Skip to main content
SpringerLink
Log in

Staples Equal Sutures for Skin Closure After Soft Tissue Tumor Resection

  • Symposium: Highlights from the First Combined 2011 Meeting of the Musculoskeletal Tumor Society and Connective Tissue Oncology Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Wound closure accounts for a relatively constant portion of the time required to complete a surgical case. Both longer closure times and wound infections contribute to higher medical costs and patient morbidity.

Questions/purposes

We therefore determined whether (1) biologic and treatment factors greater influenced wound healing than the choice of sutures or staples; and (2) different times to closure affected cost when sutures or staples are used in patients with musculoskeletal tumors.

Methods

We retrospectively reviewed 511 patients who had sarcoma resections of the buttock, thigh, and femur from 2003 to 2010; 376 had closure with sutures and 135 with staples. Data were abstracted on patient demographics, comorbidities, select procedural data, and wound complications. Wound complications were defined by hospitalization within 6 months postoperatively for a wound problem, irrigation and débridement, or infection treated with antibiotics. We determined the association between staples versus sutures and wound complications after controlling for confounding factors. The minimum followup was 2 weeks. A prospective, timed analysis of wounds closed with either sutures or staples was also performed.

Results

We found an association between obesity and radiation and wound complications. Wounds were closed an average of 5.3 minutes faster with staples than with suture (0.29 minutes versus 5.6 minutes, respectively), saving a mean 2.1% of the total operating time although the total operating time was similar in the two groups.

Conclusions

We found no difference in wound complications after closure with sutures or staples, although obesity and radiation treatment appear to affect wound outcomes. Data suggest that time saved in the operating room by closing with staples compensates for added material costs and does not compromise wound care in patients with lower extremity sarcomas.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Badrinath SS, Bhaskaran S, Sundararaj I, Rao BS, Mukesh BN. Mortality and morbidity associated with ophthalmic surgery. Ophthalmic Surg Lasers. 1995;26:535–541.

    PubMed  CAS  Google Scholar 

  2. Clarke-Pearson DL, Dodge RK, Synan I, McClelland RC, Maxwell GL. Venous thromboembolism prophylaxis: patients at high risk to fail intermittent pneumatic compression. Obstet Gynecol. 2003;101:157–163.

    Article  PubMed  Google Scholar 

  3. Clayer M, Southwood RT. Comparative study of skin closure in hip surgery. Aust N Z J Surg. 1991;61:363–365.

    Article  PubMed  CAS  Google Scholar 

  4. Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. 2003;415:4–18.

    Article  PubMed  Google Scholar 

  5. Graham D, Jeffery J, Bain D, Davies P, Bentley G. Staple vs subcuticular Vicryl skin closure in knee replacement surgery: a spectrophotographic assessment of wound characteristics. Knee. 2000;7:239–243.

    Article  PubMed  Google Scholar 

  6. Kanegaye JT, Vance CW, Chan L, Schonfeld N. Comparison of skin stapling devices and standard sutures for pediatric scalp lacerations: a randomized study of cost and time benefits. J Pediatr. 1997;130:808–813.

    Article  PubMed  CAS  Google Scholar 

  7. Khan RJK, Fick D, Yao F, Tang K, Hurworth M, Nivbrant B, Wood D. A comparison of three methods of wound closure following arthroplasty: a prospective, randomised, controlled trial. J Bone Joint Surg Br. 2006;88:238–242.

    Article  PubMed  CAS  Google Scholar 

  8. Meiring L, Cilliers K, Barry R, Nel CJ. A comparison of a disposable skin stapler and nylon sutures for wound closure. S Afr Med J. 1982;62:371–372.

    PubMed  CAS  Google Scholar 

  9. Murphy M, Prendergast P, Rice J. Comparison of clips versus sutures in orthopaedic wound closure. Eur J Orthop Surg Traumatol. 2004;14:16–18.

    Article  Google Scholar 

  10. O’Sullivan B, Davis AM, Turcotte R, Bell R, Catton C, Chabot P, Wunder J, Kandel R, Goddard K, Sadura A, Pater J, Zee B. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limb: a randomised trial. Lancet. 2002;359:2235–2241.

