Comparison of the Incidence of Post-operative Wound Infection between Skin Staples and Conventional Sutures in Abdominal Skin Closures

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1 Print ISSN: Online ISSN: DOI: /SUR/2016/52 Originl Article Comprison of the Incidence of Post-opertive Wound Infection etween Skin Stples nd Conventionl Sutures in Adominl Skin Closures Srikntih Hiremth 1, Kirn C Kils 2, B M Viny 3 1 Associte Professor, Deprtment of Generl Surgery, M. S. Rmih Medicl College nd Hospitls, Bengluru, Krntk, Indi, 2 Senior Resident, Deprtment of Generl Surgery, M. S. Rmih Medicl College nd Hospitls, Bengluru, Krntk, Indi, 3 Post-grdute Student, Deprtment of Generl Surgery, M. S. Rmih Medicl College nd Hospitls, Bengluru, Krntk, Indi Astrct Introduction: The type of suture mteril for skin closure is lso reported to influence post-opertive wound complictions. However, severl other studies hve filed to demonstrte significnt differences etween different types of suture mteril. Mterils nd Methods: This study ws conducted t M. S. Rmih hospitls, Bengluru , Krntk, Indi, where 100 ptients underwent dominl skin closure with either stples or conventionl verticl mttress suturing with Ethilon. Results: The present 1 yer oservtionl study ws conducted in the Deprtment of Surgery, M. S. Rmih Hospitls, Bengluru , Krntk, during the yer Decemer 2014-Novemer Dt otined ws tulted nd nlyzed in tles. Conclusion: The use of skin stples in low tension incision is esy, ssocited with low incidence of wound complictions, provides good cosmetic outcome nd lso tkes considerly less time for skin closure nd thus recommend its use more frequently especilly for closure of long nd multiple incisions. Keywords: Surgicl Incision, Sutures nd Skin stplers INTRODUCTION Surgery is derived from the erlier nme chirurgery, which mens hndwork. It is science nd rt tht shows the mnner in which to work on mn s ody exercising ll mnul opertions necessry to hel or s much s possile using most expedient medicines or techniques. 1-3 The gol of surgery is to chieve heling y such mens with miniml edem, no serous dischrge or infection, without seprtion of the wound edges nd with miniml scr formtion. Access this rticle online After ny surgicl procedure (ssuming there re no tension nd good lood supply) creful pproximtion of the tissues will llow heling y primry intention. 4-7 Precise pproximtion of skin incisions nd lcertions with wound closure devices is criticl for fvorle cosmetic nd functionl surgicl result. Principles of wound closure focus on relieving tension on the wound nd ringing the skin edges together in n everted orienttion. If sutures re tied too tight or left in too long, they my leve permnent suture trcts if sutures re removed efore dequte heling, the lck of wound tensile strength my result in wound dehiscence or widened scr. 8,9 Month of Sumission : Month of Peer Review : Month of Acceptnce : Month of Pulishing : Wound closure includes ensuring clen wound with stisfctory vsculrity nd hemostsis nd pposition without wound tension. Principles of wound closure focus on relieving tension on the wound nd ringing the skin edges together in n everted orienttion. Corresponding Author: Dr. Srikntih Hiremth, Deprtment of Generl Surgery, Door No. 72, 16 th Cross, 6 th Min Rod, Mlleswrm, Bengluru , Krntk, Indi. Phone: E-mil: drsrikntih@gmil.com IJSS Journl of Surgery Novemer-Decemer 2016 Volume 2 Issue 6 31

