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Biswas S, McMenemy L, Sarkar V, MacArthur J, Snowdon E, Tetlow C, George KJ. Natural language processing for the automated detection of intra-operative elements in lumbar spine surgery. Front Surg 2023; 10:1271775. [PMID: 38164290 PMCID: PMC10757971 DOI: 10.3389/fsurg.2023.1271775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
Background The aim of this study was to develop natural language processing (NLP) algorithms to conduct automated identification of incidental durotomy, wound drains, and the use of sutures or skin clips for wound closure, in free text operative notes of patients following lumbar surgery. Methods A single-centre retrospective case series analysis was conducted between January 2015 and June 2022, analysing operative notes of patients aged >18 years who underwent a primary lumbar discectomy and/or decompression at any lumbar level. Extreme gradient-boosting NLP algorithms were developed and assessed on five performance metrics: accuracy, area under receiver-operating curve (AUC), positive predictive value (PPV), specificity, and Brier score. Results A total of 942 patients were used in the training set and 235 patients, in the testing set. The average age of the cohort was 53.900 ± 16.153 years, with a female predominance of 616 patients (52.3%). The models achieved an aggregate accuracy of >91%, a specificity of >91%, a PPV of >84%, an AUC of >0.933, and a Brier score loss of ≤0.082. The decision curve analysis also revealed that these NLP algorithms possessed great clinical net benefit at all possible threshold probabilities. Global and local model interpretation analyses further highlighted relevant clinically useful features (words) important in classifying the presence of each entity appropriately. Conclusions These NLP algorithms can help monitor surgical performance and complications in an automated fashion by identifying and classifying the presence of various intra-operative elements in lumbar spine surgery.
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Affiliation(s)
- Sayan Biswas
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Lareyna McMenemy
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Ved Sarkar
- College of Letters and Sciences, University of California, Berkeley, CA, United States
| | - Joshua MacArthur
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Ella Snowdon
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Callum Tetlow
- Division of Data Science, The Northern Care Alliance NHS Group, Manchester, United Kingdom
| | - K. Joshi George
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Manchester, United Kingdom
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Contact Dermatitis in the Surgical Patient: A Focus on Wound Closure Materials. Dermatitis 2022; 34:191-200. [PMID: 35481860 DOI: 10.1097/der.0000000000000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Irritant and allergic contact dermatitis from wound closure materials can occur in patients after surgical procedures. The resulting inflammation from contact dermatitis can compromise wound healing, mimic surgical site infections, and result in wound dehiscence. Components of wound closure material, such as antibiotic coatings, dyes, sterilizing compounds, or the material itself, have been implicated as contact allergens. This article provides the latest overview of the components of 3 major forms of wound closure materials-sutures, staples, and tissue adhesives-associated with contact dermatitis, discusses their cross-reactivity, and provides diagnostic and treatment guidelines.
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Cochetti G, Abraha I, Randolph J, Montedori A, Boni A, Arezzo A, Mazza E, Rossi De Vermandois JA, Cirocchi R, Mearini E. Surgical wound closure by staples or sutures?: Systematic review. Medicine (Baltimore) 2020; 99:e20573. [PMID: 32569183 PMCID: PMC7310845 DOI: 10.1097/md.0000000000020573] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
AIM To compare the effects of sutures and staples for skin closure of surgical wounds. MATERIAL AND METHODS We included published and unpublished randomized controlled trials (RCTs) and cluster-randomized trials comparing staples with sutures. Patients were adults (aged 18 years or over) who had undergone any type of surgery. The primary outcomes were risk of overall and severe wound infection. Secondary outcomes included length of hospital stay, readmission rate, adverse events, patient satisfaction with cosmetic results, postoperative pain. RESULTS Forty-two very low to low quality RCTs with a total of 11,067 patients were included. Sutures resulted in slightly fewer overall wound infections (4.90%) compared to staples (6.75%) but it is uncertain whether there is a difference between the groups (risk ratio [RR] 1.20, 95% confidence intervals [CI] 0.80-1.79; patients = 9864; studies = 34; I = 70%). The evidence was also insufficient to state a difference in terms of severe wound infection (staples 1.4% vs sutures 1.3%; RR 1.08, 95% CI 0.61-1.89; patients = 3036; studies = 17; I = 0%), grade of satisfaction (RR 0.99, 95% CI 0.91-1.07; patients = 3243; studies = 14; I = 67%) and hospital stay. Staples may increase the risk of adverse events (7.3% for staples vs 3.5% for sutures; RR 2.00, 95% CI 1.44-2.79; patients = 6246; studies = 21; I = 33%), readmission rate (RR 1.28, 95% CI 0.18-9.05; patients = 2466; studies = 5; I = 66%) and postoperative pain (standardized mean difference [SMD] 0.41,95%CI -0.35 to 1.16; I = 88%, patients = 390 patients, studies = 5). CONCLUSIONS Due to the lack of high quality evidence, we could not state if sutures are better than staples in terms of wound infection, readmission rate, adverse events, and postoperative pain. With a low quality of evidence, sutures reduce postoperative pain and improve grade of satisfaction with the cosmetic outcome.
