We thank Mr Ball for his interesting comments following our recent
publication of surgical closure methods in orthopaedic surgery [1].
The points raised by Mr Ball are all valid. As we concluded in our
paper, a number of considerable methodological limitations were apparent
in the current evidence-base. The purpose of this review was therefore two
-fold. We first aimed to determine whether there was a difference in wound
closure method. As reported, there appeared a difference in respect to
infection rates between the two methods. Irrespective of the magnitude of
this difference, either as assessed with absolute risk reductions, or odd
ratios, this difference was reported to indicate that the previously
notion that there was little difference in outcomes, may not necessarily
be true. Secondly, we needed to ascertain the strength of the current
evidence-base. As Mr Ball reiterated from our review, there are a number
of major shortcomings to the evidence-base. We therefore recommended that
future study be conducted to examine this topic with greater rigour, and
that this should therefore certainly not be considered as “accepted
wisdom”.
[1] Toby O Smith, Debbie Sexton, Charles Mann, and Simon Donell
Sutures versus staples for skin closure in orthopaedic surgery: meta-
analysis BMJ 2010; 340: c1199
Competing interests:
TS is an author of the primary study.
Rapid Response:
In response to Mr Ball
We thank Mr Ball for his interesting comments following our recent
publication of surgical closure methods in orthopaedic surgery [1].
The points raised by Mr Ball are all valid. As we concluded in our
paper, a number of considerable methodological limitations were apparent
in the current evidence-base. The purpose of this review was therefore two
-fold. We first aimed to determine whether there was a difference in wound
closure method. As reported, there appeared a difference in respect to
infection rates between the two methods. Irrespective of the magnitude of
this difference, either as assessed with absolute risk reductions, or odd
ratios, this difference was reported to indicate that the previously
notion that there was little difference in outcomes, may not necessarily
be true. Secondly, we needed to ascertain the strength of the current
evidence-base. As Mr Ball reiterated from our review, there are a number
of major shortcomings to the evidence-base. We therefore recommended that
future study be conducted to examine this topic with greater rigour, and
that this should therefore certainly not be considered as “accepted
wisdom”.
[1] Toby O Smith, Debbie Sexton, Charles Mann, and Simon Donell
Sutures versus staples for skin closure in orthopaedic surgery: meta-
analysis BMJ 2010; 340: c1199
Competing interests:
TS is an author of the primary study.
Competing interests: No competing interests