    Article  PubMed  Google Scholar 

  11. Orlinsky M, Goldberg RM, Chan L, Puertos A, Slajer HL. Cost analysis of stapling versus suturing for skin closure. Am J Emerg Med. 1995;13:77–81.

    Article  PubMed  CAS  Google Scholar 

  12. Patel VP, Walsh M, Sehgal B, Preston C, DeWal H, Di Cesare PE. Factors associated with prolonged wound drainage after primary total hip and knee arthroplasty. J Bone Joint Surg Am. 2007;89:33–38.

    Article  PubMed  Google Scholar 

  13. Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49:1373–1379.

    Article  PubMed  CAS  Google Scholar 

  14. Pickford IR, Brennan SS, Evans M, Pollock AV. Two methods of skin closure in abdominal operations: a controlled clinical trial. Br J Surg. 1983;70:226–228.

    Article  PubMed  CAS  Google Scholar 

  15. Rebollo MH, Bernal JM, Llorca J, Rabasa JM, Revuelta JM. Nosocomial infections in patients having cardiovascular operations: a multivariate analysis of risk factors. J Thorac Cardiovasc Surg. 1996;112:908–913.

    Article  PubMed  CAS  Google Scholar 

  16. Reich DL, Bennett-Guerrero E, Bodian CA, Hossain S, Winfree W, Krol M. Intraoperative tachycardia and hypertension are independently associated with adverse outcome in noncardiac surgery of long duration. Anesth Analg. 2002;95:273–277.

    PubMed  Google Scholar 

  17. Sheplan LJ, Juliano JJ. Use of radiation therapy for patients with soft-tissue and bone sarcomas. Cleve Clin J Med. 2010;77(Suppl 1):S27–S29.

    Article  PubMed  Google Scholar 

  18. Shetty AA, Kumar VS, Morgan-Hough C, Georgeu GA, James KD, Nicholl JE. Comparing wound complication rates following closure of hip wounds with metallic skin staples or subcuticular Vicryl suture: a prospective randomised trial. J Orthop Surg (Hong Kong). 2004;12:191–193.

    CAS  Google Scholar 

  19. Singh B, Mowbray MAS, Nunn G, Mearns S. Closure of hip wound, clips or subcuticular sutures: does it make a difference? Eur J Orthop Surg Traumatol. 2006;16:124–129.

    Article  Google Scholar 

  20. Smith TO, Sexton D, Mann C, Donell S. Sutures versus staples for skin closure in orthopaedic surgery: meta-analysis. BMJ. 2010;340:c1199.

    Article  PubMed  Google Scholar 

  21. Stockley I, Elson RA. Skin closure using staples and nylon sutures: a comparison of results. Ann R Coll Surg Engl. 1987;69:76–78.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank Kelly Sims, Patient Care Manager, Vanderbilt University Medical Center, for her help in data acquisition.

Author information

Authors and Affiliations

  1. Vanderbilt University School of Medicine, Nashville, TN, USA

    David C. Moore BA & Meredith H. Sellers BA

  2. Division of Orthopaedic Oncology, Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA

    Kristin R. Archer PhD, DPT, Herbert S. Schwartz MD & Ginger E. Holt MD

  3. Vanderbilt Orthopaedic Institute, 1215 21st Avenue South, Nashville, TN, 37232-8774, USA

    Ginger E. Holt MD

Authors
  1. David C. Moore BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Meredith H. Sellers BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kristin R. Archer PhD, DPT
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Herbert S. Schwartz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ginger E. Holt MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ginger E. Holt MD.

Additional information

Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Vanderbilt University Medical Center, Nashville, TN, USA.

About this article

Cite this article

Moore, D.C., Sellers, M.H., Archer, K.R. et al. Staples Equal Sutures for Skin Closure After Soft Tissue Tumor Resection. Clin Orthop Relat Res 471, 899–904 (2013). https://doi.org/10.1007/s11999-012-2524-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-012-2524-z

Keywords

Search

Navigation