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Affiliation(s)
- Giovanni Cochetti
- Department of Surgical and Biomedical Sciences, University of Perugia
| | - Iosief Abraha
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Justus Randolph
- Tift College of Education, Mercer University, Atlanta, GA, USA
| | | | - Andrea Boni
- Department of Surgical and Biomedical Sciences, University of Perugia
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin
| | - Elena Mazza
- Department of Surgical Sciences, University of Torino, Turin
| | | | - Roberto Cirocchi
- Department of General Surgery, University of Perugia, Terni, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, University of Perugia
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de Vries CE, Dekker AC, van Veen R, van der Zeeuw FT, Coblijn UK, Brölmann FE, van Wagensveld BA. Trocar port scar quality in morbidly obese patients after bariatric surgery. Surg Obes Relat Dis 2018; 14:616-622. [DOI: 10.1016/j.soard.2018.01.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/08/2018] [Accepted: 01/25/2018] [Indexed: 12/29/2022]
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Abstract
BACKGROUND Traumatic lacerations to the skin represent a fairly common reason for seeking emergency department care. Although the incidence of lacerations has decreased over the past decades, traumatic cutaneous lacerations remain a common reason for patients to seek emergency department care. OBJECTIVE Innovations in laceration management have the potential to improve patient experience with this common presentation. DISCUSSION Studies have confirmed that delays in wound closure rarely confer increased rates of infection, although comorbidities such as diabetes, chronic renal failure, obesity, human immunodeficiency virus, smoking, and cancer should be considered. Antibiotics should be reserved for high-risk wounds, such as those with comorbidities, gross contamination, involvement of deeper structures, stellate wounds, and selected bite wounds. Topical anesthetics, which are painless to apply, have a role in select populations. In most studies, absorbable sutures perform similarly to nonabsorbable sutures and do not require revisit for removal. Novel atraumatic closure devices and expanded use of tissue adhesives for wounds under tension further erode the primacy of regular sutures in wound closure. Maintaining a moist wound environment with occlusive dressings is more important than previously thought. Most topical wound agents are of limited benefit. CONCLUSIONS Recent innovations in wound closure are allowing emergency physicians to shift toward painless, atraumatic, and rapid closure of lacerations.
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A bioinspired elastin-based protein for a cytocompatible underwater adhesive. Biomaterials 2017; 124:116-125. [DOI: 10.1016/j.biomaterials.2017.01.034] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/20/2016] [Accepted: 01/27/2017] [Indexed: 01/04/2023]
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Comparison of Skin Staples and Standard Sutures for Closing Incisions After Head and Neck Cancer Surgery: A Double-Blind, Randomized and Prospective Study. J Maxillofac Oral Surg 2015; 15:243-50. [PMID: 27298549 DOI: 10.1007/s12663-015-0809-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/13/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To investigate the merits and demerits of stapled skin closure when compared to conventional sutures in head and neck cancer surgery. MATERIALS AND METHODS A total of 80 patients (40 patients each in control and study group) were enrolled. The patients underwent closure of incision wounds following head and neck cancer surgical procedures. Skin incisions were closed with sutures using 3-0 silk in control group and with stainless steel staples in study group. Both the groups were compared for speed of closure, cost effectiveness, pain on removal, patient comfort, aesthetic outcome on day of removal, 15 and 30 days after day of removal and complications. RESULTS The mean incision length in control group was 54 ± 16.3 cm while in study group was 53.7 ± 15.4 cm which was statistically not significant (P = 0.95). The mean time of closure in control group was 34.2 ± 12 min while in study group was 3.3 ± 1.2 min which was statistically highly significant (P < 0.001). The mean cost of material for skin closure in control group was Rs. 270.0 ± 46.4 and in study group was Rs. 517.5 ± 135.7 which was also statistically highly significant (P < 0.001). CONCLUSION It was concluded that skin staples are better alternatives to conventional sutures in head and neck cancer surgery as they offer ten times faster wound closure, cost effectiveness, and similar results to sutures in terms of patient comfort, aesthetic outcome and complication rate.
