Two methods of skin closure in abdominal operations: A controlled clinical trial

Abstract

Operative bacterial contamination of surgical wounds is common. The ability of the host to eradicate these bacteria and prevent subsequent wound infection is affected by a number of factors; one of these has been shown experimentally to be the presence of suture material in the subcutaneous tissues. In a prospective randomized controlled clinical trial in 341 abdominal operations we compared the primary infection rates after two methods of skin closure: either vertical mattress monofilament nylon sutures (182 patients) or steel clips which penetrated only the dermis (159 patients). All patients received a single dose of a cephalosporin intravenously at induction of anaesthesia and neither sutures nor drains were placed in the subcutaneous plane. The overall wound infection rate in the sutured wounds was 17.0 per cent, compared with 6.3 per cent in those closed by clips (X2 = 9.26, P less than 0.01). We conclude that skin closure with clips reduces the incidence of wound infection in patients in whom operative parietal contamination has occurred.

Sutures versus staples for skin closure in orthopaedic surgery: meta-analysis

“…2 Early studies had suggested that the incidence of wound infection might be reduced with staples because of the mechanism of fixation. Johnson et al 19 21 Our findings, however, suggested the contrarynamely, that wounds closed with staples rather than sutures have four times the risk of infection. Whether this is a consequence of the clip being metallic rather than vicryl or nylon material or whether the tension developed through a mattress suture closure is superior to that of staples in reducing the incidence of opening the wound during mobilisation remains unclear.…”

Staples Compared With Subcuticular Suture for Skin Closure After Cesarean Delivery

“…Staple closure gained popularity in the 1980s when initial studies in general surgery demonstrated shorter operating times and reduction in wound infection. 24 It was hypothesized that staples may cause less damage to the wound's defenses than sutures that act as foreign bodies. 25 surgery failed to confirm a beneficial effect of staple closure for preventing wound infections.…”

Sutures Versus Staplers for Skin Closure of Midline Incision in Laparotomy Patients and Their Outcome

“…A recent survey of German abdominal surgeons demonstrated found that 79% used staplers to close the skin with remaining using either absorbable or non-absorbable suture [6]. Five randomised controlled trials dating from 1981 to 1992 have already been conducted to assess the outcome of staplers versus sutures for skin closure on superficial surgical site infection, pain, operation time and cosmetic outcome in patients who underwent abdominal surgery, three of the trials compared interrupted mattress sutures to staples [7,8,9], and two compared intracutaneous sutures versus staplers [10,11], including a comparison of different suture materials [11], while in the Pickford trial [9] the infection rate was significantly lower in favour of staplers (6.3% vs 17%), however, no significant difference could be demonstrated in the trials of Eldrup [7] and Gatt [8].The two trials comparing intracutaneous sutures to staples showed no significant difference regarding the incidence of superficial surgical site infections. Moreover, the suture material was proven to be of no impact [11].…”