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P A, Kumar K V, Ramachandraiah MK, Shanthappa AH. A Comparative Study of Wound Infections Following Wound Closure Using Staples and Absorbable Sutures Among Obese Patients Undergoing Lumbar Fusion Surgery. Cureus 2024; 16:e63254. [PMID: 39070402 PMCID: PMC11282352 DOI: 10.7759/cureus.63254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
Background Infections of the wounds, organs, or spaces that develop following surgery are known as surgical site infections (SSIs). The incidence of wound infections in obese patients undergoing lumbar spine surgery with the use of absorbable sutures versus staples for skin closure has not been studied previously. Materials and methods We conducted a retrospective observational study in our hospital where cases of lumbar spine surgery meeting the inclusion criteria were chosen retrospectively from March 2021 to March 2023. A total of 40 patients aged >18 years and <75 years who underwent lumbar spine surgery were covered by this investigation. Two cohorts with 20 patients in each were chosen from the population. Group A used a skin stapler to close wounds, whereas group B used absorbable sutures. The number of wound infections was the main result. Using SPSS version 23.0 (IBM SPSS Statistics, Armonk, NY), all data were analyzed after being entered into an Excel sheet (Microsoft Corp., Redmond, WA). Results A total of 40 participants were included in this study, and it revealed that there was no discernible variation in the groups' mean age or gender distribution. There is a significantly higher incidence of SSI in the absorbable suture group (35%) compared to the staple group (15%). The mean duration in days for the development of SSI in the absorbable suture group (9.86±2.12) was early compared to the staple group (12.67±2.08), which was statistically significant (p<0.05). Conclusion Compared to absorbable sutures, the current study showed a decreased incidence of surgical site infection in obese individuals receiving skin staples for wound closure.
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Affiliation(s)
- Akshay P
- Department of Orthopedics, Sri Devaraj Urs Medical College (SDUMC), Kolar, IND
| | - Vinod Kumar K
- Department of Orthopedics and Trauma, Sri Devaraj Urs Medical College (SDUMC), Kolar, IND
| | - Manoj K Ramachandraiah
- Department of Orthopedics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Arun H Shanthappa
- Department of Orthopedics, Sri Devaraj Urs Medical College (SDUMC), Kolar, IND
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Tang X, Shi W, Qian Y, Ge Z. Effect of suture closure and staple closure on postoperative wound complications in patients undergoing knee replacement surgery: A meta-analysis. Int Wound J 2024; 21:e14372. [PMID: 37679956 PMCID: PMC10782053 DOI: 10.1111/iwj.14372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
The purpose of this meta-analysis is to determine if the application of stitching in the closed area of the knee arthroplasty remains significantly superior to that of the staples. Data sources: EMBASE, Cochrane Libraryand, publications, and the Web of Science. Patients were treated with staples for closure of their wounds, or with conventional stitches for closure of wounds. The main findings were surgical site infection, wound dehiscence, and cutting time. The secondary results were the time to completion, the duration of the hospitalization, and the time to discharge. We incorporated the SIX trial into the meta-analyses with Review Manager V.5.3. The hazard ratio was computed as a therapeutic outcome with respect to the heterogeneity. For more than 50% of heterogeneous samples, we employed a stochastic effect model. The results showed that there was no significant difference in the degree of infection, the degree of dehiscence, the length of the cut and the degree of satisfaction of the wound. But the time to close the wound and the time to operate were significantly different. The time needed to close the wound was shorter than that of the suture (OR, -227. 22; 95% CI, -238. 74, -215. 69 p < 0. 0001); The time taken to replace the knee was also significantly lower among those who had been stapled sutures (OR, -5.46; 95% CI, -10. 43, -0.49 p = 0. 03). Wound closing materials are an afterthought for many orthopaedic surgeons. Together, the findings from a number of comparative studies indicate that the selection of wound closure materials might affect the outcome of the surgery. The evidence, however, is weak because of the heterogeneous approach adopted in earlier research. This study program is intended to provide guidance on how to select the best wound closure material for the purpose of identifying if there is any difference in the incidence of injuries among traditional stitches and staples.
