<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT04492852</url>
  </required_header>
  <id_info>
    <org_study_id>456-784-7</org_study_id>
    <nct_id>NCT04492852</nct_id>
  </id_info>
  <brief_title>Comparison of Surgical Site Infection After Skin Closure by Prolene or Staples in Bilateral Knee Arthroplasty Patients</brief_title>
  <official_title>Comparison of Surgical Site Infection After Skin Closure by Prolene or Staples in Bilateral Knee Arthroplasty Patients: A Parallel Design Randomized Controlled Trial</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Indus Hospital and Health Network</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>Aga Khan University</agency>
      <agency_class>Other</agency_class>
    </collaborator>
  </sponsors>
  <source>Indus Hospital and Health Network</source>
  <oversight_info>
    <has_dmc>Yes</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      Knee arthroplasty also known as the total knee replacement is an orthopedic surgical&#xD;
      procedure done to resurface the knee that has been severely damaged by arthritis. The optimal&#xD;
      goal of skin closure after the procedure is to promote rapid healing and an acceptable&#xD;
      cosmetic result while minimizing the risk of infection. Skin closure after knee arthroplasty&#xD;
      is done by using either of the two widely used sutures i.e. polypropylene (Prolene) sutures&#xD;
      or the skin staple sutures. The literature is very scarce on knee arthroplasty patients and&#xD;
      the results of the studies conducted have been inconclusive of the studies conducted on the&#xD;
      patients of knee arthroplasty. Moreover, there are no standard guidelines as to which type of&#xD;
      suture should be used. The type of sutures is being selected on the orders and wishes of the&#xD;
      surgeon at the time of skin closure. Prolene sutures are made up of a synthetic steroisomer&#xD;
      known as polypropylene. It is a monofilament non-absorbable, sterile surgical suture. They&#xD;
      are indicated for use in general soft tissue. It Provides permanent tensile strength&#xD;
      retention in tissue, even in the presence of infection. These sutures are exceptionally&#xD;
      smooth for an easy passage through the tissue. Prolene sutures are widely used in&#xD;
      cardiovascular, orthopedics, ophthalmic, and neurological surgical procedures. Another type&#xD;
      of sutures that are used to close the surgical wound are the staple sutures. They are used as&#xD;
      an alternative to the traditional Prolene sutures. They are non-absorbable and usually used&#xD;
      on surgical wounds that are big, complex or hard to close by using Prolene. These are&#xD;
      specialized staples made up of titanium, stainless steel or plastic.&#xD;
&#xD;
      Interventions:&#xD;
&#xD;
      The study will have 2 intervention arms. The patients will be randomized to receive either&#xD;
      Prolene sutures for wound closure or staple sutures for wound closure. After the application&#xD;
      of the intervention, routine care would be given to the patients postoperatively.&#xD;
&#xD;
      Hypothesis:&#xD;
&#xD;
      The investigators hypothesize that there is no difference in the incidence of surgical site&#xD;
      infection in bilateral TKR patients with wound closure by Prolene vs staple.&#xD;
&#xD;
      Study Design:&#xD;
&#xD;
      This study will be conducted as an open blinded, parallel design, equivalence randomized&#xD;
      controlled trial. The patients would be randomized to receive either of the two interventions&#xD;
      i.e. Prolene or Staple sutures.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Study Enrollment Procedures:&#xD;
&#xD;
      Enrollment will be a continuous process with screening and enrolling eligible patients&#xD;
      admitted through the clinic electively for primary TKR. Informed consent will be taken from&#xD;
      the patient as per routine protocol before the arthroplasty procedures in the hospital.&#xD;
      Research objectives, methodology, risks, and benefits will be explained in detail. Consent&#xD;
      for the participation in the study will only be taken by the primary investigator at his&#xD;
      clinic or the surgical resident on call preoperatively along with the consent for the&#xD;
      surgical procedure.&#xD;
&#xD;
      Pre-Randomization Evaluations Screening:&#xD;
&#xD;
      The screening will involve the routine history taking and physical examination by the doctor&#xD;
