The Influence of Absorbable Subcuticular Staples, Continuous Subcuticular Absorbable Suture, and Percutaneous Metal Skin Staples on Infection in Contaminated Wounds

Abstract

Wound infection is a threatening, troublesome, and costly complication contributing to increased mortality and morbidity. The methods and materials used to close a wound significantly influence the quality of the repair process and the risk of surgical site infection. Six pigs were used to evaluate the influence of four separate skin-closure modalities on the potentiation of infection in contaminated wounds. Full-thickness skin wounds on the abdomen were contaminated with S. aureus and then closed with one of four devices: a novel absorbable staple (InsorbTM) placed in the subcuticular tissue; a braided absorbable suture (VicrylTM); a monofilament absorbable suture (MonocrylTM); percutaneous metal staples. Wound infection was assessed 7 days after closure by clinical signs and quantitative bacterial swabs. InsorbTM staples had significantly lower infection rates than continuous VicrylTM (39% vs. 100%, p=0.002) or MonocrylTM suture (39% vs. 89%, p=0.014). The InsorbTM subcuticular staple and the metal percutaneous skin staple were statistically equivalent in wound infection rate and parameters of inflammation. The combined data for both interrupted staple modalities documented less inflammation compared to the combined data for continuous sutures. These lower levels of inflammatory metrics were statistically significant for edema (p=0.018), gauze exudate observed (p=0.007) and purulent exudate in wound (p<0.0001). In conclusion, InsorbTM staples were shown to be an acceptable choice for the closure of contaminated wounds because they had a significantly lower incidence of wound infection and inflammation when compared to continuous intradermal suture.

The use of absorbable staples for skin closure after tibial plateau leveling osteotomy

“…The main finding in this study confirms the results of a study in man in which wound‐related complications did not differ between stainless steel and absorbable staples used to close Pfannenstiel caesarean incisions . In addition, inflammation and infection did not differ between stainless steel and absorbable staples used to close experimental full‐thickness abdominal wounds in pigs . Other researchers who conducted studies in man found that wound closure with absorbable rather stainless steel staples decreased incisional complications after cesarean surgery and total hip arthroplasty .…”

Incidence of wound complications in cesarean deliveries following closure with absorbable subcuticular staples versus conventional skin closure techniques

“…The reported benefits of this type of closure include decreased tissue inflammation [3] and attenuated risk of skin contamination [4]. In studies comparing absorbable staples with suture closure there was a decreased incidence of wound infection and shorter intraoperative time [4], and in those comparing with traditional staples, decreased incidence of wound separation [4][5][6]. Currently there is no study comparing all three closure types in cesarean section.…”