Comparison of staples versus sutures in the repair of penetrating cardiac wounds

Background: Several literature reports advocate the use of skin staplers fo r repair of penetrating cardiac wounds during emergency thoracotomy. Our st udy goal was to objectively determine if stapling is a more efficient metho d of closure compared,vith suturing without compromising the strength of th e repair. Methods: This randomized, nonblinded study was conducted in a swine model. A total of four incisions, two per ventricle, were made in each animal. The 2-cm full-thickness incisions were repaired with either sutures or staples , and the time required to close each wound was recorded, After wound repai r, the animals were killed, The four wounds were isolated by removing 4,0-c m strips of myocardium oriented perpendicular to the incision. Each strip w as then placed on a tensile force testing machine, and the breaking strengt h of the sutures and staples was measured, Results: The tensile force test showed that stapled and sutured wounds have equivalent mechanical strength. The mean time of closure for stapled wound s was substantially less than that for sutured wounds, Conclusion: In this swine model, stapling took significantly less time and had equal mechanical strength compared with suturing for repair of penetrat ing cardiac wounds. Stapling during emergent resuscitation may be preferabl e to suturing.