2 Hiremth, et l.: Comprison of the Incidence of Post-opertive Wound Infection etween Skin Stples nd Conventionl Sutures in Adominl Skin Closures Surgery is the first nd the highest division of the heling rt, pure in itself, perpetul in its pplicility, working product of heven nd sure of fme on erth SUSHRUTA (400 B.C). Surgicl site infection (SSI) is the most common nosocomil infections reported in the hospitl ptients. Up to 2.5% of the ptients undergoing clen extr dominl opertions nd up to 20% of intr-dominl opertions will develop SSI. SSI remins compliction of surgicl procedures resulting in incresed moridity, mortlity, nd cost. Infection remins the most significnt fctor ffecting wound heling. A closure tht penetrtes the epidermis nd dermis only serves to uto-inoculte the wound of the ptient, driving surfce flor deep into the sucutneous tissue. Percutneous suture closure provides n extr source of contmintion through the suture cnl nd results in thin perisuturl cuff of ded epidermis, dermis, nd sucutneous ft. Suture closure lso is potentil source of foreign ody rection within the susceptile sucutneous tissue. The type of suture mteril for skin closure is lso reported to influence post-opertive wound complictions. However, severl other studies hve filed to demonstrte significnt differences etween different types of suture mteril The surgicl scr remins the only visile evidence of the surgeon s skill nd not infrequently, ll of his efforts re judged on its finl ppernce. Skin stples give net scr with good wound eversion nd miniml cross-htching effect. They cn e plced fster thn sutures nd hve lower predisposition to infection ecuse they do not penetrte entirely through the wound nd do not produce complete trck from one wound to the other MATERIALS AND METHODS This study ws conducted t M. S. Rmih hospitls, Bengluru , Krntk, Indi, where 100 ptients underwent dominl skin closure with either stples or conventionl verticl mttress suturing with Ethilon. Out of the 100 ptients, 50 underwent skin closure with stinless steel skin stples nd the remining 50 with verticl mttress suturing with Ethilon ll these ptients were llotted to either group ccording to rndom numer tle. Inclusion Criteri All ptients undergoing elective dominl surgeries Ptients giving consent for the tril. Exclusion Criteri Ptients hving lcerted wounds with skin loss Ptients hving dietes mellitus (DM) Ptients with immune compromised sttus like AIDS/HIV infection Ptients hving severe comoridities, i.e., shock, septicemi, filure of other orgn systems, recent myocrdil infrction, nd/or mlignncy. Ethicl clernce hs een otined from our institution for conducting this study. Method of Collection of Dt A detiled history of ech ptient ws otined strting with history of presenting symptoms nd ny coexisting, comorid conditions such s DM, hypertension, nd jundice were ruled out. A thorough generl physicl exmintion ws done to rule out the presence of pllor, icterus, nd cchexi. Preopertively ll ptients underwent following investigtions: Complete lood count, urine exmintion Blood sugr, lood ure, serum cretinine Liver function test (wherever needed) Chest X-ry, electrocrdiogrm (wherever needed). All cses were elective surgeries nd the mode of nesthesi ws either generl nesthesi (GA), spinl nesthesi, or short GA. Shving ws done the night efore surgery. They ll received one mndtory dose of pre-opertive prenterl ntiiotic 1 h efore the incision. Pinting ws done with 10% povidone iodine solution for ll cses. Closure Technique After the sucutneous ft ws sutured with 2-0 vicryl:. Suture group Skin ws pproximted with verticl mttress sutures using non-sorle 2-0 Ethilon t distnce of 1 cm from ech other.. Stpled group Before inserting stples, it is importnt to line up the wound edges with the centerline indictor on the hed of the stpler to mke sure tht the legs of the stple will enter the skin t equl distnces on either side of the wound edge. Ech edge is typiclly picked up with forceps, everted nd precisely lined up. The stples re then used to close the wound while 32 IJSS Journl of Surgery Novemer-Decemer 2016 Volume 2 Issue 6

