Clips versus suture technique: Is there a difference?

INTRODUCTION: Coronary artery bypass grafting (CABG) is one of the most com mon procedures performed today, and wound complications are a major source of morbidity and cost. OBJECTIVE: To determine whether there is any difference in wound outcome (i ncluding cost in a Canadian context) between a subcuticular suture techniqu e and skin stapling technique for closure of sternal and leg incisions in C ABG patients. PATIENTS AND METHODS: One hundred and sixty-two patients undergoing CABG we re prospectively, randomly placed to have their sternal and leg incisions c losed with either a subcuticular suture technique or with a skin clip. Data were obtained through chart review, in-hospital assessments and follow-up visits. Nonblinded assessments were made regarding wound leakage, inflammat ion, infection, necrosis, swelling, dehiscence and cosmesis. Each of the pa rameters was graded on a scale from 1 to 4. The cost was evaluated in Canad ian dollars. RESULTS: There were trends toward increased rates of in-hospital sternal (P =0.09) and leg (P=0.11) incision inflammation when the wounds were closed w ith skin clips. There was a significantly greater (P=0.05) rate of sternal wound infection with clips, as well as a tendency (P=0.15) toward a greater rate of mediastinitis at follow-up assessment. Cosmetic outcome was simila r for both groups. The cost incurred was significantly greater when skin cl ips were used for closure. There was a greater than threefold difference, w hich translates to a greater than $10,000 difference over one year. CONCLUSIONS: Closure with a subcuticular technique achieves better outcomes than the use of skin clips. When factoring in the increased cost incurred by using clips, as well as other intangible factors such as surgical skill acquisition, subcuticular suture closure appears to be a favourable method of wound closure in CABG patients compared with the use of skin stapling te chniques.