Comparing sutures versus staples for skin closure after orthopaedic surgery: systematic review and meta-analysis

Abstract

ObjectiveTo determine whether there still remains a significant advantage in the use of sutures to staples for orthopaedic skin closure in adult patients.DesignSystematic Review/ Meta-Analysis.Data sourcesMEDLINE-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 Grey and unpublished literature was also explored by searching: International Clinical Trial Registry, Grey Matters BIOSIS Previews, Networked Digital Library of Theses and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 criteriaArticles 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.Results13 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.ConclusionsExcept 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 numberCRD42015017481.

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 …”

Skin closure in arthroplasty surgery: Current practice

“…1 More recently, Krishnan et al performed a meta-analysis concluding that the only significant difference between staples and sutures was that staples reduced the closure time. 2 However, they believed that their results lent support to the Smith et al conclusion that clips have a higher infection rate in hip surgery than sutures. Both articles concluded that large, well-powered randomised controlled trials were necessary to determine the method of skin closure with the lowest complication rate.…”

“…The optimal goal of skin closure “is to promote rapid skin healing and an acceptable cosmetic result while minimising the risk of dehiscence or infection” . More recently, Krishnan et al performed a meta‐analysis concluding that the only significant difference between staples and sutures was that staples reduced the closure time . However, they believed that their results lent support to the Smith et al conclusion that clips have a higher infection rate in hip surgery than sutures.…”

Prevention of fracture-related infection: a multidisciplinary care package

“…In orthopaedic and trauma surgery, staples and sutures are most frequently used as wound-closing material. A systematic review and metaanalysis reported no significant difference between materials [119]. In both cases, the authors noted significant methodological limitations of included studies.…”

“…In both cases, the authors noted significant methodological limitations of included studies. Again, none of these studies was performed in a trauma population, and there is an urgent need for well-designed randomised controlled trials comparing both materials [119,120]. The WHO does not make any recommendations regarding the type of material; however, when sutures are used, they suggest using triclosan-coated sutures for preventing SSIs.…”