      and nursing staff in the clinic. Screening won't involve performing procedures that are not&#xD;
      part of routine management.&#xD;
&#xD;
      On-study/on-intervention evaluations:&#xD;
&#xD;
      After screening and assessing the eligibility, patients will be randomly allocated by a 1:1&#xD;
      ratio to the two intervention groups i.e. prolene or staple using a computer-generated&#xD;
      randomization sequence by the clinical trials unit (CTU), which they will provide to the PI,&#xD;
      after patients' admission in the hospital. Patients will be followed from the time they reach&#xD;
      the ward after surgery until their hospital discharge, which is usually around 7 days.&#xD;
&#xD;
      Data Collection:&#xD;
&#xD;
      The data collection will be done by the surgical site infection (SSI) nurses from the&#xD;
      infection control department of AKUH. These nurses are well-trained to assess the surgical&#xD;
      site infections in all the surgery patients admitted to the hospital. Training of data&#xD;
      collectors will be done by the PI to ensure the reliability and validity of the study. The&#xD;
      data collectors will be strictly instructed to respect the autonomy of participants. Data&#xD;
      collection will be done by the data collectors under the supervision of the PI and CTU.&#xD;
      Questionnaires will be checked for consistency and logical data entries. Data entry will be&#xD;
      done, and counter checked by the PI at regular intervals.&#xD;
&#xD;
      Data Storage:&#xD;
&#xD;
      Data collected will be coded and kept confidential without the identifiable information of&#xD;
      patients. The confidentiality of the study participants will be maintained throughout the&#xD;
      study period. Data collected will be kept confidential without identifiable information of&#xD;
      patients who are identified by a number assigned. The hard copy forms will be retained in a&#xD;
      secured location with the PI after data entry into computer software and will be kept as per&#xD;
      hospital protocol. The password-protected drives will be used to store data with only the PI&#xD;
      having access to it. The data will be available for AKUH ethical review committee on request&#xD;
      and might be published in a journal without disclosing any identifiable information of&#xD;
      patients. Filled questionnaires will be stored for 5 years after the study is completed as&#xD;
      per the policy of the institute.&#xD;
&#xD;
      Sample Size:&#xD;
&#xD;
      The sample size was calculated via open epi software version 3.01. The level of significance&#xD;
      was kept at 5% with a power of 80%. The percentage of exposed (staple sutures) with outcome&#xD;
      (surgical site infection) was 66%. The percentage of non-exposed (Prolene sutures) with&#xD;
      outcome (surgical site infection) was 33%. The estimated risk ratio taken from a study was 2.&#xD;
      After adding the non-response rate of 10% the final sample size came out to be 82 patients&#xD;
      with 41 patients in each arm.&#xD;
&#xD;
      Plan of Analysis:&#xD;
&#xD;
      Statistical analysis will be done by using STATA software version 15. The normality&#xD;
      assumption for the quantitative variables would be assessed using the shapiro wilk test. Mean&#xD;
      ± SD will be computed for all the normally distributed quantitative variables. The median and&#xD;
      interquartile range would be reported for the non-normally distributed quantitative&#xD;
      variables. The categorical variables would be expressed in frequencies and percentages. The&#xD;
      Cox Proportional Hazard regression will be used for the univariate and multivariable&#xD;
      analysis. Univariate analysis will be conducted, and crude risk ratios and their 95%&#xD;
      confidence intervals will be obtained. All significant independent variables at the&#xD;
      univariate stage will be regressed in a multivariable cox proportional hazard regression&#xD;
      using the stepwise method in the multivariable model and the adjusted risk ratios will be&#xD;
      obtained.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Unknown status</overall_status>
  <last_known_status>Not yet recruiting</last_known_status>
  <start_date type="Anticipated">November 2020</start_date>
  <completion_date type="Anticipated">December 2021</completion_date>
  <primary_completion_date type="Anticipated">October 2021</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Prevention</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Surgical Site Infection</measure>
