Cutaneous closure after cardiac operations: a controlled, randomized, prospective comparison of intradermal versus staple closures.
OBJECTIVE
To determine the difference in wound complication and infection rates between suture and staple closure techniques applied to clean incisions in coronary bypass patients.


BACKGROUND
The true incidence of postoperative wound complications, and their correlation with closure techniques, has been obscured by study designs incorporating small numbers, retrospective short follow-up, uncontrolled host factors, and narrowly defined complications.


METHODS
Sternal and leg wounds were studied prospectively, each patient serving as his or her own control. Two hundred forty-two patients with sternal and saphenous vein harvest wounds had half of each wound closed with staples and the other half with intradermal sutures (484 sternal and 516 leg segments). Wound complications were defined as drainage, erythema, separation, necrosis, seroma, or infection. Infections were identified in the subset having purulent drainage, antibiotic therapy, or debridement. Wounds were examined at discharge, at 1 week after discharge, and at 3 to 4 weeks after operation. Patient preferences for closure type were assessed 3 to 4 weeks after operation.


RESULTS
Neither leg nor sternal wounds had a statistically significant difference in infection rate according to closure method (leg sutured = 9.3% vs. leg stapled = 8.9%; p = 0.99, and sternal sutured = 0.4% vs. sternal stapled = 2.5%; p = 0.128). There was, however, a greater complication rate in stapled segments (leg stapled = 46.9% vs. leg sutured = 32.6%; p = 0.001, and sternal stapled = 14.9% vs. sternal sutured = 3.7%; p = 0.00005). Sutures were favored over staples among patients who expressed a preference (sternal = 75.6%, leg = 74.6%).


CONCLUSIONS
With the host factors controlled by pairing staples and sutures in each patient, we demonstrated a similar incidence of infection but a significantly lower incidence of total wound complications with intradermal suture closure than with staple closure.
Johnson
R G
RG
Department of Surgery of Beth Israel Hospital, Harvard Medical School, Boston, Massachusetts 02215, USA.
Cohn
W E
WE
Thurer
R L
RL
McCarthy
J R
JR
Sirois
C A
CA
Weintraub
R M
RM
D000368:Aged; D001026:Coronary Artery Bypass; D062109:Dermatologic Surgical Procedures; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011446:Prospective Studies; D013528:Surgical Staplers; D013536:Suture Techniques