifiers (e.g., name). 
Storing documents in hard copy:
Any documents that contain PHI (e.g., consent forms, link between the ID to subjects’ 
identifiers, de-identified research documents) will be stored in a locked cabinet within the 
office of Dr. Konrad Gruson. IRB-approved study personnel will be the only individuals 
with access to any research documents containing PHI. 
Storing Documents Electronically
Any documents that contain PHI (e.g., consent forms, subject identifier/deidentifier table) 
will be stored in a password protected computer document on the primary investigator’s 
desktop computer. Only IRB approved personnel will be the only individuals with access 
to any research documents containing PHI. Randomization information will be kept in a 
password-protected file on the computer of Dr. Konrad Gruson.
Storing Documents on Portable Electronic Devices
No PHI or research data will be stored on any portable electronic devices (e.g., laptops, 
tablets, flash drives, etc.)
Emailing Data
Any research data that will be emailed will be de-identified and encrypted according to 
Montefiore Medical Center ITS department standards. PHI will not be emailed to any 
commercial email addresses.
Potential Benefits
The proposed potential benefits of this study may include faster surgical times, decreased 
operative costs, equivalent or improved complication rates, and improved patient 
satisfaction. There is evidence to support OCA mesh closure is faster and has similar 
complications. 
Follow-up procedures
The data collection period for each patient will begin during the preoperative visit and 
end after each patient completes the in clinic 3-month follow up visit and study surveys 
patient reported outcome scores will be followed indefinitely. 
Early termination/discontinuation of the study protocol
Once enrolled, patients may elect to discontinue participation in the study at any time, as 
per the language set forth in the consent document. Note: if randomized and subjects opt 
out afterwards, they will be in the intention to treat category. Patients who elect to leave 
the study will not be followed further and their data will be managed in an appropriate 
fashion. 
Data and Safety Monitoring
IRB NUMBER: 2018-9370
IRB APPROVAL DATE: 06/11/2019
IRB NUMBER: 2018-9370
IRB APPROVAL DATE: 06/11/2019

The signed assurances of the PI (Dr. Konrad Gruson) included in the CCI/IRB Research 
Application form, including the policy for reporting internal and external adverse events 
should constitute a sufficient plan. Additionally, as a single site and small numbers of 
study subjects, close monitoring every 3 months by the study investigators (Dr. Brandon 
Tauber and Dr. Brittany Schwartz) should be adequate as well. An independent data 
safety monitor will be appointed..
Project Management
Konrad Gruson, MD – Primary Investigator – will be responsible for the research 
protocol, study implementation plan, obtaining consent from eligible patients, and data 
analysis and interpretation
Brandon M. Tauberg, MD – Primary Resident Investigator – will be responsible for the 
research protocol, study implementation plan, subject screening, obtaining consent from 
eligible patients, data collection and analysis, and coordination between different 
departments and ancillary services.
Brittany Schwartz, MD – Secondary Resident Investigator - will be responsible for the 
research protocol, study implementation plan, subject screening, obtaining consent from 
eligible patients, data collection and analysis, and coordination between different 
departments and ancillary services.
Expected Outcomes
The expected Outcomes of this randomized prospective study is faster closure times and 
non-inferior complication rates with equivalent patient satisfaction for the OCA mesh 
group compared to the conventional closure group. There is no expected increase in 
adverse outcomes for the OSA mesh group.
Appendix:
See attachments
References:
1.
Kim, S.H., et al., Increasing incidence of shoulder arthroplasty in the United 
States. J Bone Joint Surg Am, 2011. 93(24): p. 2249-54.
2.
Martin, J.G., et al., Randomized Controlled Trial of Octyl Cyanoacrylate Skin 
Adhesive versus Subcuticular Suture for Skin Closure after Implantable Venous 
Port Placement. J Vasc Interv Radiol, 2017. 28(1): p. 111-116.
3.