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Ozturk D, Sonmez BM, Altinbilek E, Kavalci C, Arslan ED, Akay S. A retrospective observational study comparing hair apposition technique, suturing and stapling for scalp lacerations. World J Emerg Surg 2013; 8:27. [PMID: 23885743 PMCID: PMC3745645 DOI: 10.1186/1749-7922-8-27] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 07/24/2013] [Indexed: 11/23/2022] Open
Abstract
Aim Scalp lacerations are commonly encountered in patients presenting to emergency department with trauma. Lacerations are repaired with suturing, stapling, adhesive tapes, and tissue adhesives. In this study, we aimed to compare the effectiveness of suturing, stapling, and hair apposition techniques used in repair of scalp lacerations in patients who presented to emergency department with scalp laceration. Materials and method After obtaining approval of local ethics committee, we examined the effects of the three technique used to repair scalp lacerations on wound healing, complication rate, and patient satisfaction by recording data. Categorical variables were expressed as n and %. X2 test was used for statistical analysis. A p value less than 0.05 was accepted statistically significant. Results Our study included a total of 134 patients of whom were treated 37 (27.6%) with hair apposition technique 49, 48 (35.8%) with suturing, and (36.6%) with stapling. There was a significant difference between the scalp repair technique and 7th and 15th day patient satisfaction rates in favor of the hair apposition technique (p < 0.05). There was a significant difference between the scalp repair technique and cosmetic problems after 15 days (p < 0.05). Cosmetic problems 15 days after the procedure were significantly lower in the hair apposition technique. Conclusion In patients presenting to emergency departments with linear scalp laceration suturing, stapling, and hair apposition techniques can be safely applied. However, hair apposition technique has the advantages of being more satisfying, and having lower cosmetic problem and complication rates compared with other techniques.
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Affiliation(s)
- Derya Ozturk
- Numune Training and Research Hospital, Emergency Department, Ankara, Turkey
| | | | | | - Cemil Kavalci
- Numune Training and Research Hospital, Emergency Department, Ankara, Turkey
| | - Engin Deniz Arslan
- Numune Training and Research Hospital, Emergency Department, Ankara, Turkey
| | - Serhat Akay
- Numune Training and Research Hospital, Emergency Department, Ankara, Turkey
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Dignon A, Arnett N. Which is the better method of wound closure in patients undergoing hip or knee replacement surgery: sutures or skin clips? J Perioper Pract 2013; 23:72-6. [PMID: 23691882 DOI: 10.1177/175045891302300402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Surgical wound closure plays an important part in any procedure and there are a considerable number of closure techniques in use today. This literature review will discuss the use of skin clips (staples) and sutures as used in an orthopaedic setting, specifically among patients having hip or knee replacement surgery. This subject has generated a considerable amount of debate and both types of closure are widely used. We were therefore interested in which technique had a lower incidence of infection.
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Affiliation(s)
- Andrée Dignon
- Department of Nursing and Health Studies, Coventry University, Priory Street. Coventry. CV1 5FR.
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Abstract
BACKGROUND Wound closure accounts for a relatively constant portion of the time required to complete a surgical case. Both longer closure times and wound infections contribute to higher medical costs and patient morbidity. QUESTIONS/PURPOSES We therefore determined whether (1) biologic and treatment factors greater influenced wound healing than the choice of sutures or staples; and (2) different times to closure affected cost when sutures or staples are used in patients with musculoskeletal tumors. METHODS We retrospectively reviewed 511 patients who had sarcoma resections of the buttock, thigh, and femur from 2003 to 2010; 376 had closure with sutures and 135 with staples. Data were abstracted on patient demographics, comorbidities, select procedural data, and wound complications. Wound complications were defined by hospitalization within 6 months postoperatively for a wound problem, irrigation and débridement, or infection treated with antibiotics. We determined the association between staples versus sutures and wound complications after controlling for confounding factors. The minimum followup was 2 weeks. A prospective, timed analysis of wounds closed with either sutures or staples was also performed. RESULTS We found an association between obesity and radiation and wound complications. Wounds were closed an average of 5.3 minutes faster with staples than with suture (0.29 minutes versus 5.6 minutes, respectively), saving a mean 2.1% of the total operating time although the total operating time was similar in the two groups. CONCLUSIONS We