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Affiliation(s)
- Xiongfei Tang
- Department of OrthopaedicsHaining People's HospitalHainingChina
| | - Wenfeng Shi
- Department of OrthopaedicsHaining People's HospitalHainingChina
| | - Yuening Qian
- Department of OrthopaedicsHaining People's HospitalHainingChina
| | - Zhen Ge
- Department of OrthopaedicsHaining People's HospitalHainingChina
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Aravindan S, Kim YJ, Tucker NJ, Heare A, Parry JA. The Routine Use of Running Subcuticular Closures in Orthopaedic Trauma Patients Does Not Increase Wound Complications. J Orthop Trauma 2023; 37:e153-e158. [PMID: 36729908 DOI: 10.1097/bot.0000000000002534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate whether the routine use of running subcuticular closures (RSC) in orthopaedic trauma patients increases the rate of wound complications and reoperations. DESIGN Retrospective comparative study. SETTING Urban Level 1 trauma center. PATIENTS/PARTICIPANTS Two hundred sixty-six patients undergoing orthopaedic trauma procedures between June 2020 and March 2022. INTERVENTION Adoption of an RSC protocol where any incision/wound that could be approximated with interrupted subcuticular 2-0 monofilament sutures was closed with a running subcuticular 3-0 monofilament suture. MAIN OUTCOME MEASUREMENTS Wound complications and subsequent reoperations. RESULTS With adoption of the RSC protocol, 91.0% of all orthopaedic trauma procedures were closed with RSC compared with 7.5% of the historical control group. There were no observed differences in the rate of wound complications (proportional difference (PD) 6.0%, confidence interval (CI) -2.3% to 14.1%; P = 0.15) or reoperations (PD 5.2%, CI -1.9% to 12.2%; P = 0.14) between the RSC and the control group. Wound complications were not associated with RSC on univariate analysis (PD 7.2%, CI -10.0% to 24.0%; P = 0.41). On multivariate analysis, an ASA>2 (odds ratio (OR) 2.4, CI 1.0 to 5.7; P = 0.03), lower extremity injuries (OR 4.9, CI 1.3 to 17.8; P = 0.01), and open reduction internal fixation procedures (OR 2.8, CI 1.1 to 7.2; P = 0.02) were found to be independently associated with wound complications. CONCLUSION RSC for orthopaedic trauma procedures was not associated with increased wound complications when compared a historical cohort. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Ye Joon Kim
- Department of Orthopaedics, Denver Health Medical Center, Denver, CO
| | - Nicholas J Tucker
- University of Colorado School of Medicine, Aurora, CO; and
- Department of Orthopaedics, Denver Health Medical Center, Denver, CO
| | - Austin Heare
- University of Colorado School of Medicine, Aurora, CO; and
- Department of Orthopaedics, Denver Health Medical Center, Denver, CO
| | - Joshua A Parry
- University of Colorado School of Medicine, Aurora, CO; and
- Department of Orthopaedics, Denver Health Medical Center, Denver, CO
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Is the Risk of Infection Lower with Sutures than with Staples for Skin Closure After Orthopaedic Surgery? A Meta-analysis of Randomized Trials. Clin Orthop Relat Res 2019; 477:922-937. [PMID: 30958392 PMCID: PMC6494321 DOI: 10.1097/corr.0000000000000690] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Two previous meta-analyses comparing staples versus sutures have led to conflicting relative risks for surgical site infection between skin closure methods after orthopaedic surgery. Consequently, the choice of sutures or staples for skin closure continues to be a subject of conversation. Recently, additional randomized trials have been published, and an updated meta-analysis is needed to inform this debate. QUESTIONS/PURPOSES To determine using a meta-analysis of randomized trials (1) whether there is a difference in surgical site infection (SSI) between staples and sutures for skin closure after orthopaedic surgery, and (2) whether that finding remains the same when the analysis is limited to randomized trials with a low risk of bias. METHODS A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing staples with sutures for skin closure after orthopaedic surgery was conducted. We excluded barbed sutures, surgical zippers, and skin adhesives from this meta-analysis. Medline, Embase, CINAHL, Cochrane Library, and Global Index Medicus were searched from date of inception to October 18, 2017. The sole outcome of interest was SSI as defined by the original study authors, with preference given to Center for Disease Control and Prevention (CDC) definitions