Primary Wound Closure
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Primary wound closure is an important step in the management of clean open wounds. Sutures or staples are 2 leading options for primary intention. Recent evidence is adding to our understanding of the risks and benefits of these 2 wound closure modalities, but we still have much to learn in order to choose the best material and closure techniques for specific wounds. This Evidence Corner reviews 2 studies on very different wounds. The results suggest that the choice of primary intention wound closure may depend on a wide array of variables in closure techniques, patients, and the type of wound being closed, as well as the measured outcomes.
Sutures or Staples For Closing Cardiovascular Surgery Wounds
Reference: Sanni A, Dunning J. Staples or sutures for chest and leg wounds following cardiovascular surgery. Interact Cardiovasc Thorac Surg. 2007;6(2):243–246. (Available at: http://icvts.ctsnetjournals.org/cgi/content/full/6/2/243. Accessed August 24, 2007).
Rationale: Sutures or staples offer different advantages as wound closure techniques.Their effects on wounds have been explored in randomized controlled trials sufficient to present a position on the best available evidence for minimizing infections in cardiovascular surgical wounds of the leg or chest.
Objective: Use a structured protocol to determine whether using sutures or staples for wound closure on closed cardiovascular surgical wounds of the leg and chest reduce wound infection rates.
Methods: The authors searched the MEDLINE reference database from 1960 to 2006 for experimental studies investigating the terms cardiac or thoracic related to coronary bypass graft or coronary artery bypass graft surgery (CABG) surgery combined with the terms suture, staple, skin closure, wound closure, or intracutaneous or transcutaneous. The search terms wound or infection were also used. Of 119 abstracts found, 9 were relevant to overall surgery, including 5 prospective, randomized, controlled trials (RCTs) relevant to wound closure of cardiovascular surgical wounds of the leg and chest.
Results: The only statistically significant differences in reported infection rates were a lower median number of infections with sutures than with staples for overall infections (1 study), and fewer superficial infections (1 study). One study reported a borderline reduction in infections in sutured versus stapled chest wounds (P = 0.06).Three studies reported no difference in infection rates between sutures and staples. In addition, there was a lower median wound discharge with sutures than staples (1 study), fewer leg and chest complications with sutures compared to staples (1 study), improved cosmetic results with Dexon continuous subcuticular sutures than with staples (1 study), and 3 studies reporting no difference on cosmetic results between sutures or staples. One study reported less time to close wounds with staples than with sutures.
Authors’ Conclusions: Three of 5 RCTs reported reduced complications using sutures as compared to staples to close cardiovascular wounds of the chest or leg.The other 2 RTCs found no difference between sutures and staples. Suture closure was concluded to be superior to staple closure for these wounds.
Staples Versus Sutures for Ileocolic Anastomoses
1. Ali A,Tait N, Sanfilippo F. Gs27p techniques for closure of midline abdominal incisions. ANZ J Surg. 2007;77(Suppl 1):A32.
2. Velmahos GC,Vassiliu P,Demetriades D, et al.Wound management after colon injury: open or closed? A prospective randomized trial. Am Surg. 2002;68(9):795–801.
3. Al-Abdullah T, Plint AC, Fergusson D. Absorbable versus nonabsorbable sutures in the management of traumatic lacerations and surgical wounds: a meta-analysis. Pediatr Emerg Care. 2007;23(5):339–344.