Grimaldi, L., et al., Octyl-2-cyanoacrylate adhesive for skin closure: eight years 
experience. In Vivo, 2015. 29(1): p. 145-8.
4.
Imbuldeniya, A.M., A. Rashid, and J.P. Murphy, A comparison of 2-octyl 
cyanoacrylate with nylon for wound closure of knee arthroscopy portals. J Wound 
Care, 2014. 23(9): p. 456-8, 460.
5.
Freitas-Junior, R., et al., The use of 2-octyl cyanoacrylate or nylon suture for skin 
closure produces similar modifications in scar tissue (an animal model). J Plast 
Reconstr Aesthet Surg, 2008. 61(8): p. 990-2.
IRB NUMBER: 2018-9370
IRB APPROVAL DATE: 06/11/2019
IRB NUMBER: 2018-9370
IRB APPROVAL DATE: 06/11/2019

6.
Prince, D., et al., Antibacterial effect and proposed mechanism of action of a 
topical surgical adhesive. Am J Infect Control, 2018. 46(1): p. 26-29.
7.
Rushbrook, J.L., et al., The antibacterial effect of 2-octyl cyanoacrylate 
(Dermabond(R)) skin adhesive. J Infect Prev, 2014. 15(6): p. 236-239.
8.
Clark, J.J.C., et al., Preventing infection in shoulder surgery. J Shoulder Elbow 
Surg, 2018. 27(7): p. 1333-1341.
9.
Krebs, V.E., et al., Wound Closure Techniques for Total Knee Arthroplasty: An 
Evidence-Based Review of the Literature. J Arthroplasty, 2018. 33(2): p. 633-638.
10.
El-Gazzar, Y., et al., The use of dermabond(R) as an adjunct to wound closure 
after total knee arthroplasty: examining immediate post-operative wound 
drainage. J Arthroplasty, 2013. 28(4): p. 553-6.
11.
Glennie, R.A., et al., MONOCRYL and DERMABOND vs Staples in Total Hip 
Arthroplasty Performed Through a Lateral Skin Incision: A Randomized 
Controlled Trial Using a Patient-Centered Assessment Tool. J Arthroplasty, 2017. 
32(8): p. 2431-2435.
12.
Mudd, C.D., J.A. Boudreau, and B.R. Moed, A prospective randomized 
comparison of two skin closure techniques in acetabular fracture surgery. J 
Orthop Traumatol, 2014. 15(3): p. 189-94.
13.
Parvizi, D., et al., Use of 2-octyl cyanoacrylate together with a self-adhering mesh 
(Dermabond Prineo) for skin closure following abdominoplasty: an open, 
prospective, controlled, randomized, clinical study. Aesthetic Plast Surg, 2013. 
37(3): p. 529-37.
14.
Richter, D., et al., A comparison of a new skin closure device and intradermal 
sutures in the closure of full-thickness surgical incisions. Plast Reconstr Surg, 
2012. 130(4): p. 843-50.
15.
Holte, A.J., et al., Use of 2-Octyl Cyanoacrylate Adhesive and Polyester Mesh for 
Wound Closure in Primary Knee Arthroplasty. Orthopedics, 2017. 40(5): p. e784-
e787.
16.
Sutton, N., N.D. Schmitz, and S.S. Johnston, Economic and clinical comparison 
of 2-octyl cyanoacrylate/polymer mesh tape with skin staples in total knee 
replacement. J Wound Care, 2018. 27(Sup4): p. S12-S22.
1.
Kim, S.H., et al., Increasing incidence of shoulder arthroplasty in the United 
States. J Bone Joint Surg Am, 2011. 93(24): p. 2249-54.
2.
Martin, J.G., et al., Randomized Controlled Trial of Octyl Cyanoacrylate Skin 
Adhesive versus Subcuticular Suture for Skin Closure after Implantable Venous 
Port Placement. J Vasc Interv Radiol, 2017. 28(1): p. 111-116.
