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Surgical wound closure is an essential component of postoperative care that influences wound healing, infection rates, cosmetic appearance, and patient satisfaction. Sutures are conventionally used for skin closure following orthopedic procedures; however, surgical staples have gained popularity because of their rapid application, secure fixation, and potentially superior cosmetic outcomes. Despite their widespread use, there remains limited evidence comparing cosmetic outcomes and patient satisfaction between staple and suture techniques in upper limb surgeries in the local setting.
This study aims to compare the cosmetic outcome and patient satisfaction between staples and sutures for wound closure following upper limb surgeries at Dhulikhel Hospital. Secondary objectives include comparing wound infection rates and duration of hospital stay between the two techniques.
A prospective comparative study is conducted among adult patients undergoing upper limb surgeries. Patients fulfilling the inclusion and exclusion criteria are recruited consecutively during the study period. Following completion of surgery, wound closure is performed either with interrupted sutures or surgical staples according to the operative plan. Wounds are to be evaluated on postoperative day 2, day 7, and day 14, with further follow-up at 30 days and 6 weeks.
Cosmetic outcome and patient satisfaction are assessed using a 5-point Visual Analogue Scale (VAS). Pain assessment, wound complications including infection, and duration of hospital stay are also documented and compared between the two groups. The findings of this study can help identify the optimal skin closure method for upper limb surgeries and contribute to improved postoperative outcomes and patient satisfaction.
HYPOTHESES OF THE STUDY Null hypothesis (Ho): there is no difference in cosmetic outcome and patient satisfaction between sutures and staple technique for wound closure following upper limb surgeries.
Alternative hypothesis (H1): there is difference in cosmetic outcome and patient satisfaction between sutures and staple technique for wound closure following upper limb surgeries
Hence, Ho : (Cosmetic and Patient satisfaction score) in Suture group = Cosmetic and Patient satisfaction score) in Staples group H1 : (Cosmetic and Patient satisfaction score) in Suture group ≠(Cosmetic and Patient satisfaction score) in Staples group
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Skin Closure with Suture Group | Active Comparator |
| |
| Skin Closure with Staple Group | Experimental |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Staples | Procedure | Following completion of the upper limb surgical procedure, skin closure is performed using sterile surgical skin staples under aseptic precautions. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Cosmetic Outcome Assessed by 5-Point Visual Analogue Scale (VAS) | Cosmetic outcome following wound closure with staples or sutures will be assessed at 30 days and 6 weeks using a 5-point Visual Analogue Scale (VAS). The scale ranges from 1 to 5, where 1 indicates excellent cosmetic appearance and 5 indicates very poor cosmetic appearance. Lower scores indicate better cosmetic outcome. | 1 year |
| Patient Satisfaction Assessed by 5-Point Satisfaction Scale | Patient satisfaction regarding wound closure will be assessed at 30 days and 6 weeks using a 5-point satisfaction scale. The scale ranges from 1 to 5, where 1 indicates extremely satisfied and 5 indicates extremely dissatisfied. Lower scores indicate greater patient satisfaction. | 1 year |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative Pain Assessed by 5-Point Pain Scale | Postoperative pain at the wound site will be assessed during follow-up visits using a 5-point pain scale ranging from 1 to 5, where 1 indicates no pain and 5 indicates very severe pain. Lower scores indicate less postoperative pain. | 1 year |
| Surgical Site Infection |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Dhulikhel Hospital, Kathmandu University Hospital | Dhulikhel | Bagmati | 45200 | Nepal |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 10167360 | Result | Rodeheaver GT, Beltran KA, Green CW, Faulkner BC, Stiles BM, Stanimir GW, Traeland H, Fried GM, Brown HC, Edlich RF. Biomechanical and clinical performance of a new synthetic monofilament absorbable suture. J Long Term Eff Med Implants. 1996;6(3-4):181-98. | |
| 4267743 | Result | Edlich RF, Panek PH, Rodeheaver GT, Turnbull VG, Kurtz LD, Edgerton MT. Physical and chemical configuration of sutures in the development of surgical infection. Ann Surg. 1973 Jun;177(6):679-88. doi: 10.1097/00000658-197306000-00006. No abstract available. |
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| Sutures | Procedure | Following completion of the upper limb surgical procedure, skin closure is performed using interrupted non-absorbable skin sutures under aseptic precautions. Skin closure is mattress as it allows for inversion or eversion of the repaired tissue, greater repair strength, and provides a greater area of soft tissue apposition to bone. |
|
Surgical site infection will be assessed clinically during postoperative follow-up visits on day 2, day 7, day 14, and day 30. Infection will be reported as presence or absence of clinical signs including redness, swelling, discharge, or wound tenderness. |
| 1 year |
| Length of Hospital Stay | Length of hospital stay will be measured in days from the date of surgery until discharge from hospital. Shorter hospital stay indicates improved postoperative recovery. | 1 year |
| 7832962 | Result | Orlinsky M, Goldberg RM, Chan L, Puertos A, Slajer HL. Cost analysis of stapling versus suturing for skin closure. Am J Emerg Med. 1995 Jan;13(1):77-81. doi: 10.1016/0735-6757(95)90248-1. |
| 7112304 | Result | Meiring L, Cilliers K, Barry R, Nel CJ. A comparison of a disposable skin stapler and nylon sutures for wound closure. S Afr Med J. 1982 Sep 4;62(11):371-2. |
| Result | Chaudhary, P., Shrestha, B. P., Khanal, G. K., Rijal, R., & Maharjan, R. (2017). Randomized controlled trial comparing outcome of use of staples and nylon sutures for closure in elective orthopedic surgery. Health Renaissance, 13(3), 137-143. https://doi.org/10.3126/hren.v13i3.17937 |
| ID | Term |
|---|---|
| D013529 | Surgical Wound Dehiscence |
| D000072836 | Surgical Wound |
| D010149 | Pain, Postoperative |
| D014946 | Wound Infection |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D014947 | Wounds and Injuries |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D007239 | Infections |
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| ID | Term |
|---|---|
| D013537 | Sutures |
| ID | Term |
|---|---|
| D053831 | Surgical Fixation Devices |
| D013523 | Surgical Equipment |
| D004864 | Equipment and Supplies |
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