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

Abstract

Objective: Appropriate skin closure is essential and several techniques are available such as dermal sutures and metal staples. Absorbable staples have promising qualities. Our aim was to lower the Surgical Site Infection (SSI) rate with the use of subcuticular absorbable skin (Insorb™) staples. Design and patients:A long-term (IDEAL) phase 4 historical comparative effectiveness trial was performed during a 2-year period from December 2012 to December 2014 in patients undergoing an infra-inguinal femoro-popliteal bypass operation. We compared closure of the skin by means of absorbable stapler with a cohort of patients treated with intracutaneous sutures. Primary outcome: Number of SSI's. Secondary outcome: Other complications, duration of surgery and hospital length of stay.Results: 44 patients were enrolled in the study; 6 patients underwent skin closure with the absorbable staples. 4 of them had an SSI. Of 38 patients treated with intracutaneous sutures 7 had an SSI (risk difference: 0.48, 95% CI 0.09-0.88). Duration of surgery (p=0.84) and length of stay (p=0.15) were similar. Conclusion:Due to a large proportion of SSI's in the absorbable stapler group the use of these subcuticular staples was discontinued in our facility. We consider the absorbable staples not strong enough for wound closure in peripheral vascular surgery.