Vanderbilt University School of Medicine, Nashville, TN, USA.
Clin Orthop Relat Res. 2013 Mar;471(3):899-904. doi: 10.1007/s11999-012-2524-z.
Wound closure accounts for a relatively constant portion of the time required to complete a surgical case. Both longer closure times and wound infections contribute to higher medical costs and patient morbidity.
QUESTIONS/PURPOSES: We therefore determined whether (1) biologic and treatment factors greater influenced wound healing than the choice of sutures or staples; and (2) different times to closure affected cost when sutures or staples are used in patients with musculoskeletal tumors.
We retrospectively reviewed 511 patients who had sarcoma resections of the buttock, thigh, and femur from 2003 to 2010; 376 had closure with sutures and 135 with staples. Data were abstracted on patient demographics, comorbidities, select procedural data, and wound complications. Wound complications were defined by hospitalization within 6 months postoperatively for a wound problem, irrigation and débridement, or infection treated with antibiotics. We determined the association between staples versus sutures and wound complications after controlling for confounding factors. The minimum followup was 2 weeks. A prospective, timed analysis of wounds closed with either sutures or staples was also performed.
We found an association between obesity and radiation and wound complications. Wounds were closed an average of 5.3 minutes faster with staples than with suture (0.29 minutes versus 5.6 minutes, respectively), saving a mean 2.1% of the total operating time although the total operating time was similar in the two groups.
We found no difference in wound complications after closure with sutures or staples, although obesity and radiation treatment appear to affect wound outcomes. Data suggest that time saved in the operating room by closing with staples compensates for added material costs and does not compromise wound care in patients with lower extremity sarcomas.
Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
伤口闭合所需的时间占手术总时间的比例相对稳定。无论是较长的闭合时间还是伤口感染都会导致更高的医疗费用和患者发病率。
问题/目的：因此，我们确定了（1）生物和治疗因素是否比缝线或缝合钉的选择更能影响伤口愈合；（2）在患有肌肉骨骼肿瘤的患者中，使用缝线或缝合钉时，不同的闭合时间是否会影响成本。
我们回顾性分析了 2003 年至 2010 年间接受臀部、大腿和股骨肉瘤切除术的 511 例患者；376 例患者采用缝线闭合，135 例患者采用缝合钉闭合。数据包括患者人口统计学、合并症、选择性手术数据和伤口并发症。术后 6 个月内因伤口问题、灌洗和清创术或抗生素治疗感染而住院的患者被定义为伤口并发症。我们在控制混杂因素后，确定了缝合钉与缝线之间与伤口并发症的关系。最小随访时间为 2 周。还对采用缝线或缝合钉闭合的伤口进行了前瞻性、定时分析。
我们发现肥胖和放疗与伤口并发症之间存在关联。与缝线相比，缝合钉的闭合速度平均快 5.3 分钟（分别为 0.29 分钟和 5.6 分钟），尽管两组的总手术时间相似，但可以节省总手术时间的 2.1%。
尽管肥胖和放疗治疗似乎会影响伤口结果，但我们发现采用缝线或缝合钉闭合后，伤口并发症没有差异。数据表明，使用缝合钉在手术室节省的时间可以弥补增加的材料成本，并且不会影响下肢肉瘤患者的伤口护理。
二级，预后研究。有关证据水平的完整描述，请参见作者指南。