whenever possible, recognizing that this may result in the pooling of more common minor events with rarer, more severe events, and in so doing, overestimate between-group differences. Because of this, subgroup analysis was planned based on severity of infection. Relative risk was calculated using a random-effects model (relative risk [RR], 95% confidence interval [CI]). Heterogeneity was estimated using I. Publication bias was explored using visual inspection of the funnel plot and Egger's test. Subgroup analysis was planned for type of orthopaedic surgery, suture material, SSI category, and country development index. Subgroup interaction p values were calculated. The Cochrane risk of bias tool was used to assess study quality. Sensitivity analysis was planned to assess whether the results changed when the analysis was limited to studies with low risk of bias. In total, 17 RCTs (2446 patients) were eligible, of which five RCTs (501 patients) were at low risk of bias. RESULTS In the primary analysis, patients randomized to staples had a higher risk of SSI versus those who received sutures for skin closure (RR, 2.05; 95% CI,1.38-3.06; I = 0%). However, most of the events were driven by superficial SSI, and only two deep infections were explicitly reported in total (one in each group). After a post-hoc sensitivity analysis excluded a highly influential trial with high risk of bias, the results were highly fragile, relying on a difference of only four additional events in the staples group. When we limited the analysis to RCTs with low risk of bias, no difference was found between sutures and staples in terms of SSI (RR, 1.45; 95% CI, 0.31-6.79; I = 46%). Effect sizes were consistent across subgroups (p value for subgroup interaction was not significant for elective versus trauma; hip versus knee arthroplasty; suture material; high versus middle- versus low-income settings). CONCLUSIONS Even in this relatively large meta-analysis, existing RCTs do not provide definitive evidence of a difference in SSI risk when staples are used instead of sutures for skin closure after orthopaedic surgery. Currently, the total body of evidence remains weak and, even when limiting to only low risk of bias studies, it is not possible to rule in or rule out clinically important differences between staples and sutures. Until randomized studies of adequate power and followup duration are performed to definitively inform this issue, the choice between staples versus sutures should be based on other factors such as local availability, surgeon preference, and cost. LEVEL OF EVIDENCE Level I, therapeutic study.
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A Prospective Comparative Study Between Subcuticular and Sutureless Technique of Skin Closure Following External Dacryocystorhinostomy. Ophthalmic Plast Reconstr Surg 2018; 35:318-321. [PMID: 30550503 DOI: 10.1097/iop.0000000000001235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare the cosmetic outcome of the surgical scar of external dacryocystorhinostomy by the subcuticular versus sutureless technique. METHODS This was a prospective interventional randomized control study conducted at tertiary level hospital. Fifty patients of primary-acquired nasolacrimal duct obstruction were included in this study. The control group patients underwent the technique of wound closure in 2 layers, subcutaneous interrupted suture with 6-0 vicryl and superficial skin with 6-0 prolene continuous subcuticular sutures. In the case group, interrupted subcutaneous sutures with 6-0 vicryl with Steristrip for skin apposition was used. The surgical scars were assessed and graded by still photographs on a computer screen by 2 independent observers unaware of the surgical technique used at 2, 6 and 12 weeks postoperatively. RESULTS The mean scar assessment score by the 2 observers were 2.60 (0.57), 2.04 (0.64), and 1.16 (0.89) in control group and 2.02 (0.65), 1.44 (0.70), and 0.44 (0.61) in case group at 2, 6, and 12 weeks, respectively. Scar grades were analyzed using chi-square test between the 2 group and Wilcoxon signed rank test within the group. The difference between the 2 groups were found to be statistically significant at 2, 6, and 12 weeks (P < 0.05). Thus, the technique of wound closure with steristrip lead to comparatively less scarring as compared with subcuticular technique. CONCLUSION The authors recommend the sutureless technique of wound closure using steristrip in Ext DCR as it has superior cosmetic results as compared with subcuticular technique of external dacryocystorhinostomy.
