Objective To compare the clinical effectiveness of different skin closure techniques in stoma reversal using network meta-analysis. Methods CNKI, WanFang Data, VIP, CBM, Cochrane Library, PubMed, Embase, and Web of Science databases were searched until February 1, 2021, and randomized controlled trials (RCTs) comparing outcomes between different skin closure techniques were included. Data were processed using Stata MP16.0 and R 3.6.1. Results The results demonstrated that 16 RCTs (n=2 139) were eligible for pooling. Six types of skin closure techniques were used: linear closure, purse-string closure, gunsight closure, linear closure and drainage, purse-string closure and drainage, and linear closure and biological mesh. Network meta-analysis indicated that the incidence of postoperative infection with linear closure was higher than that with purse-string closure [RR=6.04, 95%CI (3.11, 16.89), P<0.0001], gunsight closure [RR=10.75, 95%CI (1.12, 152.12), P=0.04], and linear closure and drainage [RR=3.18, 95%CI (1.24, 10.20), P=0.03]. The purse-string closure was superior to linear closure and biological mesh [RR=0.15, 95%CI (0.01, 0.88), P=0.03] in reducing postoperative infection. The length of hospital stay after linear suture was longer than that after linear suture and drainage [MD=1.16, 95%CI (0.29, 2.20), P=0.02]. Conclusions This network meta-analysis suggests that purse-string closure and gunsight closure might be best for reducing postoperative infection, and the addition of drainage could not further reduce the incidence of postoperative infection. In addition, implantation of the biological mesh does not increase the risk of postoperative infection. However, a large-scale RCT is warranted to confirm the results.
Objective To compare the clinical application effects of a non-invasive skin stapler and a disposable skin stapler in the closure of orthopedic surgical incisions, and to provide evidence for clinical decision-making in orthopedic incision management. Methods Patients undergoing orthopedic surgery in the Department of Orthopaedics, the First People’s Hospital of Shuangliu District, Chengdu between January 2020 and June 2021 were selected. Different surgical sites (limb trunk, shoulder, hip, knee) were used as stratification factors. Patients were randomly assigned in a 1∶1 ratio to either a non-invasive skin stapler group (treatment group) or a disposable skin stapler group (control group). The following parameters were recorded: incision closure speed, rate of Grade A healing, pain Visual Analogue Scale (VAS) scores at postoperative week 1 and at the time of stapler removal, incidence of “centipede-like” scarring at postoperative month 3, Hollander Wound Evaluation Scale (HWES) scores, patient satisfaction with incision healing, and incidence of incision-related complications. Results A total of 480 patients were included, with 240 cases in each group, 60 cases for each surgical site. The stratified analysis results showed that there was no statistically significant difference between the two groups in terms of surgical type, incision length, surgical time, intraoperative blood loss, use of antibiotics, postoperative drainage tube drainage, Grade A healing, suture speed, or incision complications at different surgical sites (P>0.05). There were statistically significant differences in the VAS scores of incision pain at 1 week after surgery and at the time of stapler removal, HWES score at 3 months after surgery, and incision healing satisfaction at 3 months after surgery between the two groups in the four limbs, shoulders, hips, and knees (P<0.01). At a 3-month follow-up, no cases of “centipede syndrome” occurred in either of the two groups, but the control group showed “punctate” scars. Conclusions Both the non-invasive skin stapler and the disposable skin stapler can close orthopedic surgical incisions safely and efficiently. However, the non-invasive skin stapler offers distinct clinical advantages in reducing removal-related pain, improving scar cosmesis, and enhancing patient subjective satisfaction. Therefore, it can be promoted in an individualized manner in orthopedic practice based on incision tension characteristics and patient needs.
