Comparative Study of Skin Closure in Hip Surgery

Abstract

A prospective, randomized controlled study was performed to compare skin staplers for closure of skin following hip surgery. Patients were randomized to have their skin closed with either continuous subcuticular non‐absorbable polypropylene ‘prolene’ suture (33 patients) or metal skin staples (Autosuture ‘Premium’ or Davis and Geck ‘Oppose’; 33 patients). All patients received prophylactic cephalosporin (Cephalothin) in pre‐ and postoperative antibiotic therapy. The wounds were examined daily and the presence of discharge, wound dehiscence and infection were noted. Any discharge at 7 days was swabbed for microbiological examination. The final cosmetic appearance was assessed at 8–12 weeks postoperatively. Scar length and width were measured and the presence of cross‐hatching noted. Wound dehiscence occurred in 1 patient (closed with staples). Wound infection developed in 2 patients at a rate of 3% (1 patient from each group). At final review (8–12 weeks postop.), the scar produced by subcuticular prolene was narrower than that produced by the skin stapler (P < 0.05). There was no significant difference in scar width between a wound which had staples removed at 10 days post operation and one where the staples were removed at 14 days. Staple insertion sites were more obvious in scars that had had the staples removed at the later time (P < 0.05).

The impact of different methods of wound closure and dressing on the rate of wound infection in patients with fracture of the neck of femur

“…In the present study cosmetic results were not examined, the investigators were solely interested in wound infection rates. Clayer and Southwood (1991) found no advantage of subcuticular suture over skin clips. Ranaboldo and RoweJones (1992) concluded that clips were resistant to infection when used in contaminated wounds.…”

Modality of wound closure after total knee replacement: are staples as safe as sutures? A retrospective study of 181 patients

“…In a prospective randomized comparative study of sutures versus staples in skin closure of 66 hip surgery procedures, the only noted difference between techniques was better cosmesis with sutures[10]. Khan et al in 2006 compared subcuticular suture, skin staples and 2-octylcyanoacrylate for closure of wounds after hip and knee replacements and found similar results with both sutures and staples[2].…”

Staples Equal Sutures for Skin Closure After Soft Tissue Tumor Resection

“…A series of prospective studies revealed inconsistent results, even among those comparing procedures at the hip [3,7,18,19,21]. A meta-analysis of several studies showed three times higher risk of infection with staples, but according to the authors, only ''one study met acceptable methodologic criteria'' [20].…”

“…Nonetheless, because the largest incision served as a marker for the site of excision or resection of the primary tumor, using these criteria allowed us to investigate the role of radiation and other tumor characteristics on wound outcomes. Sixth, although other studies have evaluated the impact of closure with staples on pain and cosmesis [3,7], we did not use patient surveys or other methods to document subjective results. Capturing these metrics was not among the goals of this study but does reflect a necessary consideration when making clinical decisions.…”

“…Initially this decision was guided solely by physician preference; however, as concerns about cost, poor wound outcomes, and patient satisfaction have become increasingly important, attention has been focused on demonstrating a clear benefit of one method over the other to guide practice [3,7,9,[18][19][20][21]. No clear advantage between sutures or staples has been demonstrated, and authors have attempted to show the advantages of each method.…”