Sternal wound closure in patients undergoing open-heart surgery: a prospective randomized study comparing intracutaneous and zipper techniques

OBJECTIVE: A prospective, randomized study was undertaken to compare a non-invasive surgical zipper to intracutaneous suture closure in open-heart surgery with respect to postoperative wound infection rate and cosmetic results. METHODS: A total number of 300 patients were included in the study, of which 150 had their skin wound closed with zipper and 150 with intracutaneous suture. The end-points were superficial and deep sternal wound infections within 6 weeks postoperatively. RESULTS: The incidence of total infection after 6 weeks was equal in the two groups (6.7 vs. 6.7%) (P=0.94). The superficial infection rate was 5.3% in the zipper group vs. 6.0% in the intracutaneous, and the deep infection rate was 1.4% in the zipper group and 0.7% in the intracutaneous. There was no statistically significant difference between the groups. Only the cosmetic result differed. On a visual scale from 1 (poorest) to 10 (best), an average score of 8.2 was obtained in the intracutaneous group versus 8.9 in the zipper group (P<0.01). CONCLUSION: The wound infection rate was equal for the intracutaneous group compared with the zipper group; however, the cosmetic result was judged better by the patients in the zipper group.