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Staple versus suture closure for ankle fracture fixation: Retrospective chart review for safety and outcomes. Foot (Edinb) 2018; 37:71-76. [PMID: 30326415 DOI: 10.1016/j.foot.2018.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/25/2018] [Accepted: 08/17/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION/AIM Recent comparisons of suture versus metal staple skin closure on the rates of wound complications in orthopaedic surgeries have yielded conflicting results. Several studies have since started to approach this question based on anatomic location, comparing suture versus staple closure in total hip and knee arthroplasty and acetabulum fracture surgery. Ankle fractures are one of the most commonly treated fractures by orthopaedic surgeons with unique challenges to skin closure due to the lack of subcutaneous support. However, to date there are no studies comparing superficial skin closure methods specifically in ankle surgery. The objective of this study was to evaluate the safety of staple versus suture closure for open fixation of acute traumatic ankle fractures. METHODS The medical records of patients treated at one institution by a single surgeon with open surgical fixation of an acute traumatic ankle fracture between 2011 and 2017 were retrospectively reviewed. Patients with less than 6 months of follow-up, polytrauma patients, diabetic patients, and patients with more than 3 medical comorbidities were excluded. Skin closure technique was determined by the presence or absence of metallic staples on postoperative imaging. Demographic variables, surgical characteristics, and postoperative outcomes up to one year were compared between patients who received superficial skin closure using staple versus suture techniques. Statistical analysis was performed using chi-squared tests and Fisher's exact tests, with p=0.05 used to denote statistical significance. RESULTS This study included 94 patients aged 18 to 75: two groups of 47 patients (Staple group and Suture group) that were demographically similar at baseline. Overweight and obese patients constituted the majority of the sample, 34% and 46% of patients, respectively. Current tobacco use was reported by 45% of patients. Fractures tended to be right-sided (63%), low energy (64%), and closed (98%), and the most common fracture types were bimalleolar (30%), lateral malleolar (24%), and pilon (19%) fractures. Ten patients (10.6%) developed local wound related complications within 4 months postoperatively, including five incidences of wound dehiscence, four superficial wound infections, and one deep infection. Eight patients (8.5%) required revision surgery due to wound related complications. There was no difference in the incidence of surgical site infections (p=0.361), local wound related complications (p=0.316), or revision surgeries (p=0.267) between wound closure techniques. Suture group patients required more staff in the operating room compared with staple group patients (p=0.001). CONCLUSION These results suggest that staples are a safe alternative to sutures for superficial skin closure in healthy, non-diabetic patients following open surgical fixation of acute traumatic ankle fractures. However, this retrospective, single-institution study was limited by the low number of available patients relative to the rare outcomes of interest. Larger, prospective studies are needed to validate the accuracy and generalizability of these results.
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Krishnan R, MacNeil SD, Malvankar-Mehta MS. Comparing sutures versus staples for skin closure after orthopaedic surgery: systematic review and meta-analysis. BMJ Open 2016; 6:e009257. [PMID: 26792213 PMCID: PMC4735308 DOI: 10.1136/bmjopen-2015-009257] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To determine whether there still remains a significant advantage in the use of sutures to staples for orthopaedic skin closure in adult patients. DESIGN Systematic Review/ Meta-Analysis. DATA SOURCES MEDLINE-OVID, EMBASE-OVID, CINAHL and Cochrane Library. Grey and unpublished literature was also explored by searching: International Clinical Trial Registry, Grey Matters BIOSIS Previews, Networked Digital Library of Theses and Dissertations, ClinicalTrials.gov, UK Clinical Trials Gateway, UK Clinical Research Network Study Portfolio, Open Grey, Grey Literature Report, and Web of Science. SELECTION CRITERIA Articles were from any country, written in English and published after 1950. We included all randomised control trials and observational studies comparing adults (≥ 18 years) undergoing orthopaedic surgery who either received staples or sutures for skin closure. The primary outcome was the incidence of surgical site infection. Secondary outcomes included closure time, inflammation, length of stay, pain, abscess formation, necrosis, discharge, wound dehiscence, allergic reaction and health-related quality of life. RESULTS 13 studies were included in our cumulative meta-analysis conducted using Review Manager V.5.0. The risk ratio was computed as a measure of the treatment effect taking into account heterogeneity. Random-effect models were applied. There was no significant difference in infection comparing sutures to staples. The cumulative relative risk was 1.06 (0.46 to 2.44). In addition, there was no difference in infection comparing sutures to staples in hip and knee surgery, respectively. Lastly, except for closure time, there was no significant difference in secondary outcomes comparing sutures to staples. CONCLUSIONS Except for closure time, there was no significant difference in superficial infection and secondary outcomes comparing sutures to staples was found. Given that there may in fact be no difference in effect between the two skin closure and the methodological limitations of included studies, authors should begin to consider the economic and logistic implications of using staples or sutures for skin closure. PROSPERO REGISTRATION NUMBER CRD42015017481.
