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Journal of Long-Term Effects of Medical Implants
SJR: 0.332 SNIP: 0.491 CiteScore™: 0.89

ISSN Print: 1050-6934
ISSN Online: 1940-4379

Journal of Long-Term Effects of Medical Implants

DOI: 10.1615/JLongTermEffMedImplants.v16.i1.30
pages 19-27

A Revolutionary Advance in Skin Closure Compared to Current Methods

Angela Pineros-Fernandez
Research Assistant in Plastic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
Lisa S. Salopek
Plastic Surgery Research, University of Virginia Health System, Charlottesville, Virginia USA 22908-1351
Pamela F. Rodeheaver
Research Assistant in Plastic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
David B. Drake
Associate Professor of Plastic Surgery & Orthopedic Surgery. University of Virginia Health System PO Box 800376 Charlottesville VA 22908-0376, USA
Richard Edlich
Legacy Verified Level I Shock Trauma Center Pediatrics and Adults, Legacy Emanual Hospital; and Plastic Surgery, Biomedical Engineering and Emergency Medicine, University of Virginia Health System, USA
George T. Rodeheaver
Plastic Surgery Research Program, Department of Plastic Surgery, University of Virginia Health System, Charlottesville, VA, USA


Six pigs were used to evaluate the influence of three separate modalities on contaminated wounds. Full-thickness skin wounds on the abdomen were contaminated with 104 or 105 Staphylococcus aureus and then closed with one of three methods. The three closure modalities included (1) a new absorbable staple (Insorb™) placed in the subcuticular tissue, (2) a braided Vicryl™ suture, and (3) percutaneous metal staples. Any foreign body material implanted in tissue increases the risk of infection at that site. Wound closure always involves the use of a foreign body. Historically, sutures have been the primary material used to close tissue. The newer synthetic sutures are significangly more biodegradable and cause less infection than sutures composed of protein, such as silk and catgut. Metal staples are also associated with a low risk of infection. Recently, Incisive Surgical, Inc. (Plymouth, Minnesota) has developed an absorbable polymer staple specifically for subcuticular skin closure. The purpose of this study was to compare the new Insorb™ staple to both an absorbable polymer suture and a metal staple. Wound infection was assessed 7 days after closure by clinical signs and quantitative bacterial swabs. The results demonstrated that wounds closed with Insorb™ staples had the lowest incidence (33%) of infection, followed by percutaneous metal staples (44%). All wounds (100%) closed with Vicryl™ suture became infected. The incidence of wound infection directly correlated with the level of quantitative bacterial count at analysis. The Insorb™ staple was associated with significantly reduced closure time, less inflammation and infection, and better aesthetic result compared to Vicryl™. Compared to metal staples, the Insorb™ subcuticular staplers demonstrated comparable closure time without the need for later staple removal. In conclusion, the closure of contaminated wounds with the Insorb™ staples is a superior choice to Vicryl™ suture because they have a significantly (p = 0.009) lower incidence of infection. The Insorb™ staple is a revolutionary advance in subcuticular skin stapling.