1 / 24

Grand Rounds Paper of the week

Grand Rounds Paper of the week. Subcuticular sutures versus staples for skin closure after open gastrointestinal surgery: a phase 3, multicentre, open-label, randomised controlled trial. Tsujinaka et al, The Lancet 28 September-04 October, 2013. Introduction-1.

edie
Download Presentation

Grand Rounds Paper of the week

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Grand RoundsPaper of the week

  2. Subcuticular sutures versus staples for skin closure after open gastrointestinal surgery: a phase 3, multicentre, open-label, randomised controlled trial Tsujinaka et al, The Lancet 28 September-04 October, 2013

  3. Introduction-1 • Post op wound complications are common problem • Sub-cuticular suture (SCS) is an attractive way of skin closure in most types of surgery • Many ASA class 1 (clean surgery) studies with SCS found • Low wound complications • Good cosmetic appearance

  4. Introduction-2 • However in ASA class 2 (clean-contaminated) wounds the usefulness of one over the other is not know • Staples are preferred • Convenience of use • Speed of use

  5. Study aims • Toinvestigate differences in prevention of wound complications between sub-cuticular sutures and staples after elective upper and lower gastrointestinal open surgery

  6. The Fight Vs

  7. Study design-1 • Large-scale multi-centre phase 3 randomised control trial • B/t June 1, 2009 and Feb 28, 2012 • Superiority trial

  8. Study design-2 • Inclusion criteria • Pt undergoing Upper or lower GI surgery • Age >20 • Adequate organ function • Exclusion criteria (among others) • Emergency or laparoscopic surgery • Pervious history of midline incision • Long term corticosteroids use • Active infections • Uncontrolled DM

  9. Study arms • Subcuticular suture group • Interrupted subcuticular sutures with 3-0 or 4-0 monofilament absorbable suture • The interval of the sucuticular sutures was 15–25 mm and the length of the bite of sutures was 15–25 mm from the edge of the skin. • ± Use of sterile strips or skin glue for epidermal approximation (an institutional choice) • Staples group • Metallic skin staples, which were the choice of individual institutions, 10–15 mm apart were used. • Before the trial, investigators from participating institutions were instructed on how to do subcuticular sutures during the trial

  10. Randomisation • Randomisation by a computer-generated permuted-block sequence • Patients were randomly assigned (1:1) to either subcuticular sutures or staples arms and • Balanced according to institution, sex, and type of surgery (ie. upper or lower gastrointestinal open surgery)

  11. Study outcomes • Primary outcome • Incidence of wound complications within 30 days of surgery. • Secondary outcome • Incidence of hypertrophic scar formation 6 months after surgery

  12. Results-2

  13. Results-3

  14. Results-4

  15. Results-5

  16. Results-6

  17. Results-7

  18. Discussion 1 • Strengths • Level 1 evidence (RCT) • Simple methodology • Large study and long duration • Surgeon well trained to put suture/staples • Information about surgery at upper vs lower GI • Cant be double/single blinded

  19. Discussion 2 • Weakness • No data on number of patients approached or assessed for eligibility • Third arm with skin glue could be used • Did not include hepatobiliary or pancreatic surgery • No data on duration of surgery, patients' satisfaction, patients' preference

  20. Conclusions • Unlike in ASA class 1 surgery this trial failed to prove subcuticular sutures were a new standard procedure for skin closure after gastrointestinal surgery; • The formation of hypertrophic scars was significantly reduced with subcuticular sutures compared with staples

  21. Take home message Like/Unlike

  22. Future?? Upper GI Lower GI

  23. Thank you

More Related