Sutures, Staples, and Glue

Is there any scientific guidance to help us make decisions beyond sparing patients the discomfort of staple removal? There is some good literature available, although not all of it specifically pertains to the foot and ankle.

Dermabond vs. sutures

A prospective randomized controlled trial involving 84 feet compared the use of topical skin adhesive (TSA) and nylon sutures (NSs) in elective open forefoot surgery. The study found that topical skin adhesive was linked to increased inflammation and more instances of wound separation compared to nylon sutures. The conclusion was that sutures were the better option. 

Sutures vs. staples

A single-blind randomized clinical trial was conducted with 70 patients with diabetic mellitus patients undergoing total knee arthroplasty (TKA). The participants were divided into two groups: 35 patients had their wounds closed with sutures, and 35 with staples. Follow-up evaluations, conducted between two to eight weeks post-surgery, assessed wound infection and dehiscence. The use of the staple technique compared to suture had no difference in the rates of wound opening and infection. Although there was no clear winner, clinicians favored using sutures.