Electronic Letters to:

Arthroplasty: R. J. K. Khan, D. Fick, F. Yao, K. Tang, M. Hurworth, B. Nivbrant, and D. Wood A comparison of three methods of wound closure following arthroplasty: A PROSPECTIVE, RANDOMISED, CONTROLLED TRIAL J Bone Joint Surg Br 2006; 88-B: 238-242 [Abstract] [Full text] [PDF]

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Electronic letters published:

Are staples really better than subcuticular sutures?

Kedar J Deogaonkar, Jamie Monaghan, Mark Lewis   (20 June 2006)

A comparison of three methods of wound closure following arthroplasty

Navraj S Atwal, G.M. Holt   (12 May 2006)

A comparison of three methods of wound closure following arthroplasty.

K C Kong   (7 February 2006)

Are staples really better than subcuticular sutures? 20 June 2006
Kedar J Deogaonkar, Orthopaedic Registrar Royal Gwent Hospital, Jamie Monaghan, Mark Lewis Send letter to journal: Re: Are staples really better than subcuticular sutures? kedar_deogao{at}yahoo.com Kedar J Deogaonkar, et al.	Sir, We read this article with interest and we applaud the authors' thoroughly researched and well-structured work on the topic. However, we disagree with their conclusion. The data put forward by Khan et al concludes that in using skin staples rather than subcuticular sutures or 2-octylcyanoacrylate (OCA) “wound glue” for the closure of hip and knee wounds following arthroplasty, there was no significant difference in length of stay in hospital (i.e. complications) and no less patient satisfaction with the cosmetic outcome. As skin staples are the quicker method of wound closure, they were recommended by the group as the method of choice. In our opinion, skin staples produce more problems in the post-operative period. We have observed that with staples, our patients complain more of wound pain while in-situ and on removal. A subcuticular suture tends to produce a perceived better cosmetic outcome – this is due to the psychology of seeing a neat ‘suture-free’ surface when the wounds are exposed to the patient for the first few times. There is also evidence to the contrary on the subject of post-operative wound infections being more common with the use of staples than with glue or subcuticular sutures.1 K.J. DEOGAONKAR, Orthopaedic Registrar, J. MONAGHAN, M. LEWIS, Royal Gwent Hospital, Newport, UK. 1. Shetty AA, Kumar VS, Morgan-Hough C, et al. Comparing wound complication rates following closure of hip wounds with metallic skin staples or subcuticular vicryl suture: a prospective randomised trial. J Orthop Surg (Hong Kong) 2004;12:191-3.
A comparison of three methods of wound closure following arthroplasty 12 May 2006
Navraj S Atwal, Clinical Research Fellow Cheltenham General Hospital, G.M. Holt Send letter to journal: Re: A comparison of three methods of wound closure following arthroplasty nav_atwal{at}hotmail.com Navraj S Atwal, et al.	Sir, We read with interest the article by Khan et al in the February 2006. The authors report no significant difference in patient satisfaction regarding the wound, and reveal significantly faster wound closure using staples. They use this to form their conclusion that skin staples should be the skin closure of choice for both hip and knee replacements. We appreciate the findings of this well-conducted study, despite the small sample sizes and difficulties with adequate blinding. From the figures quoted, two minutes per case are saved by using skin staples. If a maximum of five joint replacements were performed on an all-day operating list this would provide ten minutes of additional time. We propose that this would be very difficult to reallocate productively. The relative costs of a subcuticular suture at about £2.10, compared with a stapling device costing about £13.83, further weakens the conclusion that skin staples should be the closure method of choice. Since the authors have elegantly demonstrated no significant difference in the clinical outcome, it would be difficult for us to justify the additional costs. N.S. Atwal MRCS,MB ChB,BSc(Hons), Clinical Research Fellow, G.M. Holt MB ChB,FRCS(Tr & Orth), Consultant Orthopaedic Surgeon, Cheltenham General Hospital, Cheltenham, UK.
A comparison of three methods of wound closure following arthroplasty. 7 February 2006
K C Kong, Consultant Orthopaedic Surgeon King George Hospital, Essex, UK. Send letter to journal: Re: A comparison of three methods of wound closure following arthroplasty. kck{at}doctors.org.uk K C Kong	Sir, I read this article with interest. The authors acknowledged that the major drawback with the study was the small number of patients in each group. Although there were no statistical differences between the three groups in relation to complications, there were six late infections out of 63 THR and TKR staple closures in comparison with one out of 64 sutured THR and TKR patients. This difference was not statistically significant because of the small number of cases. There were statistically more wound infections in staple closure of wounds in a randomised controlled study of wound closure in patients undergoing surgical treatment for proximal hip fractures.1 However, the difference in rate of infections may be the result of the patients being older in this study.1 In the absence of a proven benefit other than rapid closure, it seems there is insufficient justification to recommend the use of staples over sutures for wound closure in hip and knee arthroplasty, particularly in the older patient, until further data is available. K.C. Kong, Consultant Orthopaedic Surgeon, King George Hospital, Essex, UK. 1. Shetty AA, Kumar VS, Morgan-Hough C, et al. Comparing wound complications following closure of hip wounds with metallic skin staples or subcuticular vicryl suture. J Orthop Surg 2004;12:191-193.