Staples Can Have Advantages
As correctly pointed out by the authors of the article, the majority of surgical site infections after surgical procedures is caused by the patient’s own flora (1). Almost two third of all pathogens causing surgical site infections in a gastrointestinal surgery setting are Escherichia coli or enterococci (2). The primary reservoir for pathogens associated with surgical site infections occurring after abdominal surgery is the gastrointestinal tract, although intestinal bacteria can be part of the transient skin flora. Apparently, translocation of pathogens into the surgical wound does not typically arise from the skin. Therefore, the hypothetical advantage of intracutaneous sutures (quote: ‘With regard to the patient’s own flora as the main source of surgical site infections, tight skin closure without injury to dermal structures might possibly help prevent surgical site infections.’) indicated by the authors is of little relevance. Consequently, their study found no difference between the two techniques with regard to the primary endpoint of their study and A2 and A3 wound infections (3).
It should also be noted that staples—essentially interrupted stitches—have the advantage, especially if used for the closure of long incisional wounds, that individual staples can be removed to treat fluid retention and local (early) infections (within short sections of the wound) without creating major dehiscence. An increased number of cases of wound dehiscence after removal of the staples, as reported by the authors, has to be taken into account, especially in the elective setting. However, with regard to their significance for the further healing process, the question arises as to the extent of wound dehiscence. To avoid wound dehiscence, the technique used to place staples should ensure meticulous approximation of the wound edges without inversion, as well as adequate distances between the staples, to the wound edges and to the angle of the wound. The authors demonstrated with their study that intracutaneous sutures also play a role in an elective gastrointestinal surgery setting.
MOR Dr. med. Benedikt Lampl
Specialist in Visceral Surgery
Deputy Head of Section, Infection Control and Hygiene—Hospital Hygiene
Health Authority [Gesundheitsamt] of Regensburg, Regensburg, Germany
Conflict of interest
The author declares no conflict of interest.
|1.||Maurer E, Reuss A, Maschuw K, et al.: Superficial surgical site infection following the use of intracutaneous sutures versus staples—a randomized single-center trial in an elective gastrointestinal surgery setting. Dtsch Arztebl Int 2019; 116: 365–71 VOLLTEXT|
|2.||Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO): Prävention postoperativer Wundinfektionen. Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsbl 2018; 61:448–73 CrossRef MEDLINE|
|3.||Cruse PE, Foord R: A five-year prospective study of 23,649 surgical wounds. Arch Surg 1973; 107: 206–10 CrossRef MEDLINE|