Comparison of staples versus sutures in the repair of penetrating cardiac wounds.

BACKGROUND: Several literature reports advocate the use of skin staplers for repair of penetrating cardiac wounds during emergency thoracotomy. Our study goal was to objectively determine if stapling is a more efficient method of closure compared with suturing without compromising the strength of the repair.

METHODS: This randomized, nonblinded study was conducted in a swine model. A total of four incisions, two per ventricle, were made in each animal. The 2-cm full-thickness incisions were repaired with either sutures or staples, and the time required to close each wound was recorded. After wound repair, the animals were killed. The four wounds were isolated by removing 4.0-cm strips of myocardium oriented perpendicular to the incision. Each strip was then placed on a tensile force testing machine, and the breaking strength of the sutures and staples was measured.

RESULTS: The tensile force test showed that stapled and sutured wounds have equivalent mechanical strength. The mean time of closure for stapled wounds was substantially less than that for sutured wounds.

CONCLUSION: In this swine model, stapling took significantly less time and had equal mechanical strength compared with suturing for repair of penetrating cardiac wounds. Stapling during emergent resuscitation may be preferable to suturing.