Medications including corticosteroids, transplant anti-rejection medications, disease-modifying anti-rheumatic drugs warfarin, asprin, clopidogrel and heparin were noted by patient report. Medical comorbidities affecting wound healing including: diabetes, peripheral vascular disease, renal failure requiring dialysis, liver failure and inflammatory arthritis were identified. The aim of this pilot study was to: determine the sample size required to definitively prove the superiority of sutures or staples for wound closure in orthopaedic surgical procedures in terms of reducing wound complications.īaseline parameters including age, weight, height were collected. Available studies report rates of between 13% and 60%. More importantly, great uncertainty exists surrounding the incidence of all infectious and non-infectious wound complications after open orthopaedic procedures. However, no comparative trial exists that has the statistical power to determine if the rate of infection in wounds closed with staples is different from that in wounds closed with sutures in orthopedic procedures. Additionally, the included studies employed heterogeneous outcome definitions drawing into question the generalizability of the meta-analysis.Īnimal studies have shown the mechanical equivalence of stapled and sutured wounds, and clinical studies in several specialties have also failed to show superiority of the cosmetic appearance of stapled or sutured wounds. The ensuing debate surrounding the results of this meta-analysis has pointed out that the included studies did not uniformly employ experimental designs that limit bias. A recent meta-analysis comparing staples to sutures in orthopaedic wound closure demonstrated a three-fold increase in infections in stapled wounds compared with sutured wounds. Most surgeons choose a method of closure based on training, past experiences, and convenience. Few research studies address the burden that these complications such as wound drainage, wound necrosis, dehiscence and blistering place on patients, office staff and the healthcare system as a whole. A potentially more insidious post-operative occurrence are the minor complication(s) faced by patients related to their wound closure. Orthopedic SSIs can prolong hospital stay by a median of two weeks per patient and increased healthcare costs by more than 300% per case. Two-hundred and ninety-thousand SSIs occur in the United States annually following elective orthopedic surgery resulting in $1 billion to $10 billionadditional healthcare costs according to CDC estimates. Surgical site infections (SSIs) are one of the most common, and most important, nosocomial infections in post-operative patients. Trial registrationĬ identifier NCT01146236 (registered June 14, 2010) It was demonstrated that suturing skin requires more time and staples are more painful to remove. This study suggests that 42% of patients report a wound complication with no difference between sutures and staples. Patients in the staple group (mean=3.7, CI =2.8–4.6) reported more pain with removal than suture group (mean=2.5, CI =1.6–3.4). The time to close wounds was shorter in the staple group (mean=4.8 min, CI = 2.6–7.1) than the suture group (mean=12 min, CI = 7.9–16). The total number of patients reporting a wound complication was 59 of 148 patients completing six-week followup (41%), with no differennce between sutures and staples (RR = 0.77, CI = 0.52–1.14). Time to close and pain with removal of closure material were compared using a Student’s t-test. The incidence of complications was compared using Fisher’s exact test. Wounds were assessed for complications for six weeks. MethodsĮligible adult orthopaedic patients were randomized to have wounds closed with sutures or staples. The aim of this study was to compare sutures and staples in terms of: incidence of wound complications to determine the sample size for a definitive trial comparing wound closure methods. Less clear is the effect of closure material on the incidence of non-infectious wound complications. However, the findings of a recent meta-analysis suggest that the rate of surgical site infections (SSIs) is increased by using staples to close surgical wounds. In the spectrum of surgical decision-making, wound closure material is often an afterthought.
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