    <time_frame>6 weeks for superficial infections and 1 year for deep infections</time_frame>
    <description>Primary outcome of the study is the incidence of surgical site infection (superficial or deep) within 6 weeks for superficial infections and 1 year for deep infections.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Post Operative complications</measure>
    <time_frame>Within 2 weeks of surgery</time_frame>
    <description>The secondary outcomes of the study include the incidence of post-operative complication that includes; seroma, hematoma, pain, or bleeding</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Pain Score</measure>
    <time_frame>post-operative follow up at 14th post-op day</time_frame>
    <description>assess and compare the pain scores at the time of suture removal using the Visual Analogue Scale (VAS) pain scale. score of '0' represents no pain whereas a score of '10' represents severe/unbearable pain.</description>
  </secondary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Anticipated">82</enrollment>
  <condition>Total Knee Replacement</condition>
  <arm_group>
    <arm_group_label>Interventional Arm 1</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>After total knee replacement, the skin closure of the patients in this group will be done using polypropylene (PROLENE) sutures.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Interventional Arm 2</arm_group_label>
    <arm_group_type>Active Comparator</arm_group_type>
    <description>After total knee replacement, the skin closure of the patients in this group will be done using staple sutures.</description>
  </arm_group>
  <intervention>
    <intervention_type>Procedure</intervention_type>
    <intervention_name>Polypropylene (PROLENE) sutures</intervention_name>
    <description>After total knee replacement, the skin closure of the patients in this group will be done using polypropylene (PROLENE) sutures.</description>
    <arm_group_label>Interventional Arm 1</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Procedure</intervention_type>
    <intervention_name>Staple Sutures</intervention_name>
    <description>After total knee replacement, the skin closure of the patients in this group will be done using staple sutures.</description>
    <arm_group_label>Interventional Arm 2</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Adult patients of age 40-70 years&#xD;
&#xD;
          -  Undergoing bilateral knee arthroplasty at AKUH Karachi.&#xD;
&#xD;
          -  Both the genders would be included.&#xD;
&#xD;
          -  Patients having American Society of Anesthesiologists (ASA) level of I, II and III&#xD;
&#xD;
          -  Patients having functional class of I, II and III pre-operatively&#xD;
&#xD;
          -  Patients opting to undergo Bilateral knee arthroplasty under care of the selected&#xD;
             surgeon (A) for the study.&#xD;
&#xD;
          -  Patients undergoing bilateral TKR electively&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Patients unwilling to consent.&#xD;
&#xD;
          -  Patients unable to comprehend due to the language barrier&#xD;
&#xD;
          -  Patients who have a Glasgow Coma Scale i.e. GCS&lt;15 (cognitive impairment)&#xD;
&#xD;
          -  Patients undergoing a knee revision surgery&#xD;
&#xD;
          -  Patients having a previous incision/scar in the operative field will be excluded&#xD;
&#xD;
          -  Patients having documented allergy to Prolene or stainless steel&#xD;
&#xD;
          -  Patients having a documented underlying malignancy&#xD;
&#xD;
          -  Patients undergoing unilateral TKR or staged bilateral TKR&#xD;
&#xD;
          -  Patients undergoing emergency TKR.&#xD;
&#xD;
          -  Patients having undergoing surgery due to trauma or fracture&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>40 Years</minimum_age>
    <maximum_age>70 Years</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Ahsun Jiwani, MSc. Epibio</last_name>
    <role>Principal Investigator</role>
    <affiliation>The Indus Hospital</affiliation>
  </overall_official>
  <overall_contact>
    <last_name>Dr Shahryar Noordin</last_name>
    <phone>+922134864350</phone>
    <phone_ext>4350</phone_ext>
    <email>shahryar.noordin@aku.edu</email>
  </overall_contact>
  <overall_contact_backup>
    <last_name>Dilshad Begum</last_name>
    <phone>+922134862303</phone>
    <phone_ext>2303</phone_ext>
    <email>dilshad.begum@aku.edu</email>
  </overall_contact_backup>
  <reference>
