Staples for skin closure in surgeryBMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c403 (Published 17 March 2010) Cite this as: BMJ 2010;340:c403
- B I Singh, consultant orthopaedic surgeon,
- C Mcgarvey, specialist registrar, trauma and orthopaedics
- 1Medway Foundation NHS Trust, Gillingham ME7 5NY
About 230 million major surgical procedures are performed worldwide each year,1 and morbidity and mortality after surgery vary widely. Three recent publications highlight the long term implications of surgical complications, both for 30 day survival and “sickness absence.”1 2 3 In the linked systematic review (doi:10.1136/bmj.c1199), Smith and colleagues assess clinical outcomes using staples compared with sutures in wound closure in orthopaedic surgery.4
Postoperative infection is a major source of morbidity, mortality, and hospital costs, but it is not completely avoidable because certain factors—such as age, drugs, systemic illness, and type of surgery—cannot be changed. Interventions to reduce infection, such as the use of perioperative antibiotics and clean air operating theatres, are well established. The literature is sparse, however, on the role of skin closure technique on the rates of infection.
Wound closure creates the tensile strength that holds the wound edges together and it provides an effective seal until healing takes over. Effective wound healing minimises infection and produces a satisfactory cosmetic result. In orthopaedic surgery, superficial infection can be associated with increased risk of deep infection and reduced implant survival.
The preferred method of …