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.
- SourceAvailable from: Sabrina H Brounts[Show abstract] [Hide abstract]
ABSTRACT: Objective To compare the in vitro biomechanical properties of a novel subcuticular stapling device to current methods of abdominal skin closure for equine abdominal surgery.Study DesignIn vitro randomized, matched design.Sample PopulationEquine ventral median abdominal skin specimens (n = 24 horses).Methods Subcuticular absorbable staples (SAS), metallic staples (MS), polyglyconate suture (PG), and nylon monofilament (NYL) were applied to longitudinally transected portions of equine ventral midline skin. Loads that resulted in an initial failure point and the ultimate failure load and mechanism were recorded.ResultsMean ± SD loads at initial failure for PG (86 N ± 64 N), NYL (81 N ± 142 N), and SAS (70 N ± 20 N) were not significantly different from each other. PG and SAS were significantly higher than MS (43 N ± 17 N; P < .05). Ultimate failure load for PG (563 N ± 157 N) and NYL (558 N ± 162 N) were significantly higher than either MS (175 N ± 44 N) or SAS (96 N ± 20N; P < .001). For the suture groups, nearly all failures occurred because of skin pull through whereas all SAS staples failed because of staple fracture. Failure patterns were mixed for MS.ConclusionsSAS had the lowest ultimate failure load; however, other measured variables identified characteristics of SAS that may be clinically beneficial.Veterinary Surgery 07/2014; 44(2). DOI:10.1111/j.1532-950X.2014.12245.x · 0.99 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: ABSTRACT: Surgical site wound closure plays a vital role in post-operative success. This effect is magnified in regard to commonly performed elective procedures such as total knee arthroplasty. The use of either sutures or staples for skin re-approximation remains a contested subject, which may have a significant impact on both patient safety and surgical outcome. The literature remains divided on this topic. Two cohorts of patients at a level one trauma and regional referral center were reviewed. Cohorts consisted of consecutive total knee arthroplasties performed by two surgeons who achieved surgical wound re-approximation by either staples or absorbable subcuticular sutures. Outcome variables included time of surgery, wound dehiscence, surgical site infection per Center for Disease Control criteria and repeat procedures for debridement and re-closure. 181 patients qualified for study inclusion. Staples were employed in 82 cases (45.3% of total) and sutures in 99 cases (54.7%). The staples group had no complications while the sutures group had 9 (9.1%). These consisted of: 4 infections (2 superficial, one deep, one organ/space); three patients required re-suturing for dehiscence; one allergic type reaction to suture material; and one gout flare resulting in dehiscence. The mean surgical time with sutures was 122.3 minutes (sd = 33.4) and with staples was 114 minutes (sd = 24.4). This study demonstrated significantly fewer complications with staple use than with suture use. While all complications found in this study cannot be directly attributed to skin re-approximation method, the need for further prospective, randomized trials is established.Patient Safety in Surgery 10/2011; 5(1):26. DOI:10.1186/1754-9493-5-26
- [Show abstract] [Hide abstract]
ABSTRACT: Various methods of skin closure exist in joint replacement surgery. Although subcuticular skin closure techniques offer an aesthetic advantage over conventional skin stapling, no measurable differences have been reported. Furthermore, newer barbed sutures, such as the V-Loc absorbable suture (Covidien, Mansfield, Massachusetts), theoretically distribute tension evenly through the wound and help decrease knot-related complications. The purpose of this study was to evaluate whether wound complication rates were (1) lower in V-Loc closure cases as theoretically suggested, (2) lower for subcuticular closure vs staples, and (3) significantly different for knee and hip joint reconstruction.A retrospective chart review was conducted of 278 consecutive cases of primary joint reconstruction performed by a single surgeon (L.P.). The study group comprised 106 men and 161 women. Average patient age at surgery was 63 years (range, 18-92 years), and average body mass index of the cohort was 33.7 kg/m(2) (range, 25-51 kg/m(2)). Skin was closed via staple gun or subcuticular stitch (3-0 Biosyn [Covidien] vs V-Loc). Seven (3.9%) wound complications occurred in 181 cases closed with staples. Four (7.8%) wound complications occurred in 51 cases closed via subcuticular Biosyn suture. Six (13.0%) wound complications occurred in 46 cases closed with V-Loc suture. The staple group had a lower rate of complications when compared with the suture group as a whole (P=.033) and when compared specifically with the V-Loc suture group (P=.017).Orthopedics 05/2012; 35(5):e641-6. DOI:10.3928/01477447-20120426-16 · 0.98 Impact Factor