Stapler versus polyamide sutures for skin closure for sternal wounds in coronary artery bypass graft surgery – our experience

Abstract

Introduction: Patients undergoing coronary artery bypass graft surgery constitute a large population of patients with anatomically similar incisions created under similar circumstances. Aim: Our study aimed at analysing and comparing rates of surgical site infections (SSIs) at the sternotomy sites based on the material used for skin closure of the sternal wound with special emphasis on presence of risk factors such as diabetes (glycated haemoglobin (HbA 1c) > 9) and obesity (body mass index (BMI) > 30 kg/m 2) in the 2 respective groups. Material and methods: This is a retrospective observational study. A total of 864 patients were included in the study. The patients were grouped into 2 groups depending on the sternal wound closure strategy used. One group consisted of patients in whom polyamide sutures were used for skin closure, while the other group comprised patients in whom skin staples were used for skin closure. Incidence of sternal wound SSIs in both groups was noted. Co-morbid conditions such as diabetes mellitus (with HbA1c > 9) and obesity (BMI > 30 kg/m 2) were noted and analysed as contributory factors for SSIs. Results: Group A comprised 432 patients out of whom 42 (9.72%) had sternal wound SSIs. Group B comprised the other 432 patients of whom only 20 (4.62%) developed sternal wound SSIs. Co-morbid conditions were analysed in each group. Group A showed SSI in 22/64 (34.3%) diabetic patients, 6/28 (21.8%) obese patients and 16/22 (72.72%) with diabetes and obesity. Group B showed SSIs in 6/56 (10.715) diabetics, 4/26 (6.01%) obese and 4/24 (16.67%) with diabetes and obesity. Conclusions: By pairing staples and sutures, we observed a significantly lower incidence of total wound complications with suture than with staple closure.

A meta‐analysis examined the effect of topical vancomycin application in decreasing sternal wound infections post cardiac surgery

“…Twenty‐three thousand seven hundred and forty five participants with CS were enrolled in the chosen studies; 8730 of them used TV, while 15 015 served as controls. From a total of 1054 applicable studies that were appraised, 10 papers between 1989 and 2022 that met the inclusion criteria and were encompassed in the meta‐analysis were selected 7,14‐22 …”

“…The occurrence of deep SWIs post CS the use of TV compared with control criteria and were encompassed in the meta-analysis were selected. 7,[14][15][16][17][18][19][20][21][22] The TV had significantly lower SWIs post CS (OR, 0.34; 95% CI, 0.20-0.57; P < .001) with moderate heterogeneity (I2 = 62%), and deep SWIs post CS (OR, 0.26; 95% CI, 0.11-0.65; P = .004) with moderate heterogeneity (I2 = 65%) compared with control as shown in Figures 2 and 3. However, there was no significant difference found between TV and control in superficial SWIs post CS (OR, 0.30; 95% CI, 0.07-1.30; P = .011) with moderate heterogeneity (I2 = 68%) as shown in Figure 4.…”

“…At the start of the investigations, 23 745 participants had CS at the start of the examination; 8730 of them used TV, while 15 015 were control. 7,[14][15][16][17][18][19][20][21][22] The TV had significantly lower SWIs, and deep SWIs post CS compared with control. However, there was no significant difference found between TV and control in superficial SWIs post CS.…”

“…At the start of the investigations, 23 745 participants had CS at the start of the examination; 8730 of them used TV, while 15 015 were control 7,14‐22 . The TV had significantly lower SWIs, and deep SWIs post CS compared with control.…”

Single-blind, randomized study comparing clinical equivalence of trulene and prolene polypropylene sutures in elective primary coronary artery bypass graft surgery

“…A recent review demonstrated the common reason for readmissions after 30 days of CABG were infection and sepsis (6.9–28.6%), cardiac arrhythmia (4.5–26.7%), congestive heart failure (5.8–15.7%), respiratory complications (1–20%) and pleural effusion (0.4–22.5%) [ 25 ]. A study done by Jadhao et al compared incidence of sternal wound SSIs among stapler and polyamide suture groups, and found higher incidence of SSIs in stapler group (9.72%) than the polyamide suture group (7.17%) [ 26 ]. In the present study, incidence of superficial SSI was recorded by 6 th week post-DOD in one subject of the Trulene® group.…”