Staples versus sutures for closing leg wounds after vein graft harvesting for coronary artery bypass surgery

Fausto Biancari, Valentina Tiozzo
Cochrane Database of Systematic Reviews 2010 May 12, (5): CD008057

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 STRATEGY: We searched the following electronic databases: The Cochrane Wounds Group Specialised Register (searched 11/3/10); The Cochrane Central Register of Controlled Trials (CENTRAL) - The Cochrane Library 2010 Issue 1; Ovid MEDLINE - 1950 to March Week 1 2010; Ovid MEDLINE - In-Process & Other Non-Indexed Citations (Searched 11/3/10); Ovid EMBASE - 1980 to 2010 Week 09 and EBSCO CINAHL - 1982 to March 11 2010. No date or language restrictions were applied.

SELECTION CRITERIA: 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 relative risk 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 (relative risk 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 (relative risk 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.

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