    <citation>Liu S, Wang Y, Kotian RN, Li H, Mi Y, Zhang Y, He X. Comparison of Nonabsorbable and Absorbable Suture in Total Knee Arthroplasty. Med Sci Monit. 2018 Oct 23;24:7563-7569. doi: 10.12659/MSM.910785.</citation>
    <PMID>30350827</PMID>
  </reference>
  <reference>
    <citation>Barrow J, Divecha H, Board T. Skin closure in arthroplasty surgery: Current practice. Int Wound J. 2018 Dec;15(6):966-970. doi: 10.1111/iwj.12956. Epub 2018 Jul 6.</citation>
    <PMID>29978557</PMID>
  </reference>
  <results_reference>
    <citation>Smith TO, Sexton D, Mann C, Donell S. Sutures versus staples for skin closure in orthopaedic surgery: meta-analysis. BMJ. 2010 Mar 16;340:c1199. doi: 10.1136/bmj.c1199.</citation>
    <PMID>20234041</PMID>
  </results_reference>
  <results_reference>
    <citation>Gatt D, Quick CR, Owen-Smith MS. Staples for wound closure: a controlled trial. Ann R Coll Surg Engl. 1985 Sep;67(5):318-20.</citation>
    <PMID>3901864</PMID>
  </results_reference>
  <results_reference>
    <citation>Clayer M, Southwood RT. Comparative study of skin closure in hip surgery. Aust N Z J Surg. 1991 May;61(5):363-5. doi: 10.1111/j.1445-2197.1991.tb00235.x.</citation>
    <PMID>2025190</PMID>
  </results_reference>
  <results_reference>
    <citation>Khan RJ, Fick D, Yao F, Tang K, Hurworth M, Nivbrant B, Wood D. A comparison of three methods of wound closure following arthroplasty: a prospective, randomised, controlled trial. J Bone Joint Surg Br. 2006 Feb;88(2):238-42. doi: 10.1302/0301-620X.88B2.16923.</citation>
    <PMID>16434531</PMID>
  </results_reference>
  <verification_date>July 2020</verification_date>
  <study_first_submitted>July 27, 2020</study_first_submitted>
  <study_first_submitted_qc>July 27, 2020</study_first_submitted_qc>
  <study_first_posted type="Actual">July 30, 2020</study_first_posted>
  <last_update_submitted>July 30, 2020</last_update_submitted>
  <last_update_submitted_qc>July 30, 2020</last_update_submitted_qc>
  <last_update_posted type="Actual">August 3, 2020</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>Indus Hospital and Health Network</investigator_affiliation>
    <investigator_full_name>Ahsun Jiwani</investigator_full_name>
    <investigator_title>Junior Biostatistician</investigator_title>
  </responsible_party>
  <keyword>Knee Replacement</keyword>
  <keyword>Prolene</keyword>
  <keyword>Staples</keyword>
  <keyword>Surgical Site Infection</keyword>
  <keyword>Skin Closure</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Infections</mesh_term>
    <mesh_term>Surgical Wound Infection</mesh_term>
  </condition_browse>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT04492852
org study id: 456-784-7
nct id: NCT04492852
lead sponsor: 
collaborator: 
has dmc: Yes
is fda regulated drug: No
is fda regulated device: No
Knee arthroplasty also known as the total knee replacement is an orthopedic surgical
      procedure done to resurface the knee that has been severely damaged by arthritis. The optimal
      goal of skin closure after the procedure is to promote rapid healing and an acceptable
      cosmetic result while minimizing the risk of infection. Skin closure after knee arthroplasty
      is done by using either of the two widely used sutures i.e. polypropylene (Prolene) sutures
      or the skin staple sutures. The literature is very scarce on knee arthroplasty patients and
      the results of the studies conducted have been inconclusive of the studies conducted on the
      patients of knee arthroplasty. Moreover, there are no standard guidelines as to which type of
      suture should be used. The type of sutures is being selected on the orders and wishes of the
      surgeon at the time of skin closure. Prolene sutures are made up of a synthetic steroisomer
      known as polypropylene. It is a monofilament non-absorbable, sterile surgical suture. They
      are indicated for use in general soft tissue. It Provides permanent tensile strength
      retention in tissue, even in the presence of infection. These sutures are exceptionally
      smooth for an easy passage through the tissue. Prolene sutures are widely used in
      cardiovascular, orthopedics, ophthalmic, and neurological surgical procedures. Another type
      of sutures that are used to close the surgical wound are the staple sutures. They are used as
      an alternative to the traditional Prolene sutures. They are non-absorbable and usually used
      on surgical wounds that are big, complex or hard to close by using Prolene. These are
      specialized staples made up of titanium, stainless steel or plastic.