3.
Grimaldi, L., et al., Octyl-2-cyanoacrylate adhesive for skin closure: eight years 
experience. In Vivo, 2015. 29(1): p. 145-8.
4.
Imbuldeniya, A.M., A. Rashid, and J.P. Murphy, A comparison of 2-octyl 
cyanoacrylate with nylon for wound closure of knee arthroscopy portals. J Wound 
Care, 2014. 23(9): p. 456-8, 460.
5.
Freitas-Junior, R., et al., The use of 2-octyl cyanoacrylate or nylon suture for skin 
closure produces similar modifications in scar tissue (an animal model). J Plast 
Reconstr Aesthet Surg, 2008. 61(8): p. 990-2.
IRB NUMBER: 2018-9370
IRB APPROVAL DATE: 06/11/2019
IRB NUMBER: 2018-9370
IRB APPROVAL DATE: 06/11/2019

6.
Prince, D., et al., Antibacterial effect and proposed mechanism of action of a 
topical surgical adhesive. Am J Infect Control, 2018. 46(1): p. 26-29.
7.
Rushbrook, J.L., et al., The antibacterial effect of 2-octyl cyanoacrylate 
(Dermabond(R)) skin adhesive. J Infect Prev, 2014. 15(6): p. 236-239.
8.
Clark, J.J.C., et al., Preventing infection in shoulder surgery. J Shoulder Elbow 
Surg, 2018. 27(7): p. 1333-1341.
9.
Krebs, V.E., et al., Wound Closure Techniques for Total Knee Arthroplasty: An 
Evidence-Based Review of the Literature. J Arthroplasty, 2018. 33(2): p. 633-638.
10.
El-Gazzar, Y., et al., The use of dermabond(R) as an adjunct to wound closure 
after total knee arthroplasty: examining immediate post-operative wound 
drainage. J Arthroplasty, 2013. 28(4): p. 553-6.
11.
Glennie, R.A., et al., MONOCRYL and DERMABOND vs Staples in Total Hip 
Arthroplasty Performed Through a Lateral Skin Incision: A Randomized 
Controlled Trial Using a Patient-Centered Assessment Tool. J Arthroplasty, 2017. 
32(8): p. 2431-2435.
12.
Mudd, C.D., J.A. Boudreau, and B.R. Moed, A prospective randomized 
comparison of two skin closure techniques in acetabular fracture surgery. J 
Orthop Traumatol, 2014. 15(3): p. 189-94.
13.
Parvizi, D., et al., Use of 2-octyl cyanoacrylate together with a self-adhering mesh 
(Dermabond Prineo) for skin closure following abdominoplasty: an open, 
prospective, controlled, randomized, clinical study. Aesthetic Plast Surg, 2013. 
37(3): p. 529-37.
14.
Richter, D., et al., A comparison of a new skin closure device and intradermal 
sutures in the closure of full-thickness surgical incisions. Plast Reconstr Surg, 
2012. 130(4): p. 843-50.
15.
Holte, A.J., et al., Use of 2-Octyl Cyanoacrylate Adhesive and Polyester Mesh for 
Wound Closure in Primary Knee Arthroplasty. Orthopedics, 2017. 40(5): p. e784-
e787.
16.
Sutton, N., N.D. Schmitz, and S.S. Johnston, Economic and clinical comparison 
of 2-octyl cyanoacrylate/polymer mesh tape with skin staples in total knee 
replacement. J Wound Care, 2018. 27(Sup4): p. S12-S22.
17.
Draaijers, L.J., et al., The patient and observer scar assessment scale: a reliable 
and feasible tool for scar evaluation. Plast Reconstr Surg, 2004. 113(7): p. 1960-
5; discussion 1966-7.
IRB NUMBER: 2018-9370
IRB APPROVAL DATE: 06/11/2019
IRB NUMBER: 2018-9370
IRB APPROVAL DATE: 06/11/2019