3 Hiremth, et l.: Comprison of the Incidence of Post-opertive Wound Infection etween Skin Stples nd Conventionl Sutures in Adominl Skin Closures the first ssistnt dvnces the forceps, everting the edges of the wound. They re plced t distnce of 5 mm from one nother. This technique is continued until the entire wound is everted nd closed with stples. The time required for skin closure ws recorded. For the sutures group, etdine ointment ws pplied nd pcked dressing given. For the stpled group simple dry guze dressing ws given. Postopertively ll ptients received totl of 3 dys of prenterl nd orl ntiiotics. The ptients who underwent Mesh repir received totl of 5 dys of prenterl nd orl ntiiotics. On the 3 rd post-opertive dy, the wound ws evluted for inflmmtion, infection, nd wound gpe. Inflmmtion ws defined s excessive redness nd tenderness of incision site with indurtion. Infection ws defined s ny persistence of superficil cellulitis or indurtion with serosnguinous or pus dischrge from wound site lsting eyond 7 th postopertive dy. The ptients were usully dischrged fter suture removl on the 7-8 th dy for the sutures group nd the stpled group ptients fter the 1 st wound evlution if there ws no wound inflmmtion/infection. In cse of wound infection or dischrge in ny group, the dischrge ws sent for culture nd sensitivity. The totl hospitl sty ws noted. Ptients were re-evluted for infection/gpe/inflmmtion during follow-up on 15 dys/1 month. Sttisticl nlysis ws performed using the Mnn Whitney test, nd the P vlue ws clculted. At 1 month follow-up: The wounds were evluted t 1 month follow-up which were rted for cosmesis on previously vlidted cosmesis visul nlog score (VAS) which hs een demonstrted to e relile nd vlid outcome mesure of cosmesis. The cosmetic VAS is 100 mm line with worst scr t 0 nd est scr t 100. A senior surgeon rted photogrphs unwre of the method used to close the wound. Worst scr Best scr 100 Using the line s continuous entity the surgeon mrked the ptient s scr on the line. The score ws then mesured in millimeters from 0 to 100. The men VAS for ech group ws clculted. Sttisticl evlution ws done fter consulting the college sttisticin. Using the student s unpired t-test, the P vlue ws clculted. OBSERVATIONS AND RESULTS The present 1 yer oservtionl study ws conducted in the Deprtment of Surgery, M. S. Rmih Hospitls, Bengluru , Krntk, during the yer Decemer 2014-Novemer Dt otined ws tulted nd nlyzed s Tles 1-7. Tle 1: Age distriution Age distriution (yers) Stples Conventionl Totl method < > Grnd totl Tle 2: Residence Plce Stples Conventionl method Totl Bengluru Outside Bengluru Grnd totl Tle 3: Socio economic sttus Socio economic sttus Stples Conventionl method Totl Low Middle High Grnd totl Tle 4: Litercy of the study popultion Eduction Stples Conventionl method Totl Illiterte Primry eduction Secondry 6 6 Intermedite Degree Grnd totl Tle 5: Employment sttus Employment Stples Conventionl method Totl sttus Unemployed Unskilled 4 4 Semiskilled Skilled Professionl Grnd totl IJSS Journl of Surgery Novemer-Decemer 2016 Volume 2 Issue 6 33

4 Hiremth, et l.: Comprison of the Incidence of Post-opertive Wound Infection etween Skin Stples nd Conventionl Sutures in Adominl Skin Closures Grph 1 nd shows the ge distriution in stples group. The grphs show tht the mjority were in the 40+ yer s ge group. Grph 2 nd shows the ge distriution in conventionl suture group. The grphs show tht the mjority were in the 40+ yer s ge group. Tle 6: Dignosis Dignosis Stples Conventionl method Totl Herni Chronic ppendicitis Cholelithisis Lymphdenopthy Others Grnd totl Tle 7: Procedure Procedure Stples Conventionl method Totl Herniorrhphy Mesh plsty Appendecectomy Cholecystectomy Explortory lprotomy Grnd totl Grph 3 nd shows the sex distriution of the stples group. The pie chrt shows tht 34 of the study popultion were mles nd the remining 16 were femles. Grph 4 nd shows the sex distriution of the conventionl sutures group. The pie chrt shows tht 38 of the study popultion were mles nd the remining 12 were femles. Grph 5 nd shows the residence of the study popultion. The grph shows tht 46% were from Bengluru nd nery res wheres the remining 54% were from other towns/cities in Krntk. Grph 6 nd shows the eduction sttus of the stples group. The grph shows tht 1 out of 50 of study popultion ws educted up to primry school level. 7 were educted up to high school level. 8 were educted up to intermedite. 34 were educted up to degree level or ove. Grph 7 nd shows the occuption of the stples group. The r chrt nd pie chrt show tht mjority, i.e., 31 out of 50 were skilled. 8 were involved in semiskilled lor nd 8 in professionl jos. 3 were unemployed. Grph 1: ( nd ) Age distriution in stples group Grph 2: ( nd ) Age distriution in conventionl suture group 34 IJSS Journl of Surgery Novemer-Decemer 2016 Volume 2 Issue 6

5 Hiremth, et l.: Comprison of the Incidence of Post-opertive Wound Infection etween Skin Stples nd Conventionl Sutures in Adominl Skin Closures Grph 3: ( nd ) Sex distriution of the stples group Grph 4: ( nd ) Sex distriution of the conventionl sutures group Grph 5: ( nd ) Residence of the study popultion IJSS Journl of Surgery Novemer-Decemer 2016 Volume 2 Issue 6 35

