Sutures versus staples for wound closure in orthopaedic surgery: a randomized controlled trial

Abstract

BackgroundA recently published meta-analysis comparing metallic staples to sutures in orthopaedic procedures revealed three fold increase in risk for infection in stapled wounds. The studies included in the meta-analysis are at risk of bias due to experimental design limitations. A large randomized controlled trial is proposed to direct orthopaedic surgeons in their choice of wound closure material.Methods/DesignA parallel group randomized controlled trial with institutional review board approval will be conducted. Patients will be randomized intraoperatively to have skin wounds closed with sutures or staples. Dressings will be used to maintain blinding outcome assessors. The primary outcome measure will be a composite all-cause wound complication outcome measure composed of: infection, wound drainage, wound necrosis, blistering, dehiscence, suture abscess and material sensitivity reaction. An independent review board blinded to treatment assignment will adjudicate suspected complications based on clinical data. All deceased patients will also be reviewed. An interim analysis of complications will take place after half of the patients have been recruited. All data will be analyzed by a blinded statistician. Dichotomous primary and secondary outcome measures will be analyzed using the Chi-squared statistic. Continuous outcome measures will be analyzed using Student's t-test. Subgroup analysis will compare infection rates using sutures versus staples in each anatomic area (upper extremity, pelvis/acetabulum, hip/femur, knee, ankle). A further subgroup analysis will be conducted comparing trauma patients to elective surgery patients. Non-infected revision surgery will also be compared to primary surgery.DiscussionWound closure material is an afterthought for many orthopaedic surgeons. The combined results of several comparative trials suggests that the choice of wound closure materials may have an impact on the rate of surgical site infections. However, the strength of the evidence is poor given the heterogeneity of the methods employed in previous studies. The following study protocol aims to guide surgeons in their choice of wound closure material by determining if there is a difference in complication rates in sutured and stapled wounds.Trial RegistrationThis trial was registered at ClinicalTrials.gov under the identifier NCT01146236 (registered June 14, 2010)

The Chitranjan Ranawat Award: Running Subcuticular Closure Enables the Most Robust Perfusion After TKA: A Randomized Clinical Trial

“…Many studies have previously compared wound closure techniques in TKA [2,3,6,[15][16][17][18]. Results have been highly variable and currently there is no consensus on a superior closure method.…”

“…Many studies have compared different closure techniques in TKA [2,3,6,[15][16][17][18]. From the perspective of wound complications, one recent meta-analysis by Smith et al showed that staple closure resulted in increased rates of infection after both hip and knee arthroplasty in comparison to running subcuticular [17].…”

“…Multiple studies have compared different closure techniques in TKA [2,3,6,[15][16][17][18]. The majority of these studies have involved running subcuticular closure versus staple closure and focused on factors such as cost, performance time, patient satisfaction, and wound complications.…”

Abdominal skin incision closure with non-absorbable sutures versus staples- a comparative study

“…All the reviewed articles echoed the fact that stapling of wound was quicker and time saving when compared to conventional wound/skin closure methods. [4][5][6][7][8][9][10][11][12][13] The mean time saving of 80% was possible with stapling devices and was 2.7 times faster than conventional methods. 6,11 Most of the articles reviewed were also having an overall similar view when comparing the cost of using staples against conventional methods.…”

“…There was an overall agreement in the fact that staples were associated with more pain and discomfort to patients. 7,9,10,16 A meta-analysis which compared most of randomized control trials made a strong statement in need to incorporate more objective methods for assessment of cosmetic and patient satisfaction in further studies. 10 Except the fact that staples were faster, costlier and painful, none of the other factors compared here below have a clear consensus and the views of one group of study differed significantly from the other beyond comparison.…”