Comparative Evaluation of Three Skin Closure Materials- A Microbiological Pilot Study

Abstract

Introduction: The goal of a skin closure technique is to precisely approximate the wound edges without tension for sufficient time, to allow healing to take place. The presence of a suture in surgical wounds has been found to increase the tissue’s susceptibility to infection. Increased microbial colonisation in a particular area results in higher risk of infection. There are limited studies investigating the presence and the type of microbial colonisation with respect to different skin closure techniques, especially metal staples. Aim: To compare and analyse microbial colonisation and wound complications in association with the use of surgical staples, nylon and polypropylene suture material; and to compare and analyse the incidence of wound complications in association with these three materials. Materials and Methods: A cross-sectional study was conducted on 60 patients, of which 20 underwent closure by prolene, 20 by nylon and 20 by metal staples. The prolene sutures, nylon sutures and staples were removed on 8th to 14th day postoperatively. The removed suture fragments and the staples were inoculated aerobically in suitable culture media according to the standard methodology to look for microbial growth. The results were derived using repeated measures ANOVA and Chi-square test. Results: A total of 70% of the patients from prolene group were found to have bacterial growth on microbial colonisation, whereas 30% did not show any growth. In the nylon group, 50% of the patients demonstrated bacterial growth whereas the rest of the 50% showed no growth. In the staples group 95% of the patients did not show any bacterial growth on culture media and only 5% showed positive bacterial growth. All of these differences were highly statistically significant (p<0.001). The most common colonising bacteria was Staphylococcus aureus followed by Klebsiella spp followed by Pseudomonas aeruginosa. Conclusion: The findings of this study suggested that prolene was most prone to bacterial colonisation followed by nylon and staples. The most common micro-organisms found were Staphylococcus aureus, Pseudomonas aeruginosa and Klebsiella spp.