Staples versus sutures for closing leg wounds after vein graft harvesting for co

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Fausto Biancari*,
• Valentina Tiozzo
  

Editorial Group: Cochrane Wounds Group

Published Online: 12 MAY 2010

Assessed as up-to-date: 10 NOV 2011

DOI: 10.1002/14651858.CD008057.pub2

Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Abstract

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• Abstract
• Plain language summary
• 摘要
  

Background
Surgical site infection (SSI) after saphenous vein graft harvesting is a complication occurring in up to 18% of patients who undergo coronary artery bypass surgery (CABG). It is not known whether the method of skin closure influences the infection rate.
Objectives
To compare the rates of SSI and wound dehiscence of staples and sutures for skin closure after saphenous vein graft harvesting for CABG.
Search methods
For this first update we searched The Cochrane Wounds Group Specialised Register (searched 4 November 2011); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4); Ovid MEDLINE (2010 to October Week 4 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, November 3, 2011); Ovid EMBASE (2010 to 2011 Week 43); and EBSCO CINAHL (2010 to 28 October 2011).
Selection criteria
Randomised controlled trials comparing staples and sutures for closing leg wounds after vein graft harvesting in patients undergoing CABG were eligible for inclusion in this review.
Data collection and analysis
Two review authors independently assessed the titles and abstracts of references identified by the search strategy against the selection criteria and extracted data from eligible trials. Included trials were assessed for the following risks of bias: generation of random allocation sequence, allocation concealment, blinding, incomplete outcome data, selective reporting and freedom from other biases. For dichotomous variables, we calculated the risk ratio with 95% confidence intervals (CI).
Main results
We included three prospective, randomised studies reporting on a total of 148 leg wounds closed with staples and 175 with sutures after vein graft harvesting in patients undergoing CABG. All trials were of sub-optimal methodological quality and all trials were at risk of bias. Leg wound infection rate was 10.8% (16/148) after leg wound closure with staples compared with 8% (14/174) with sutures (risk ratio 1.20, 95% CI 0.60 to 2.39). Leg wound dehiscence occurred in 9.3% (10/108) of patients after leg wound closure with staples compared with 8.8% (12/137) with sutures (risk ratio 1.05, 95%CI 0.43 to 2.53).
Authors' conclusions
These results suggest that there is no evidence of a difference in the risk of SSI and wound dehiscence when staples rather than sutures are used to close leg wounds after vein graft harvesting during CABG, however more research is needed.
  Plain language summary

• Top of page
• Abstract
• Plain language summary
• 摘要
  

Staples versus sutures for closing leg wounds after vein graft harvesting for coronary artery bypass surgery
Surgical wounds are usually closed by using either an interrupted or continuous suture using absorbable or non absorbable suture materials. Skin staples are an alternative to sutures and are usually used at the discretion of the surgeon. Skin wound closure with metallic clips is considered to be a fast and effective alternative to sutures. Furthermore, it is commonly believed that staples are less traumatic and may reduce wound complications. This makes the use of staples attractive as it may reduce the risk of postoperative wound complications.
Surgical site infection (SSI) after saphenous vein graft harvesting is a postoperative complication that may occur in up to 18% of patients who undergo coronary artery bypass surgery (CABG). We considered the effects of using either staples or sutures for closing the skin after saphenous vein graft harvesting for CABG on rates of wound infection and wound dehiscence. We included four studies reporting on a total of 148 leg wounds closed with staples and 174 with sutures after vein graft harvesting in patients undergoing isolated CABG.  
There was no difference in leg wound infection rate or in leg wound dehiscence when wounds were closed with staples rather than with sutures.

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摘要
Top of page
Abstract
Plain language summary
摘要
背景
冠狀動脈繞道手術中縫合取腿部隱靜脈之傷口採取打釘或縫線的比較

冠狀動脈繞道手術 (coronary artery bypass surgery, CABG) 患者取隱靜脈之傷口的感染率 (Surgical site infection, SSI) 達18% 。究竟是哪一種傷口縫合方法影響傷口感染率，仍是未知。

目標
研究目的為比較冠狀動脈繞道手術取腿部隱靜脈之傷口縫合採取縫線或打釘兩種方法的傷口感染率及傷口裂開情形

搜尋策略
透過電子資料庫檢索資料：來自Cochrane傷口群組中專業的註冊者 (搜尋 11/3/10) ；Cochrane中心隨機試驗群的註冊者?Cochrane圖書館2010第1期；Ovid MEDLINE?1950年至2010年3月第1週; Ovid MEDLINE ? 翻譯中及其他非引文索引(搜索11/3/10); Ovid EMBASE?1980至2010第9週和EBSCO CINAHL?1982年至2010年3月11日。沒有對日期或語言進行設限。

選擇標準
試驗的對象為冠狀動脈繞道術取腿部隱靜脈的傷口縫合採取打釘和縫線兩種方式均納入收案條件。

資料收集與分析
兩位作者獨立評估標題和摘要並引用確定地檢索策略，比對選擇標準及從試驗中擷取數據。包括試驗中可能的研究偏差：隨機分配序列的產生，分派的隱匿姓，矇蔽性，不完整的結果數據，選擇性的報告和其他偏差的避免。對於類別變項，計算相對危險性 (relative risk) 95％信賴區間(95% CI)。

主要結論
納入三個前瞻性隨機研究，148位腿部傷口接受打釘， 175位冠狀動脈繞道術取腿部隱靜脈的傷口縫合採取縫線。所有試驗的研究方法並不十分理想，且存在研究偏差的風險。傷口縫合採打釘組的傷口感染率為10.8% (16/148) ，相較於傷口縫合組的感染率為8% (14/174) (relative risk 1.20, 95% CI 0.60 to 2.39) 。在傷口裂開方面，打釘組發生率9.3% (10/108) ，相較於傷口縫合組的發生率為8.8% (12/137) (relative risk 1.05, 95% CI 0.43 to 2.53) 。

作者結論
這個結果建議冠狀動脈繞道術取腿部隱靜脈的傷口在預防傷口的感染及裂開情形並沒有證實打釘方式優於傷口縫合，建議仍須進一步研究。