6 Hiremth, et l.: Comprison of the Incidence of Post-opertive Wound Infection etween Skin Stples nd Conventionl Sutures in Adominl Skin Closures Grph 6: ( nd ) The eduction sttus of the stples group Grph 7: ( nd ) The occuption of the stples group Grph 8 nd shows the occuption of the conventionl sutures group. The r chrt nd pie chrt show tht mjority i.e., 25 out of 50 were skilled. 7 were involved in semiskilled lor nd 9 in professionl jos. 5 were unemployed nd 4 were unskilled. Grph 9 nd shows the finl dignosis in the stples group. The grph shows mjority of the ptients hd chronic ppendicitis (17 out of 50) nd herni (14 out of 50). 9 ptients hd cholelithisis for which cholecystectomy ws done. 10 ptients were dignosed to hve other disorders mentioned ove. Grph 10 nd shows the finl dignosis in the conventionl sutures group. The grph shows mjority of the ptients hd herni (19 out of 50) nd chronic ppendicitis (17 out of 50). 12 ptients hd cholelithisis for which cholecystectomy ws done. 2 ptients were dignosed to hve other disorders mentioned ove. Grphs 11 nd shows the procedures conducted on stples group.17 out of 50 underwent ppendicectomy nd 13 out of 50 underwent cholecyctectomy. 8 ptients underwent herniorrhphy nd 6 ptients ech underwent mesh repir nd explortory lprotomy. Grphs 12 nd shows the procedures conducted on conventionl sutures group. 17 out of 50 underwent ppendicectomy nd 13 out of 50 underwent herniorrhphy. 12 ptients underwent cholecystectomy nd 6 ptients underwent mesh repir nd 2 ptients underwent explortory lprotomy. Stples Group Aout 3 ptients hd post-opertive wound inflmmtion, out of which 2 ptients developed wound infection in the form of purulent dischrge on the 6 th post-opertive dy. 1 ptient went on to develop wound gpe. Conventionl Suture Group Aout 11 ptients developed wound inflmmtion out of which 5 ptients developed wound infection nd 3 ptients hd gping of wound. P vlue clculted using Mnn Whitney test. P vlue ws which ws very significnt (Tle 8). 36 IJSS Journl of Surgery Novemer-Decemer 2016 Volume 2 Issue 6

7 Hiremth, et l.: Comprison of the Incidence of Post-opertive Wound Infection etween Skin Stples nd Conventionl Sutures in Adominl Skin Closures Grph 8: ( nd ) The occuption of the conventionl sutures group Grph 9: ( nd ) The finl dignosis in the stples group Grph 10: ( nd ) The finl dignosis in the conventionl sutures group Tle 8: Wound complictions Complictions Stples Sutures Totl Inflmmtion Infection Gpe P= (VS) Ptients were followed up fter dischrge t 8 th -10 th postopertive dy for removl of stples. Cosmetic evlution ws done t 1 month follow-up. No ptients were lost to follow-up. Averge VAS of ptients in stple group t the end of 1 month ws (±5.50) while the verge for suture group ws (±6.17). P vlue clculted using Student s unpired t-test. P < which ws highly significnt (Tle 9). IJSS Journl of Surgery Novemer-Decemer 2016 Volume 2 Issue 6 37

8 Hiremth, et l.: Comprison of the Incidence of Post-opertive Wound Infection etween Skin Stples nd Conventionl Sutures in Adominl Skin Closures Grph 11: ( nd ) The procedures conducted on stples group Grph 12: ( nd ) Procedures conducted on conventionl sutures group Tle 9: Cosmetic evlution Cosmetic outcome Stples Sutures P vlue VAS <0.001 (HS) SD VAS: Visul nlogue score, SD: Stndrd devition DISCUSSION Wound closure is s importnt s ny other ction performed y the surgeon. And prt from the need for producing helthy nd strong scr, it is the surgeon s responsiility to ensure its estheticlly plesing physicl ppernce. Skin stples re n lterntive to regulr sutures in offering this dvntge. Sutures re used to fcilitte the process of wound heling y: 1. Closing ded spce within the wound 2. Supporting wounds until their tensile strength is incresed 3. Approximting skin edges. Sutures initite foreign ody response (i.e., tissue rection). The initil tissue rection is ttriuted to the injury inflicted y the pssge of suture nd needle nd rection to the suture mteril itself. The rection of living tissue to injury or foreign odies is clled inflmmtion. The inflmmtory response usully peks etween 2 nd 7 dys fter implnttion. The longer suture mss stys in the humn ody, the more likely it is to produce undesirle tissue rections. For the surgeon, scr my e the only trdemrk of the surgicl procedure performed, s Fitz Gion hs stted, By your scrs you will e judged (Fitz Gion, 1968). There re mny fctors tht ffect the cosmetic outcome of scrs. The following fctors re importnt in compring the vrious methods tht re ville. 1. Incidence of complictions (for exmple, infection) 2. Cosmetic results 3. Ptient comfort nd cceptility 4. Ese of post-opertive wound cre (dressing, wound inspection), ese of deling with complictions should they occur, nd ese of removl 38 IJSS Journl of Surgery Novemer-Decemer 2016 Volume 2 Issue 6

