Is the Risk of Infection Lower with Sutures than with Staples for Skin Closure After Orthopaedic Surgery? A Meta-analysis of Randomized Trials

Abstract

Background Two previous meta-analyses comparing staples versus sutures have led to conflicting relative risks for surgical site infection between skin closure methods after orthopaedic surgery. Consequently, the choice of sutures or staples for skin closure continues to be a subject of conversation. Recently, additional randomized trials have been published, and an updated meta-analysis is needed to inform this debate. Questions/purposes To determine using a meta-analysis of randomized trials (1) whether there is a difference in surgical site infection (SSI) between staples and sutures for skin closure after orthopaedic surgery, and (2) whether that finding remains the same when the analysis is limited to randomized trials with a low risk of bias. Methods A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing staples with sutures for skin closure after orthopaedic surgery was conducted. We excluded barbed sutures, surgical zippers, and skin adhesives from this meta-analysis. Medline, One of the authors (YRR) received personal fees from Medtronic (Minneapolis, MN, USA) outside the submitted work. Each author certifies that his or her institution waived approval for the reporting of this investigation and that all investigations were conducted in conformity with ethical principles of research.

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

“…A special suture technique and/or materials also have been suggested to contribute to a reduction in postoperative PJIs [174,175]. On the other hand, PJI rates do not vary when staples are used instead of sutures for skin closure [176]. Overall, it is very difficult to distinguish facts and opinions in the individual surgeon practices.…”

A novel zipper device versus sutures for wound closure after surgery: a systematic review and meta‐analysis

“…23 Although several metaanalyses had attempted to clarify the differential SSI risk between skin closure modalities, an ideal modality with both anti-infection and cosmesis effects remains uncertainly as wound cosmesis is currently considered more important than it was previously. 5,7,11,24 Tissue adhesives may provide a better cosmetic result but they are used less widespread due to the problems with wound dehiscence. A novel zipper skin closure device has been developed to overcome these problems, but no significantly difference of SSI between the zipper and subcuticular sutures was found in the previous meta-analyses.…”

“…6 Furthermore, current evidence indicates the risk of postoperative infection is not lower with sutures than staples for skin closure. 7 Recently, a novel atraumatic, noninvasive zipper surgical wound closure device has become popular in orthopaedic and cardiothoracic surgical procedures. 6,[8][9][10] It is sterile, adjustable, hydrocolloid adhesive-based, and designed to replace staples and sutures for closure of the superficial skin layer, which can be applied directly to intact skin on either side of the incision and provides uniform force along the wound edge.…”

“…Sutures and staples are most commonly used, but staples can cause infections, bleed, additional dress, or scar formation on piercing sites after removed 6 . Furthermore, current evidence indicates the risk of postoperative infection is not lower with sutures than staples for skin closure 7 …”

Contemporary Strategies to Prevent Infection in Hip and Knee Arthroplasty

“…The authors concluded that staples may have subtle clinical advantages over suture closure. In a 2019 meta-analysis of RCTs by Krishnan et al [40], the authors included any study comparing compared sutures with staples for skin closure after any orthopaedic surgery. Although not specific to TJR, 6 of the 17 trials included only patients undergoing elective THA or TKA.…”