Abstract
Background: A subcuticular suture is an ideal closure method of a surgical wound, in patients undergoing foot & ankle surgery, when the aim is healing by primary intention. However, the addition of adhesive strips over the subcuticular suture has become an accepted method of closure despite being based on anecdotal, rather than experimental evidence.
Methods: We performed a prospective study to compare the postoperative wound complications of combination closure (3/0 Monocryl & steri strips) with subcuticular closure alone (3/0 Monocryl). Patients undergoing foot & ankle surgery were allocated to either group on an alternate basis. The wounds of sixty consecutive patients were assessed clinically for wound complications at one-week post op.
Results: Patients who had a combined closure were more likely to develop a wound discharge (23% vs 7%), friable skin (53% vs 3%) and were more likely to have non-opposed wound edges (60% vs 23%). They were also twice as likely to return to clinic for a further wound check (20% vs 10%).
Discussion: Adhesive strips were originally developed as wound dressings and offer no improvement in the tensile strength of the subcuticular closure. Instead their addition exposes the surgical wound to the possibility of epidermal injury from the adhesive in the tape and increases the likelihood of developing wound complications. We recommend meticulous closure of surgical wounds of the foot and ankle with continuous, absorbable, subcuticular suture without adhesive strips, for an optimal outcome.
Correspondence should be addressed to: D. Singh, BOFAS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
