CUTANEOUS CLOSURE AFTER CARDIAC OPERATIONS - A CONTROLLED, RANDOMIZED, PROSPECTIVE COMPARISON OF INTRADERMAL VERSUS STAPLE CLOSURES

Objective To determine the difference in wound complication and infect ion rates between suture and staple closure techniques applied to clea n incisions in coronary bypass patients. Background The true incidence of postoperative wound complications, and their correlation with clos ure techniques, has been obscured by study designs incorporating small numbers, retrospective short follow-up, uncontrolled host factors, an d 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 harves t wounds had half of each wound closed with staples and the other half with intradermal sutures (484 sternal and 516 leg segments). Wound co mplications 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 exa mined at discharge, at 1 week after discharge, and at 3 to 4 weeks aft er 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 cl osure 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 sta pled = 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%).