A Revolutionary Advance in Skin Closure Compared to Current Methods

Abstract

Six pigs were used to evaluate the influence of three separate modalities on contaminated wounds. Full-thickness skin wounds on the abdomen were contaminated with 10(4) or 10(5) Staphylococcus aureus and then closed with one of three methods. The three closure modalities included (1) a new absorbable staple (Insorb) placed in the subcuticular tissue, (2) a braided Vicryl suture, and (3) percutaneous metal staples. Any foreign body material implanted in tissue increases the risk of infection at that site. Wound closure always involves the use of a foreign body. Historically, sutures have been the primary material used to close tissue. The newer synthetic sutures are significangly more biodegradable and cause less infection than sutures composed of protein, such as silk and catgut. Metal staples are also associated with a low risk of infection. Recently, Incisive Surgical, Inc. (Plymouth, Minnesota) has developed an absorbable polymer staple specifically for subcuticular skin closure. The purpose of this study was to compare the new Insorb staple to both an absorbable polymer suture and a metal staple. Wound infection was assessed 7 days after closure by clinical signs and quantitative bacterial swabs. The results demonstrated that wounds closed with Insorb staples had the lowest incidence (33%) of infection, followed by percutaneous metal staples (44%). All wounds (100%) closed with Vicryl suture became infected. The incidence of wound infection directly correlated with the level of quantitative bacterial count at analysis. The Insorb staple was associated with significantly reduced closure time, less inflammation and infection, and better aesthetic result compared to Vicryl. Compared to metal staples, the Insorb subcuticular staplers demonstrated comparable closure time without the need for later staple removal. In conclusion, the closure of contaminated wounds with the Insorb staples is a superior choice to Vicryl suture because they have a significantly (p = 0.009) lower incidence of infection. The Insorb staple is a revolutionary advance in subcuticular skin stapling.

Cutaneous wound closure materials: An overview and update

“…[29] Their disadvantages include high retention of package shape, difficult handling, knot insecurity, and potentially cutting through tissue [Table 3]. [30]…”

“…By contrast, contaminated wounds closed by non-braided sutures showed a significantly reduced incidence of wound infection. [30] Many surgeons prefer non-absorbable monofilament sutures for their easy gliding through tissue, easy handling, minimal inflammatory response and unlikeliness to break prematurely. [29] Other surgeons prefer absorbable sutures because there is no need for suture removal, and they save time and decrease patient anxiety and discomfort.…”

First Application of an Absorbable Skin Stapler in Peripheral Vascular Surgical Procedures

“…Widely adopted are transcutaneous non-absorbable sutures, absorbable sutures and metal staples. Since 2005, a new technique was developed using subcuticular absorbable staples of polylactic/polyglycolic copolymer (comparable with braided absorbable threads such as Vicryl™), named Insorb™ Absorbable Skin Stapler (Incisive Surgical Inc., Plymouth, MN, USA) [1].…”

“…Metal staples cause skin irritation and require removal [12,14]. The puncture holes result in scarring, as well [1]. Although absorbable staples seem to cause some short-term patient discomfort they also proved to have advantages over metal staples [14].…”

Skin closure with subcuticular absorbable staples after cesarean section is associated with decreased analgesic use

“…In animal models, this method of skin closure has shown less histological inXammation [9] and fewer wound infections than either surgical steel staples or subcuticular suture [10]. Unfortunately, little is known about how this skin closure technique compares to the other more established techniques after cesarean delivery in humans.…”