Winning Wound-Closure Solutions

Most surgeons seal up incisions with sutures or staples out of repetition and routine. Cosmesis is an afterthought as their focus begins to shift to the next case. But should it be? "The scar is often the only thing patients remember about their surgeries," says Jeffrey S. Freed, MD, MPH, FACS, a clinical professor in the department of surgery at the Icahn School of Medicine at Mount Sinai in New York City. "I tell all my third-year medical students the same thing — don't overlook the scar."

The next time a surgeon tells you there's no reason to stop using tried-and-true wound closure methods, let them know new alternatives provide plenty of benefits, including sending their patients home with a constant visual reminder of the cutting-edge care they received.

Many of the wound closure products on the market are non-invasive devices such as adhesives and adhesive and tension-distributing combos or more-involved external tissue expanders. If you're like most surgical facility leaders, you want to know if adding one of these new products will save your facility money. They can — as long as you properly assess the true cost of wound closure. Factor into your decision-making the time savings that can neutralize the difference in upfront costs between most wound closure options and traditional sutures or staples. Mere minutes can determine whether a procedure is profitable for your facility.

"You can save around three or four minutes in closure time alone at the end of a case," says Sherwin S.W. Ho, MD, a professor of orthopaedic surgery and rehabilitation medicine and the director of the sports medicine fellowship program at University of Chicago (Ill.) Medicine. "That time really does add up."

When it comes to evaluating emerging wound-care devices, weigh your options the same way you would with new drugs — by analyzing randomized, controllable studies on the efficacy of the product as well as whether it's able to save your facility money. Dr. Freed points out the healthcare industry spends hundreds of millions of dollars on wound care each year, and there's a lot of incentive for companies to create the ideal product. That means you should keep a close eye on what's in the pipeline and identify products that show promise.

There's also a very compelling safety reason for expedient wound closure — especially in today's OR environment. It's worth emphasizing the safety benefits of limiting exposure with patients who are potentially carrying the coronavirus. "We're in the middle of a pandemic, and every patient contact is a worrisome event for caregivers who put themselves at risk," says Dr. Freed. "When it comes to not having a contagion transmission in the OR, time is of the essence."

Wound closure technology also eliminates the need for patients to schedule post-op appointments to have staples or sutures removed. Safely reducing or limiting provider-patient visits until the pandemic is under control is in everyone's best interests.

"Staplers and suture require a post-op visit for removal," points out Dr. Freed. "That's a time-consuming, non-reimbursable event that requires an interaction with the patient."

Of course, absorbable stitches are an option, but they can lead to abscesses — drainage, pus or redness around the wound — that essentially negate any of the benefits of the patient not having to return to have the stitches removed. "Approximately one out of every 20 patients will end up with redness or drainage from an abscess and wind up having to come in for follow-up treatment," says Dr. Ho.

COVID-19 dangers aside, non-invasive wound closure options are the safer option. Suture use carries the constant risk of needlestick injuries for surgeons and surgical team members. Staples, meanwhile, can harm patients. "If you punch 50 staples into the skin, there's a risk, albeit a small one, of infection," says Dr. Freed. Plus, he points out, non-invasive wound closure options don't traumatize tissue like staples do, and less tissue trauma leads to better outcomes.