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Affiliation(s)
- Rohin Krishnan
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - S Danielle MacNeil
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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Gkegkes ID, Mavros MN, Alexiou VG, Peppas G, Athanasiou S, Falagas ME. Adhesive strips for the closure of surgical incisional sites: a systematic review and meta-analysis. Surg Innov 2011; 19:145-55. [PMID: 21926099 DOI: 10.1177/1553350611418989] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The authors evaluated the available evidence regarding the use of adhesive strips for the management of surgical incisions and compared them with sutures and other closure materials. Study design. Systematic review and meta-analysis of randomized controlled trials (RCTs). RESULTS Twelve RCTs studying 1317 incisions in 1023 patients were included. No difference was found regarding the development of infection (odds ratio [OR] = 0.47; 95% Confidence interval [CI] = 0.12-1.85), dehiscence (OR = 1.22; 95% CI = 0.32-4.64), and overall cosmetic result (standardized mean difference = 0.01; 95% CI = -0.19 to 0.20). Closure with strips resulted in significantly lower incidence of redness (OR = 0.57; 95% CI = 0.37-0.89). The available data on pain, need for resuturing, swelling, patient satisfaction, and closure time with the use of strips could not be synthesized; however, regarding the latter 2 outcomes, application of strips seemed favorable. There was significant heterogeneity among the studies. CONCLUSIONS The findings suggest that adhesive strips may be an efficient closure material for certain small-length incisions. Further research is warranted on outcomes such as dehiscence and the need for resuturing.
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Juergens S, Maune C, Kezze F, Mohr T, Scheuer K, Mallmann P. A randomized, controlled study comparing the cosmetic outcome of a new wound closure device with Prolene suture closing caesarean wounds. Int Wound J 2011; 8:329-35. [PMID: 21615866 DOI: 10.1111/j.1742-481x.2011.00789.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A prospective, randomised study was conducted to compare the wound closure performance and cosmetic outcome of caesarean section wounds closed with traditional Prolene suture or a new wound closure device (Leukosan(®) SkinLink). Sixty-one patients referred to primary section were allocated to wound closure with either Leukosan(®) SkinLink or Prolene suture. Cosmetic outcome as the primary measure was evaluated by the patient, the surgeon as well as by independent examiners blinded to the method of wound closure. Evaluations were recorded at 3, 6 and 12 months following wound closure. Both methods of wound closure scored equally high on the visual analogue scale for cosmetic evaluation at the 3-, 6- and 12-month follow-ups as assessed by the patient, surgeon and the blinded observers. The study has shown that innovative methods for wound closure compared with traditional methods such as suture providing excellent cosmetic results represent a valid alternative to physician and patient for surgical incisions.
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Affiliation(s)
- Sven Juergens
- Department of Gynaecology and Obstetrics, University of Cologne, 50924 Cologne, Germany.
