title: Single-layer versus multiple-layer closure of leg wounds after long saphenous vein harvest: a prospective randomized trial.
abstract: BACKGROUND
  The long saphenous vein harvested by traditional techniques is an important conduit for coronary artery bypass grafting (CABG). The purpose of this study was to determine if a single-layer closure over a drain improved wound healing compared with the traditional two-layer closure after harvest.
  
  
  METHODS
  Seventy-eight consecutive patients undergoing CABG were prospectively randomized to have their leg wound closed by either a single-layer technique with a suction drain or multiple layers. All wounds were assessed using the additional treatment, presence of serous discharge, erythema, purulent exudate, and separation of the deep tissues, isolation of bacteria, and the duration of inpatient stay (ASEPSIS) score postoperatively and 6 weeks later.
  
  
  RESULTS
  Forty-four patients (5 females) had their wound closed by the single-layer technique and 34 (6 females) closed in multiple layers. The ASEPSIS scores were significantly lower (p = 0.001) in those patients closed with a single layer (mean, 4.4) than those with multiple layers (mean, 6.8). Patients whose legs were closed with the single-layer technique had less peripheral edema compared with the multiple-layer group (chi2, p < 0.001). Using univariate analysis there was no correlation between ASEPSIS scores and length of wound incision (p = 0.49), whereas increasing age was found to have a weak positive correlation (r =0.24; p = 0.04).
  
  
  CONCLUSIONS
  Single-layer leg wound closure over a suction drain is superior to the traditional multiple-layer closure. A possible mechanism of better wound healing in the former technique might be through decreased tissue handling and a reduction in leg edema.
authors.affiliation: Southwest Cardiothoracic Centre, Division of Cardiothoracic Surgery, Derriford Hospital, Plymouth, United Kingdom.
authors.forename: Muhammed
authors.initials: M
authors.lastname: Zafar
authors.forename: Anil
authors.initials: A
authors.lastname: John
authors.forename: Zahid
authors.initials: Z
authors.lastname: Khan
authors.forename: Simon M
authors.initials: SM
authors.lastname: Allen
authors.forename: Adrian J
authors.initials: AJ
authors.lastname: Marchbank
authors.forename: C Terence
authors.initials: CT
authors.lastname: Lewis
authors.forename: Malcolm J R
authors.initials: MJ
authors.lastname: Dalrymple-Hay
authors.forename: James
authors.initials: J
authors.lastname: Kuo
authors.forename: Jonathan
authors.initials: J
authors.lastname: Unsworth-White
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D007866:Leg / Q000601:surgery*; D008297:Male; D011446:Prospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D013396:Suction; D013536:Suture Techniques; D020858:Tissue and Organ Harvesting