Staple vs. subcuticular vicryl skin closure in knee replacement surgery: a spectrophotographic assessment of wound characteristics.
ABSTRACT Staple closure is a popular method of skin closure for patients undergoing knee replacement surgery. There are no guidelines regarding spacing of staples and some concern exists with regard to wound oxygenation in knees subject to early movement. We compared cutaneous wound characteristics in terms of blood oxygenation and blood content, using two types of skin closure. Staples or 4/0 subcuticular vicryl were used. We found favourable blood perfusion characteristics when using stapled closure. Our results also suggest that optimum wound oxygenation requires staple spacing of 6 mm or more.
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ABSTRACT: BACKGROUND: Wound closure accounts for a relatively constant portion of the time required to complete a surgical case. Both longer closure times and wound infections contribute to higher medical costs and patient morbidity. QUESTIONS/PURPOSES: We therefore determined whether (1) biologic and treatment factors greater influenced wound healing than the choice of sutures or staples; and (2) different times to closure affected cost when sutures or staples are used in patients with musculoskeletal tumors. METHODS: We retrospectively reviewed 511 patients who had sarcoma resections of the buttock, thigh, and femur from 2003 to 2010; 376 had closure with sutures and 135 with staples. Data were abstracted on patient demographics, comorbidities, select procedural data, and wound complications. Wound complications were defined by hospitalization within 6 months postoperatively for a wound problem, irrigation and débridement, or infection treated with antibiotics. We determined the association between staples versus sutures and wound complications after controlling for confounding factors. The minimum followup was 2 weeks. A prospective, timed analysis of wounds closed with either sutures or staples was also performed. RESULTS: We found an association between obesity and radiation and wound complications. Wounds were closed an average of 5.3 minutes faster with staples than with suture (0.29 minutes versus 5.6 minutes, respectively), saving a mean 2.1% of the total operating time although the total operating time was similar in the two groups. CONCLUSIONS: We found no difference in wound complications after closure with sutures or staples, although obesity and radiation treatment appear to affect wound outcomes. Data suggest that time saved in the operating room by closing with staples compensates for added material costs and does not compromise wound care in patients with lower extremity sarcomas. LEVEL OF EVIDENCE: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.Clinical Orthopaedics and Related Research 08/2012; · 2.79 Impact Factor
Article: Let’s add three other studies[Show abstract] [Hide abstract]
ABSTRACT: The take home message of the meta-analysis by Smith and colleagues as broadcast in the media was that the risk of developing a wound infection after orthopaedic surgery is significantly higher when the wound is closed with staples rather than sutures.1 However, the meta-analysis does not support this conclusion.Firstly, we found three new studies in a Pub …BMJ. 12/2009; 340.
- European Journal of Orthopaedic Surgery & Traumatology 06/2006; 16(2):124-129. · 0.18 Impact Factor