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Lazar HL, McCann J, Fitzgerald CA, Cabral HJ. Adhesive Strips Versus Subcuticular Suture for Mediansternotomy Wound Closure. J Card Surg 2011; 26:344-7. [DOI: 10.1111/j.1540-8191.2011.01257.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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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Closure of hip wound, clips or subcuticular sutures: does it make a difference? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2006; 16:124-129. [PMID: 28755123 DOI: 10.1007/s00590-005-0043-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2005] [Accepted: 10/13/2005] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to investigate wound healing and complications following surgery for fracture neck of femur. Seventy-one patients were prospectively divided into two groups, according to the method of skin closure: group A had clips; group B had subcuticular vicryl® sutures. There were 41 patients in group A, and 30 patients in group B. There were 13 males and 58 females with an average age of 84.3 years (range 67-100 years). Thirty-seven patients underwent fixation with a dynamic hip screw, while 34 had undergone either a hemi or total hip arthroplasty. The wounds were inspected at days 2, 5, 7, 10 and 14 days, for discharge, redness and infection. There was a statistically significantly greater amount of wound discharge (P<0.002) and redness (P<0.009) in group A (clips) as compared to group B (vicryl). There were three cases of infection; all in patients where clips had been used for skin closure. We concluded that subcuticular vicryl sutures were significantly better than clips in terms of wound healing as well as cost. Except for some decrease in operative time there does not seem to be any advantage in the use of clips for wound closure.
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Abstract
BACKGROUND The absorbable continuous subcuticular suture is frequently used to close surgical incisions where the aim is healing by primary intention. A form of adhesive surgical tape is commonly also placed over the wound but this combination closure seems to have its development based on anecdotal, rather than experimental evidence. The present study reviews the scientific literature on the development of sutureless wound closure and presents the current evidence for the use of combination wound closure. METHODS Review was undertaken of the medical literature using the PubMed Internet database and cross-referencing major -articles on the subject. The following combinations of key words were searched: skin closure, wound closure, suture technique, sutureless, adhesive tape, op-site, staples, subcuticular suture, complication, infection and scars. RESULTS Taped closure alone has advantages of lower wound infection rates and greater wound tensile strength, but disadvantages of epidermal reaction, skin edge inversion, doubtful safety and time required for meticulous surgical technique. The use of the continuous absorbable subcuticular suture allows accurate skin edge approximation, which increases the safety margin. The combination closure has a slightly superior cosmetic result to sutureless techniques but no study has been performed to compare the results of combination subcuticular suture and tape, with tape or subcuticular suture alone. CONCLUSIONS There is no evidence in the scientific literature to justify or support the practice of closing a surgical wound with both subcuticular suture and adhesive surgical tape.
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Affiliation(s)
- Jeremy D Kolt
- Sandringham and District Memorial Hospital, Melbourne, Victoria, Australia.
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Wolterbeek JH, van Leeuwen AAM, Breslau PJ. Skin closure after infrainguinal bypass surgery: a prospective randomised study. Eur J Vasc Endovasc Surg 2002; 23:321-4. [PMID: 11991693 DOI: 10.1053/ejvs.2001.1593] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND PURPOSE wound complications after infrainguinal bypass surgery occur frequently and may jeopardise an underlying graft. The purpose of this study was to investigate the role of suture material in the occurrence of wound complications. METHODS prospective randomised trial. 170 consecutive patients underwent femoro-popliteal or femoro-tibial bypass surgery and were randomised between wound closure with continuous polyamide sutures (Ethilon) or with skin staples. RESULTS ten patients were excluded because of re-intervention or death within 2 weeks after operation. The wound was closed with a continuous polyamide suture (Ethilon) in 77 patients and with metallic skin staples in 83 patients. The groups were comparable in age, use of corticosteroids, occurrence of diabetes mellitus and operation time. Skin closing time was significantly shorter in the staples group (6.4 min versus 2.7 min, p<0.001). Overall, there were no significant differences between continuous polyamide sutures and metallic skin staples in superficial infections (8% versus 2%), deep infections (1% versus 1%), serous leakage or haematoma. CONCLUSION we found no significant differences in the incidence of wound complications in infrainguinal bypass surgery comparing continuous polyamide (Ethilon) and skin staples. The time needed for wound closure was significantly reduced using metallic staples, but this had no effect on the total operation time. Choices of closing materials should be guided by surgeon's preference.
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Affiliation(s)
- J H Wolterbeek
- Red Cross Hospital, Department of Surgery, The Hague, The Netherlands
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