      Interventions:

      The study will have 2 intervention arms. The patients will be randomized to receive either
      Prolene sutures for wound closure or staple sutures for wound closure. After the application
      of the intervention, routine care would be given to the patients postoperatively.

      Hypothesis:

      The investigators hypothesize that there is no difference in the incidence of surgical site
      infection in bilateral TKR patients with wound closure by Prolene vs staple.

      Study Design:

      This study will be conducted as an open blinded, parallel design, equivalence randomized
      controlled trial. The patients would be randomized to receive either of the two interventions
      i.e. Prolene or Staple sutures.
Study Enrollment Procedures:

      Enrollment will be a continuous process with screening and enrolling eligible patients
      admitted through the clinic electively for primary TKR. Informed consent will be taken from
      the patient as per routine protocol before the arthroplasty procedures in the hospital.
      Research objectives, methodology, risks, and benefits will be explained in detail. Consent
      for the participation in the study will only be taken by the primary investigator at his
      clinic or the surgical resident on call preoperatively along with the consent for the
      surgical procedure.

      Pre-Randomization Evaluations Screening:

      The screening will involve the routine history taking and physical examination by the doctor
      and nursing staff in the clinic. Screening won't involve performing procedures that are not
      part of routine management.

      On-study/on-intervention evaluations:

      After screening and assessing the eligibility, patients will be randomly allocated by a 1:1
      ratio to the two intervention groups i.e. prolene or staple using a computer-generated
      randomization sequence by the clinical trials unit (CTU), which they will provide to the PI,
      after patients' admission in the hospital. Patients will be followed from the time they reach
      the ward after surgery until their hospital discharge, which is usually around 7 days.

      Data Collection:

      The data collection will be done by the surgical site infection (SSI) nurses from the
      infection control department of AKUH. These nurses are well-trained to assess the surgical
      site infections in all the surgery patients admitted to the hospital. Training of data
      collectors will be done by the PI to ensure the reliability and validity of the study. The
      data collectors will be strictly instructed to respect the autonomy of participants. Data
      collection will be done by the data collectors under the supervision of the PI and CTU.
      Questionnaires will be checked for consistency and logical data entries. Data entry will be
      done, and counter checked by the PI at regular intervals.

      Data Storage:

      Data collected will be coded and kept confidential without the identifiable information of
      patients. The confidentiality of the study participants will be maintained throughout the
      study period. Data collected will be kept confidential without identifiable information of
      patients who are identified by a number assigned. The hard copy forms will be retained in a
      secured location with the PI after data entry into computer software and will be kept as per
      hospital protocol. The password-protected drives will be used to store data with only the PI
      having access to it. The data will be available for AKUH ethical review committee on request
      and might be published in a journal without disclosing any identifiable information of
      patients. Filled questionnaires will be stored for 5 years after the study is completed as
      per the policy of the institute.

      Sample Size:

      The sample size was calculated via open epi software version 3.01. The level of significance
      was kept at 5% with a power of 80%. The percentage of exposed (staple sutures) with outcome
      (surgical site infection) was 66%. The percentage of non-exposed (Prolene sutures) with
      outcome (surgical site infection) was 33%. The estimated risk ratio taken from a study was 2.
      After adding the non-response rate of 10% the final sample size came out to be 82 patients
      with 41 patients in each arm.