9 Hiremth, et l.: Comprison of the Incidence of Post-opertive Wound Infection etween Skin Stples nd Conventionl Sutures in Adominl Skin Closures 5. Time tken to close the wound 6. Although sutures re inexpensive, they typiclly tke longer to plce, nd there is lso risk of needle stick injury to the surgeon nd operting stff 7. Needle stick injuries to the surgeon 8. Stitch scess my develop 9. Injury to the lood vessels in the skin resulting in hemtom. In this study, 100 ptients underwent dominl wound closure. Out of the 100, 50 underwent closure of skin with skin stples while the remining 50 ptients hd their skin closed with non-sorle sutures. There ws no significnt difference etween the results of ppliction of stplers or sutures t vrious ntomic regions. The most common region of the surgicl wounds in this study ws Mcurney s 17 in ech group nd inguinl, 14 in stples nd 19 in suture group, the regionl distriution of surgicl wounds in the stples group ws mid line 10, sucostl 9 nd mong the suture group midline 2 nd sucostl 12. The comprisons of these two groups were done in reltion to: 1. Post-opertive complictions 2. Cosmetic outcome. Wound Complictions The primry ojective of our study ws to mesure the incidence of post-opertive wound infection. Wound complictions included: 1. Inflmmtion 2. Infection 3. Wound gpe. Inflmmtion ws defined s the presence of redness nd tenderness t the site of incision. In our study, 11 ptients hd wound inflmmtion in the suture group s compred to 3 in stpled group. The difference ws found to e sttisticlly very significnt (P = ). Infection of the wound is the presence of serosnguinous dischrge or frnk pus. It ws present in 2 ptients of the stpled group nd 5 ptients of the suture group. Wound gpe ws seen in 1 ptient of the stpled group nd 3 of the verticl mttress sutured group which ws found to e significnt. Ptients with wound infection hd their dischrge sent for culture nd sensitivity nd ntiiotics were instituted s per the report. Secondry suturing ws done in 2 ptients of the suture group. In the other 2 ptients, 1 ech in stple nd suture groups, the wounds heled with regulr dressings. All of the ptients were evluted 1 month fter dischrge. There is uniform greement tht skin wounds closed y stples exhiit superior resistnce to infection thn skin wounds contminted y the lest rective suture. The superior resistnce of stpled wounds to infection s compred with the resistnce of sutured wounds ws confirmed y the experimentl study of Stillmn et l., in contminted wounds in mice, stpled wounds displyed lower incidence of infection thn wounds pproximted y either percutneous suture (4-0 silk, 4-0 monofilment nylon, nd 4-0 polyglycolic cid suture) or sucuticulr sutures (4-0 polyglycolic). No difference ws found with regrd to wound infection in rndomized tril conducted y Eldrup et l., when they compred stpler with conventionl skin closure. Cosmesis All the ptients were followed up 1 month fter dischrge for evlution of the scr. A senior surgeon who ws linded to the method of closure evluted it. No ptients were lost to follow-up. Cosmetic outcome for the remining ptients were evluted sed on VAS. VAS VAS otined y nlysis of month post-opertive photogrphs, reveled cosmetic results etween the two groups (±5.50) for stples nd (±6.17) for suture group, which ws sttisticlly highly significnt (P ). George et l. nd Mcgregor et l. studied wound closure in the ccident nd emergency deprtment nd found tht stpled closure promotes wound edge eversion, formtion of n incomplete loop with decresed tissue strngultion, nd lck of residul cross mrks. In study compring stples closure with nylon wound closure in hed nd neck surgeries y Meiring et l. showed tht the cosmetic result of stples is s good s if not etter thn tht with nylon sutures. Luowski et l. compred stpled nd sutured dominl wound closure which resulted in lmost equl cosmetic scores for verticl wounds. No significnt difference in wound ppernces ws found in study conducted y Bhti et l. in closure of plmr skin following Duyputren s contrcture. dos Sntos et l. hve compred the cosmetic results of stplers with noncontinuous nylon sutures. 7 They hve oserved tht the wounds closed with stplers were cosmeticlly superior in 80% of the cses. There re no studies ville in the literture compring the results IJSS Journl of Surgery Novemer-Decemer 2016 Volume 2 Issue 6 39

