title: Sutures versus staples for wound closure in orthopaedic surgery: a pilot randomized controlled trial.
abstract: BACKGROUND
  In the spectrum of surgical decision-making, wound closure material is often an afterthought. However, the findings of a recent meta-analysis suggest that the rate of surgical site infections (SSIs) is increased by using staples to close surgical wounds. Less clear is the effect of closure material on the incidence of non-infectious wound complications.The aim of this study was to compare sutures and staples in terms of: incidence of wound complications to determine the sample size for a definitive trial comparing wound closure methods.
  
  
  METHODS
  Eligible adult orthopaedic patients were randomized to have wounds closed with sutures or staples. Time for skin closure was recorded. Wounds were assessed for complications for six weeks. The incidence of complications was compared using Fisher's exact test. Time to close and pain with removal of closure material were compared using a Student's t-test.
  
  
  RESULTS
  The total number of patients reporting a wound complication was 59 of 148 patients completing six-week followup (41%), with no differennce between sutures and staples (RR = 0.77, CI = 0.52-1.14). The time to close wounds was shorter in the staple group (mean=4.8 min, CI = 2.6-7.1) than the suture group (mean=12 min, CI = 7.9-16). Patients in the staple group (mean=3.7, CI =2.8-4.6) reported more pain with removal than suture group (mean=2.5, CI =1.6-3.4).
  
  
  CONCLUSIONS
  This study suggests that 42% of patients report a wound complication with no difference between sutures and staples. It was demonstrated that suturing skin requires more time and staples are more painful to remove.
  
  
  BACKGROUND
  Clinicaltrials.gov identifier NCT01146236 (registered June 14, 2010).
authors: Orthopedic Trauma Institute, University of California, 2550 23rd Street, Building 9, 2nd Floor, 94110, San Francisco, CA, USA. jshantz2@gmail.com.
authors: Jesse A
authors: JA
authors: Slade Shantz
authors: James
authors: J
authors: Vernon
authors: Saam
authors: S
authors: Morshed
authors: Jeff
authors: J
authors: Leiter
authors: Gregory
authors: G
authors: Stranges
references: Pediatr Emerg Care. 2002 Jun;18(3):171-3
references: 12066001
references: J Hand Surg Br. 2002 Feb;27(1):53-4
references: 11895347
references: J Orthop Surg (Hong Kong). 2004 Dec;12(2):191-3
references: 15621905
references: Eur J Orthop Surg Traumatol. 2006 Jun;16(2):124-129
references: 28755123
references: BMJ. 2010 Mar 16;340:c1199
references: 20234041
references: Can J Surg. 1988 Jan;31(1):19-20
references: 3276371
references: Infect Control Hosp Epidemiol. 2002 Apr;23(4):183-9
references: 12002232
references: Infect Control Hosp Epidemiol. 1999 Nov;20(11):725-30
references: 10580621
references: J Bone Joint Surg Am. 2007 Jan;89(1):33-8
references: 17200307
references: World J Surg. 2011 May;35(5):973-80
references: 21327598
references: Ann R Coll Surg Engl. 2007 Jan;89(1):41-3
references: 17316519
references: Aust N Z J Surg. 1991 May;61(5):363-5
references: 2025190
references: Interact Cardiovasc Thorac Surg. 2007 Apr;6(2):243-6
references: 17669827
references: J Bone Joint Surg Br. 2006 Feb;88(2):238-42
references: 16434531
references: Ann R Coll Surg Engl. 1987 Mar;69(2):76-8
references: 3566131
references: Am J Obstet Gynecol. 2009 Mar;200(3):265.e1-4
references: 19254586
references: J Clin Epidemiol. 2010 Aug;63(8):e1-37
references: 20346624
references: Ann R Coll Surg Engl. 1985 Sep;67(5):318-20
references: 3901864