Leg Wound Closure after Saphenous Vein Harvesting in Patients Undergoing Coronary Artery Bypass Grafting: A Prospective Randomized Study Comparing Intracutaneous, Transcutaneous and Zipper Techniques

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Abstract
Objective : Two prospective randomized studies were undertaken to compare different suture closure techniques with respect to postoperative wound infection rates and cosmetic results after saphenous vein harvesting in patients undergoing coronary artery bypass surgery. Design : A total of 166 patients were included in the first study, in which 85 had their leg wounds closed with transcutaneous and 81 with intracutaneous suture. In the second study, 168 patients were selected to a non-invasive surgical zipper ( n = 78) or intracutaneous suture ( n = 90). Results : In the first study the overall infection rate was 20.5%, 17.6% in the transcutaneous group compared with 23.5% in the intracutaneous group ( p = 0.35). In the second study the infection rate was 19.3%, 15.3% in the zipper group vs 23.3% in the intracutaneous group ( p = 0.20). On a cosmetic scale from 1 to 10, an average score of 8.0 was obtained in the percutaneous (p.c.) group vs 8.3 in the intracutaneous (i.c.) group ( p = 0.35), and 9.0 in the zipper group vs 8.4 in the i.c. group ( p = 0.003). Conclusion : The incidence of leg wound infection after saphenous vein harvesting in coronary artery bypass graft surgery is high. The zipper closing method may give a lower infection rate and a better cosmetic result compared with the intracutaneous suture.