10 Hiremth, et l.: Comprison of the Incidence of Post-opertive Wound Infection etween Skin Stples nd Conventionl Sutures in Adominl Skin Closures of ppliction stplers to vrious ntomic regions. Although Rnoldo nd Rowe-Jones hve compred the results of stpler with sucuticulr sorle sutures for lprotomy wounds nd divided them into lower nd upper dominl regions, no mention ws mde y them regrding the ppernce of the scr t vrious sites. 6 There ws no significnt enefit of stplers over sucuticulr sutures in their study. In this study, the time tken to complete wound closure with the use of stplers s compred to sutures ws not done. In the study y Rnoldo nd Rowe-Jones the rte of wound closure ws 8 s/cm with stpler nd 12.7 s/cm with sutures. 6 Knegye et l., oserved tht stplers were six times fster thn stndrd sutures. 4 Eldrup et l. nlyzed 137 ptients nd concluded tht mechnicl sutures took one-third of the time tken y conventionl sutures. 5 Meiring et l. hve recorded tht there ws 80% time sving, wheres Hrvey nd Logn hve reported 66.6% time sving with the use of stplers. 8,9 dos Sntos et l. found in prospective tril tht the men skin closure time with stple ws 5 min nd 25 min with nylon suture. 7 In study done y Woltereek et l., they compred vrious methods of skin closure in infringuinl ypss surgeries nd cme to conclusion tht time needed for wound closure is significntly reduced using metllic stples. Ritchie et l. crried out prospective doule lind rndomized study compring stples versus sutures in the closure of sclp wound nd found tht stpling ws significntly fster nd less pinful 80. Cost Fctor The cost of stplers used in this study PROXIMATE PLUS MD (Ethicon Endo-Surgery) is Rs per stpler nd reuse is not recommended even fter resteriliztion. Ethilon sutures cost pproximtely Rs nd re 6 times cheper thn the disposle skin stpler. A prospective study done y dos Sntos et l. concluded tht even though stpled closure ws fster it ws found to e costlier. 7 Orlinsky et l. did cost nlysis of stpling versus suturing for skin closure nd concluded tht stpling is less costly thn suturing nd tht the dvntge ppers to increse s lcertion or wound length increses. 7,8 Limittions Smple size ws smll Long term follow-up of t lest 1 yer is required for cosmetic evlution, which ws not possile in our study. Skin stples hve severl dvntges over conventionl sutures. They re quick nd esy to use. Cosmeticlly, they produce good wound eversion nd hve miniml crosshtch scr. Skin stples re reltively inert nd cn e left in situ for longer period of time without ny complictions nd in ddition, ptient cn tke th in the erly post-opertive period. 22 To summrize, the considerle ltertion hs tken plce from the conventionl skin suture technique nd switch over to the new er of cosmesis, in the form of skin stpling to chieve ner virgin scrless skin. CONCLUSION Severl methods of skin closure re ville to close the skin incisions in plce of sutures such s stples, clips, steristrips, nd glue dhesives. Wound infection is gret hzrd in dominl skin closure s it cn led to disstrous complictions. Cosmesis is essentil nd importnt spect in this dy of modern surgicl prctice. A cosmetic scr gives stisfction to the ptient nd lso to the surgeon. Preventing wound infection is necessry s it my led not only to n ugly scr ut lso occurrence nd recurrence of herni. In our study, comprison of dominl skin closure with stples nd verticl mttress sutures ws done. We found tht: Incidence of post-opertive wound infection ws less with skin stples Skin stples provided etter cosmesis thn the verticl mttress skin closure. Hence, we conclude tht the use of skin stples in low tension incision is esy, ssocited with low incidence of wound complictions, provides good cosmetic outcome nd lso tkes considerly less time for skin closure nd thus recommend its use more frequently especilly for closure of long nd multiple incisions. 40 IJSS Journl of Surgery Novemer-Decemer 2016 Volume 2 Issue 6

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