      Plan of Analysis:

      Statistical analysis will be done by using STATA software version 15. The normality
      assumption for the quantitative variables would be assessed using the shapiro wilk test. Mean
      ± SD will be computed for all the normally distributed quantitative variables. The median and
      interquartile range would be reported for the non-normally distributed quantitative
      variables. The categorical variables would be expressed in frequencies and percentages. The
      Cox Proportional Hazard regression will be used for the univariate and multivariable
      analysis. Univariate analysis will be conducted, and crude risk ratios and their 95%
      confidence intervals will be obtained. All significant independent variables at the
      univariate stage will be regressed in a multivariable cox proportional hazard regression
      using the stepwise method in the multivariable model and the adjusted risk ratios will be
      obtained.
allocation: Randomized
intervention model: Parallel Assignment
primary purpose: Prevention
masking: None (Open Label)
measure: Surgical Site Infection
time frame: 6 weeks for superficial infections and 1 year for deep infections
description: Primary outcome of the study is the incidence of surgical site infection (superficial or deep) within 6 weeks for superficial infections and 1 year for deep infections.
measure: Post Operative complications
time frame: Within 2 weeks of surgery
description: The secondary outcomes of the study include the incidence of post-operative complication that includes; seroma, hematoma, pain, or bleeding
measure: Pain Score
time frame: post-operative follow up at 14th post-op day
description: assess and compare the pain scores at the time of suture removal using the Visual Analogue Scale (VAS) pain scale. score of '0' represents no pain whereas a score of '10' represents severe/unbearable pain.
arm group label: Interventional Arm 1
arm group type: Experimental
description: After total knee replacement, the skin closure of the patients in this group will be done using polypropylene (PROLENE) sutures.
arm group label: Interventional Arm 2
arm group type: Active Comparator
description: After total knee replacement, the skin closure of the patients in this group will be done using staple sutures.
intervention type: Procedure
intervention name: Polypropylene (PROLENE) sutures
description: After total knee replacement, the skin closure of the patients in this group will be done using polypropylene (PROLENE) sutures.
arm group label: Interventional Arm 1
intervention type: Procedure
intervention name: Staple Sutures
description: After total knee replacement, the skin closure of the patients in this group will be done using staple sutures.
arm group label: Interventional Arm 2
criteria: 
gender: All
minimum age: 40 Years
maximum age: 70 Years
healthy volunteers: No
last name: Ahsun Jiwani, MSc. Epibio
role: Principal Investigator
affiliation: The Indus Hospital
last name: Dr Shahryar Noordin
phone: +922134864350
phone ext: 4350
email: shahryar.noordin@aku.edu
last name: Dilshad Begum
phone: +922134862303
phone ext: 2303
email: dilshad.begum@aku.edu
citation: Liu S, Wang Y, Kotian RN, Li H, Mi Y, Zhang Y, He X. Comparison of Nonabsorbable and Absorbable Suture in Total Knee Arthroplasty. Med Sci Monit. 2018 Oct 23;24:7563-7569. doi: 10.12659/MSM.910785.
PMID: 30350827
citation: Barrow J, Divecha H, Board T. Skin closure in arthroplasty surgery: Current practice. Int Wound J. 2018 Dec;15(6):966-970. doi: 10.1111/iwj.12956. Epub 2018 Jul 6.
PMID: 29978557
citation: Smith TO, Sexton D, Mann C, Donell S. Sutures versus staples for skin closure in orthopaedic surgery: meta-analysis. BMJ. 2010 Mar 16;340:c1199. doi: 10.1136/bmj.c1199.
PMID: 20234041
citation: Gatt D, Quick CR, Owen-Smith MS. Staples for wound closure: a controlled trial. Ann R Coll Surg Engl. 1985 Sep;67(5):318-20.
PMID: 3901864
citation: Clayer M, Southwood RT. Comparative study of skin closure in hip surgery. Aust N Z J Surg. 1991 May;61(5):363-5. doi: 10.1111/j.1445-2197.1991.tb00235.x.
PMID: 2025190
citation: Khan RJ, Fick D, Yao F, Tang K, Hurworth M, Nivbrant B, Wood D. A comparison of three methods of wound closure following arthroplasty: a prospective, randomised, controlled trial. J Bone Joint Surg Br. 2006 Feb;88(2):238-42. doi: 10.1302/0301-620X.88B2.16923.
PMID: 16434531
responsible party type: Principal Investigator
investigator affiliation: Indus Hospital and Health Network
investigator full name: Ahsun Jiwani
investigator title: Junior Biostatistician
mesh term: Infections
mesh term: Surgical Wound Infection