Intracutaneous versus transcutaneous suture techniques: comparison of sternal wound infection rates in open-heart...

In open-heart surgery, sternal wound infection after median sternotomy is a critical complication. The intracutaneous suture is conventionally used in closing sternal incisions. In this prospective, randomized, controlled clinical trial, intracutaneous and transcutaneous suture techniques for closing the sternum were compared with respect to postoperative sternal wound infections and cosmetic results. In this study, we included 100 patients who had undergone open-heart surgery. Skin wounds were closed with intracutaneous suture in 50 patients and with transcutaneous suture in the remaining 50. Superficial or deep sternal infections that developed within 6 postoperative weeks were evaluated. Cosmetic results were similar in the 2 groups. Deep wound infections were not observed in either group. Superficial infection of postoperative sternal wounds occurred at rates of 2% (n=1) and 16% (n=8) for transcutaneous and intracutaneous techniques, respectively (P = 0.016). One patient in the transcutaneous group and 6 patients in the intracutaneous group who developed superficial sternal infections were diabetic. Although the use of the transcutaneous suture technique in closing sternal incisions of cardiac surgery patients provided no cosmetic improvement, it decreased the risk of superficial sternal infection and reduced the length of postoperative hospital stay, particularly in diabetic patients.