found no difference in wound complications after closure with sutures or staples, although obesity and radiation treatment appear to affect wound outcomes. Data suggest that time saved in the operating room by closing with staples compensates for added material costs and does not compromise wound care in patients with lower extremity sarcomas. LEVEL OF EVIDENCE Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Bré LP, Zheng Y, Pêgo AP, Wang W. Taking tissue adhesives to the future: from traditional synthetic to new biomimetic approaches. Biomater Sci 2013; 1:239-253. [DOI: 10.1039/c2bm00121g] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Zempsky WT, Zehrer CL, Lyle CT, Hedbloom EC. Economic comparison of methods of wound closure: wound closure strips vs. sutures and wound adhesives. Int Wound J 2006; 2:272-81. [PMID: 16618333 PMCID: PMC7951558 DOI: 10.1111/j.1742-4801.2005.00130.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Our objective was to review and assess the treatment of low-tension wounds and evaluate the cost-effectiveness of wound closure methods. We used a health economic model to estimate cost/closure of adhesive wound closure strips, tissue adhesives and sutures. The model incorporated cost-driving variables: application time, costs and the likelihood and costs of dehiscence and infection. The model was populated with variable estimates derived from the literature. Cost estimates and cosmetic results were compared. Parameter values were estimated using national healthcare and labour statistics. Sensitivity analyses were used to verify the results. Our analysis suggests that adhesive wound closure strips had the lowest average cost per laceration ($7.54), the lowest cost per infected laceration ($53.40) and the lowest cost per laceration with dehiscence ($25.40). The costs for sutures were $24.11, $69.91 and $41.91, respectively; the costs for tissue adhesives were $28.77, $74.68 and $46.68, respectively. The cosmetic outcome for all three treatments was equivalent. We conclude adhesive wound closure strips were both a cost-saving and a cost-effective alternative to sutures and tissue adhesives in the closure of low-tension lacerations.
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Affiliation(s)
- William T Zempsky
- Department of Pediatrics, Connecticut Children's Medical Center, University of Connecticut School of Medicine, 282 Washington Street, Hartford, CT 06106, USA.
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Khan ANGA, Dayan PS, Miller S, Rosen M, Rubin DH. Cosmetic outcome of scalp wound closure with staples in the pediatric emergency department: a prospective, randomized trial. Pediatr Emerg Care 2002; 18:171-3. [PMID: 12066001 DOI: 10.1097/00006565-200206000-00005] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study is to compare the cosmetic outcome of scalp wound closure with staples to traditional skin sutures. METHODS A prospective, randomized trial was conducted using a convenience sample of children (aged 1-16 y) with simple scalp lacerations admitted to the pediatric emergency department. After parental consent was obtained, patients were randomly assigned to either a stapling or suturing procedure. A trained attending physician completed the procedure following a standard protocol. Based on previously published data, a sample size of 18 patients per group was calculated to give 85% power to detect a 10% difference on a visual analogue scale (VAS) score (two-sided alpha 0.05). Initial outcome of wound healing at 7 to 10 days and final cosmetic outcome after 6 to 18 months were estimated using a VAS. Cosmetic outcome was assessed by a physician blinded to the procedure. Data were analyzed using SPSS (Version 8.02; SPSS Inc., Chicago, IL). The VAS scores for the two treatment groups were compared using the two-tailed Student t test. Analysis of age, race, mode of injury, time interval, and size of the wound were performed to estimate the strength of the association of VAS score with the treatment, adjusted for the covariates. RESULTS A total of 42 patients were enrolled. Of the 42, 38 (90.5%) finished the initial follow-up and 31 of those 38 (81.6%) finished the final follow-up. There were no significant demographic differences between groups at recruitment and first follow-up. Among those patients who completed the final follow-up, 15 underwent stapling, and 16 underwent suturing. There were no significant demographic or baseline differences between the groups. Procedure time was significantly lower in the stapling group (P = 0.001). Final follow-up evaluations were completed in 12 +/- 4 months. The mean VAS scores at first and final follow-up were 78.75 +/- 16.16 and 96.31 +/- 8.06 for the suturing group and 86.67 +/- 9.76 and 97 +/- 7.02 for the stapling group (P = 0.17). There remained no significant difference in the final follow-up VAS score between groups when adjusted for covariates. CONCLUSION Stapling appears to be a fast and cosmetically acceptable alternative to suturing for simple scalp lacerations.
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Affiliation(s)
- Abu N G A Khan
- Department of Pediatrics, Babies Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA.
