Staples versus sutures for closing leg wounds after vein graft harvesting for coronary artery bypass surgery

Surgical wounds are usually closed by using either an interrupted or continuous suture using absorbable or non absorbable suture materials. Skin staples are an alternative to sutures and are usually used at the discretion of the surgeon. Skin wound closure with metallic clips is considered to be a fast and effective alternative to sutures. Furthermore, it is commonly believed that staples are less traumatic and may reduce wound complications. This makes the use of staples attractive as it may reduce the risk of postoperative wound complications.

Surgical site infection (SSI) after saphenous vein graft harvesting is a postoperative complication that may occur in up to 18% of patients who undergo coronary artery bypass surgery (CABG). We considered the effects of using either staples or sutures for closing the skin after saphenous vein graft harvesting for CABG on rates of wound infection and wound dehiscence. We included four studies reporting on a total of 148 leg wounds closed with staples and 174 with sutures after vein graft harvesting in patients undergoing isolated CABG.  

There was no difference in leg wound infection rate or in leg wound dehiscence when wounds were closed with staples rather than with sutures.

Authors' conclusions: 

These results suggest that there is no evidence of a difference in the risk of SSI and wound dehiscence when staples rather than sutures are used to close leg wounds after vein graft harvesting during CABG, however more research is needed.

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Background: 

Surgical site infection (SSI) after saphenous vein graft harvesting is a complication occurring in up to 18% of patients who undergo coronary artery bypass surgery (CABG). It is not known whether the method of skin closure influences the infection rate.

Objectives: 

To compare the rates of SSI and wound dehiscence of staples and sutures for skin closure after saphenous vein graft harvesting for CABG.

Search strategy: 

For this first update we searched The Cochrane Wounds Group Specialised Register (searched 4 November 2011); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4); Ovid MEDLINE (2010 to October Week 4 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, November 3, 2011); Ovid EMBASE (2010 to 2011 Week 43); and EBSCO CINAHL (2010 to 28 October 2011).

Selection criteria: 

Randomised controlled trials comparing staples and sutures for closing leg wounds after vein graft harvesting in patients undergoing CABG were eligible for inclusion in this review.

Data collection and analysis: 

Two review authors independently assessed the titles and abstracts of references identified by the search strategy against the selection criteria and extracted data from eligible trials. Included trials were assessed for the following risks of bias: generation of random allocation sequence, allocation concealment, blinding, incomplete outcome data, selective reporting and freedom from other biases. For dichotomous variables, we calculated the risk ratio with 95% confidence intervals (CI).

Main results: 

We included three prospective, randomised studies reporting on a total of 148 leg wounds closed with staples and 175 with sutures after vein graft harvesting in patients undergoing CABG. All trials were of sub-optimal methodological quality and all trials were at risk of bias. Leg wound infection rate was 10.8% (16/148) after leg wound closure with staples compared with 8% (14/174) with sutures (risk ratio 1.20, 95% CI 0.60 to 2.39). Leg wound dehiscence occurred in 9.3% (10/108) of patients after leg wound closure with staples compared with 8.8% (12/137) with sutures (risk ratio 1.05, 95%CI 0.43 to 2.53).

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