SLR - March 2011 - Nathan Young
Reference: Smith TO, Sexton D, Mann C, et al. (2010). Sutures Versus Staples for Skin Closure in Orthopaedic Surgery: Meta-Analysis. British Medical Journal, 340:c1199.
Scientific Literature Review
Reviewed by: Nathan Young, DPM, PGY-2
Residency Program: Southern Arizona VA Healthcare System
Podiatric Relevance:
Although rarely used in foot surgery, surgical skin staples may be more commonly in ankle surgery. This article is a meta-analysis of the published literature comparing wound infection rates with skin closure using staples versus sutures.
Methods:
A literature search was performed on numerous medical journal databases regarding clinical trials of wound closure after orthopaedic surgery comparing staples and sutures. Exclusion criteria included: (1) Use of synthetic adhesives, (2) Cadaveric or animal studies, (3) Studies which gave insufficient data on population characteristics, surgical procedure, or outcomes.
Results:
Six studies were found that met the inclusion criteria. The total number of patients among the six studies was 683. The mean age in the staple group was 82 years, and 80 years in the suture group. Three of the studies compared the complications after hip surgeries, two compared hip and knee surgeries, and one compared lower limb trauma surgeries. The meta-analysis showed that the relative risk of wound infection in staples versus sutures for skin closure was 3.83 with a 95% confidence interval from 1.38 to 10.68. This means that skin closure using staples increased the likelihood for wound infection by 3.83 times compared to sutures.
Conclusions:
The authors performed a meta-analysis of the literature comparing wound infection rates when closing with either staples or sutures. The meta-analysis includes the results of six published studies, though they report that only one of the studies included was of acceptable methodological quality. Based on their data, patients undergoing orthopaedic surgery are at greater than three times higher risk of wound infection if the skin is closed using staples instead of sutures. The authors found no difference between the groups when comparing wound discharge, inflammation, necrosis, allergic reaction, or dehiscence. The authors report that due to the methodological limitations, a definitive randomized trial should be performed to properly assess the risk of wound infection after skin closure with sutures or metallic staples.