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Nayduch DA. Trauma Wound Management. Nurs Clin North Am 1999. [DOI: 10.1016/s0029-6465(22)02428-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Kanegaye JT, McCaslin RI. Pediatric scalp laceration repair complicated by skin staple migration. Am J Emerg Med 1999; 17:157-9. [PMID: 10102317 DOI: 10.1016/s0735-6757(99)90051-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Skin staples are ideal for pediatric scalp laceration closure because of their rapidity of placement and economy and ease of use. We report two cases of rotatory staple migration necessitating improvised removal techniques. Clinicians should be alert for this complication, which may result from a combination of staple design, local anatomic factors, superficial placement, and prolonged delay prior to removal.
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Affiliation(s)
- J T Kanegaye
- Division of Emergency Medicine, Children's Hospital and Health Center, San Diego, CA 92123, USA
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Johnson RG, Cohn WE, Thurer RL, McCarthy JR, Sirois CA, Weintraub RM. Cutaneous closure after cardiac operations: a controlled, randomized, prospective comparison of intradermal versus staple closures. Ann Surg 1997; 226:606-12. [PMID: 9389394 PMCID: PMC1191122 DOI: 10.1097/00000658-199711000-00005] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine the difference in wound complication and infection rates between suture and staple closure techniques applied to clean incisions in coronary bypass patients. BACKGROUND The true incidence of postoperative wound complications, and their correlation with closure techniques, has been obscured by study designs incorporating small numbers, retrospective short follow-up, uncontrolled host factors, and narrowly defined complications. METHODS Sternal and leg wounds were studied prospectively, each patient serving as his or her own control. Two hundred forty-two patients with sternal and saphenous vein harvest wounds had half of each wound closed with staples and the other half with intradermal sutures (484 sternal and 516 leg segments). Wound complications were defined as drainage, erythema, separation, necrosis, seroma, or infection. Infections were identified in the subset having purulent drainage, antibiotic therapy, or debridement. Wounds were examined at discharge, at 1 week after discharge, and at 3 to 4 weeks after operation. Patient preferences for closure type were assessed 3 to 4 weeks after operation. RESULTS Neither leg nor sternal wounds had a statistically significant difference in infection rate according to closure method (leg sutured = 9.3% vs. leg stapled = 8.9%; p = 0.99, and sternal sutured = 0.4% vs. sternal stapled = 2.5%; p = 0.128). There was, however, a greater complication rate in stapled segments (leg stapled = 46.9% vs. leg sutured = 32.6%; p = 0.001, and sternal stapled = 14.9% vs. sternal sutured = 3.7%; p = 0.00005). Sutures were favored over staples among patients who expressed a preference (sternal = 75.6%, leg = 74.6%). CONCLUSIONS With the host factors controlled by pairing staples and sutures in each patient, we demonstrated a similar incidence of infection but a significantly lower incidence of total wound complications with intradermal suture closure than with staple closure.
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Affiliation(s)
- R G Johnson
- Department of Surgery of Beth Israel Hospital, Harvard Medical School, Boston, Massachusetts 02215, USA
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Kanegaye JT, Vance CW, Chan L, Schonfeld N. Comparison of skin stapling devices and standard sutures for pediatric scalp lacerations: a randomized study of cost and time benefits. J Pediatr 1997; 130:808-13. [PMID: 9152292 DOI: 10.1016/s0022-3476(97)80025-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To compare the total costs and the physician time requirements for suture and staple repair of pediatric scalp lacerations. STUDY DESIGN Eighty-eight children, 13 months to 16 years of age, coming to a children's hospital emergency department with simple scalp lacerations were prospectively randomly selected to receive staple or suture repair. Wound lengths, times required for initial wound care and closure, and equipment use were recorded. Patients returned in 1 week for suture or staple removal and wound reevaluation. The two methods were compared in terms of both time expended and costs of equipment and physician compensation. RESULTS Forty-five children underwent staple repair and 43 underwent suture repair. There were no differences in age, sex, wound length, number of sutures or staples per centimeter, or physician experience. Stapling resulted in shorter wound closure times (65 vs 397 seconds; p < 0.0001) and shorter overall times for wound care and closure (395 vs 752 seconds; p < 0.0001). Staple repair was less expensive in terms of equipment ($12.55 vs $17.59; p < 0.0001) and total cost based on equipment and physician time ($23.55 vs $38.51; p < 0.0001). The follow-up rate was 91%, with no cosmetic or infectious complications in either group. CONCLUSIONS Stapling is faster and less expensive than suturing in the repair of uncomplicated pediatric scalp lacerations, with no additional complications. Physicians who treat children with scalp lacerations should consider the use of stapling devices.
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Affiliation(s)
- J T Kanegaye
- Division of Emergency Medicine, Childrens Hospital of Los Angeles, California, USA
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