Comparative study of leg wound skin closure in coronary artery bypass graft operations.

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Abstract
A prospective randomized study of 4 different methods of leg wound skin closure after removal of the long saphenous vein was carried out in 113 patients undergoing coronary artery bypass grafting. These methods were: continuous nylon vertical mattress suture (27 patients); continuous subcuticular absorbable (Dexon) suture (29 patients); metal skin staples (Autosuture) (27 patients); and adhesive sutureless skin closure (Op-site) (30 patients). All wounds were examined by 2 independent observers at 5, 10 and 45 days after operation. At 5 days, inflammation, extent of edema, discharge and infection were assessed. At 10 days attention was paid to the state of wound healing and at 45 days to the final cosmetic appearance. The use of continuous subcuticular suture resulted in significantly less discharge than did the use of metal staples, nylon verticle mattress suture or Op-site. The incidence of established wound infection was 4.5% overall, with no infection in the wounds closed with Dexon. Assessment of the healing process showed subcuticular Dexon to be more effective than metal staples or vertical mattress nylon suture. The final cosmetic result showed continuous subcuticular suture to be superior to nylon vertical mattress suture and skin staples but as effective as Op-site sutureless skin closure.