Comparative study of leg wound skin closure in coronary artery bypass graft operations.

Abstract

A prospective randomised study of four different methods of leg wound skin closure after removal of the long saphenous vein was carried out in 113 patients undergoing coronary artery bypass grafting. These methods were: (1) continuous nylon vertical mattress suture (27 patients); (2) continuous subcuticular absorbable (Dexon) suture (29 patients); (3) metal skin staples (Autosuture) (27 patients); and (4) adhesive sutureless skin closure ("Op-site") (30 patients).All wounds were examined by two independent observers at five, 10, and 45 days after operation. At five days, inflammation, extent of oedema, discharge, and infection were assessed. At 10 days attention was paid to the state of wound healing and at 45 days to the final cosmetic appearance. The use of continuous subcuticular suture resulted in significantly less discharge than did the use of metal staples, nylon vertical mattress suture, or Op-site. The incidence of established wound infection was 4*5% overall, with no infection in the wounds closed with Dexon. Assessment of the healing process showed subcuticular Dexon to be more effective than metal staples or vertical mattress nylon suture. The final cosmetic result showed continuous subcuticular suture to be superior to nylon vertical mattress suture and skin staples but as effective as Op-site sutureless skin closure.Coronary artery bypass grafting is now one of the most commonly performed operations in the world. The most widely used conduit for bypassing the obstructed coronary artery is still a reversed segment of the patient' s own long saphenous vein, and no synthetic substitute has yet been found that gives results as good as, let alone better than, autologous vein.' Nevertheless, removal of the entire long saphenous vein is necessary for multiple grafts and requires a long incision in the leg from ankle to groin.2 Despite complications from this wound possibly being troublesome and protracted, this part of the operation is often delegated to a junior member of the surgical team. Surprisingly little attention has been paid to the leg wound in coronary artery bypass grafting operations and in particular to the best method of skin closure. We report here the results of a prospective, randomised study of four different methods of leg wound skin closure.

Compliance with preoperative care measures reduces surgical site infection after colorectal operation

“…Current literature has reported a relationship between inflammatory bowel disease and use of chronic steroids with an increased risk for SSI, however, our results do not highlight this association. Lastly, Dermabond, although vastly preferred by patients has been anecdotally avoided in colorectal surgery given its perceived risk for increased SSI rates, however, we did not find an elevated infection risk when compared to the standard use of staples on multivariate analysis …”

Prospective study of long-term patient perceptions of their skin cancer surgery

“…1 Many other wound management methods have been adopted with the hope of improving scars but have shown no significant benefit in formal randomized control trials. 3,4 Wounds repaired under some tension are predominantly closed with sutures, with similar or somewhat improved results when compared with wounds closed with glues, [5][6][7][8][9] staples, 10,11 or tapes. [12][13][14][15][16][17] Little is known of the aspects of skin cancer surgery that might result in a higher risk of the patient feeling neutral or negative toward their treatment experience or their scar.…”

Association between incisional surgical site infection and the type of skin closure after stoma closure

“…Capillary vessel loops in the dermis provide the main blood supply to cutaneous wound healing while collagen formation in the dermis offers tensile strength to the wound. [15][16][17] Therefore, proper reconstruction of the dermis is the critical process in the restoration of cutaneous function. The appropriate contact of dermis achieved by subcuticular suturing may promote proper wound healing and restoration of cutaneous function, which, in turn, enhances host defense against infection.…”