title: Intracutaneous suture versus transcutaneous skin stapling for closure of midline or horizontal skin incision in elective abdominal surgery and their outcome on superficial surgical site infections--INTRANS: study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Surgical site infections are the third most frequent type of nosocomial infections. Evidence-based recommendations have been given regarding preoperative hospitalization, hygiene and air-conditioning, patient conditions, and wound dressing. However, no general recommendations concerning wound closure exist. Systematic reviews and meta-analyses suppose a benefit of intracutaneous suture compared to skin staples in orthopedic and obstetric surgery. Literature data for skin closure in elective abdominal surgery are still deficient.
  
  
  METHODS
  Patients scheduled for any elective abdominal surgery requiring midline or horizontal laparotomy are potentially eligible for the trial. Trial-specific exclusion criteria are date of admission exceeding four days prior to surgery, antibiotic treatment within the past 14 days, any previous midline or horizontal laparotomy in case the procedure requires the same skin incision as before, neurophysiological deficits or severe psychiatric or neurologic diseases that do not allow an informed consent or compliance, and participation in any other interventional trial with interference of intervention and outcome. The trial is created for process innovation within standardized surgical procedures. It is designed as a prospective randomized controlled single center trial in a parallel design including an active comparator and an intervention group. The intervention addresses the closure of skin after the main surgical procedure: intracutaneous suture in the intervention group and transcutaneous skin stapling in the control group. The rate of superficial surgical site infections is defined as the primary endpoint. Secondary endpoints are time for skin closure, satisfaction with the cosmetic outcome 30 days after surgery, prolongation of hospital stay, and duration of sick-leave due to surgical site infections. The primary efficacy analysis follows the intention-to-treat principle. A χ2 test will be applied.
  
  
  CONCLUSIONS
  The trial is expected to balance the shortcomings of the current evidence. It will help to define the gold standard for wound closure in elective abdominal surgery. Patients' safety and quality of life are assumed to be enhanced. Therapy costs are likely to be reduced and health care optimized.
  
  
  BACKGROUND
  German Clinical Trials Register (DRKS) DRKS00004542.
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Giessen and Marburg GmbH-Location Marburg, Baldingerstrasse, D-35043 Marburg, Germany. maschuw@med.uni-marburg.de.
authors.forename: Katja
authors.initials: K
authors.lastname: Maschuw
authors.forename: Christine
authors.initials: C
authors.lastname: Heinz
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Maurer
authors.forename: Alexander
authors.initials: A
authors.lastname: Reuss
authors.forename: Carmen
authors.initials: C
authors.lastname: Schade-Brittinger
authors.forename: Detlef Klaus
authors.initials: DK
authors.lastname: Bartsch
mesh_terms: D000005:Abdomen / Q000601:surgery*; D058107:Abdominal Wound Closure Techniques / Q000009:adverse effects; D016009:Chi-Square Distribution; D002985:Clinical Protocols; D017558:Elective Surgical Procedures; D005858:Germany; D006801:Humans; D007902:Length of Stay; D017060:Patient Satisfaction; D011446:Prospective Studies; D012107:Research Design; D018582:Sick Leave; D017792:Surgical Stapling / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D013536:Suture Techniques / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome