Comparative Study of Outcome of two Methods (Sutures Vs Staples) of Skin Closure in Orthopedic Surgery

Abstract

Introduction: Surgical site wound closure plays vital role in post-operative success. The use of either sutures or staples for skin approximation is a frequently debated issue. We compared the outcome of using staples versus sutures in elective orthopedic surgical procedures. Material and Methods: Study was conducted in tertiary care teaching hospital in central India over a period of 2 years which included all patients aged between 18 to 80 years undergoing elective open surgeries. Computer generated random number randomized them in two groups. Skin closure was done by either monofilament nylon or metallic staples. The wounds were assessed for infection, wound dehiscence, pain during removal on the basis of VAS pain scale. Follow up was done in the 6th week in terms of patient satisfaction using visual analogue scale (VAS) and validated cosmesis scoring system Hollander Wound Evaluation Score (HWES). Results : Total 503 wounds were included in this study (262 in suture and 241 in staple groups), 14 (5.3%) wounds were culture positive in the suture group within 8th postoperative day as compared to 36(14.9%) in staples group with χ2 9.65 and (p=0.002) which is significant. 320 wounds with >10cms incision were analyzed (166 in suture and 154 in staple group) out of which 12 (7.22%) were infected in suture group and 24 (15.5%) in staple group with χ2 was 7.6 and (p=0.006) that statistically significant. Conclusion:We found a statistically significant higher incidence of superficial wound infection following skin closure by metallic staples as compared to monofilament nylon.

Is the Risk of Infection Lower with Sutures than with Staples for Skin Closure After Orthopaedic Surgery? A Meta-analysis of Randomized Trials

“…Three trials included only trauma patients [16,24,28]. Eight trials involved heterogeneous populations, including elective, trauma, and otherwise non-specified patients [5,11,17,22,26,27,29,34]. One trial stratified results by THA and TKA [17] (Table 1).…”

“…Nonabsorbable sutures were used in eight studies [3,5,11,15,22,24,29,34] and absorbable sutures were used in five studies [8,12,17,26,28]. Two studies used both suture materials [27,39] (Table 1; Table 4…”

“…Blinding was largely absent as a result of the nature of the interventions being studied. Only three articles made some effort to blind the participants, outcome assessors, or the data analyst [11,17,27]. High risk for attrition bias was noted in one study [27].…”

“…This suggests that for every 34 patients receiving staples instead of sutures for skin closure, there will be one additional SSI within 1 year of surgery (Table 3). One trial contributed heavily toward the overall effect due to its high incidence of SSIs [11]. Because this trial had a high risk of bias and a very high event rate (in both study arms) relative to the other studies, we performed a post-hoc sensitivity analysis to exclude this study.…”

“…These potential risk factors for SSI would suggest the need for adjusted or subgroup analysis; however, they were not performed, thus limiting confidence in the two currently available systematic review and meta-analyses. Furthermore, since the most recent meta-analysis [20], several additional randomized controlled trials (RCTs) have been identified [3,11,15,16,23,26,29]. Consequently, an updated meta-analysis is warranted to assess whether current RCT evidence supports the superiority of staples or sutures for wound closure after orthopaedic surgery, or whether more research is needed before definitive clinical recommendations can be made regarding SSI reduction.…”