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Original Articles: Adult Cardiac

Invited Commentary

Department of Thoracic and Cardiovascular Surgery, Rikshospitalet University Hospital, Oslo, N-0027 Norway

(Email: ivar.risnes{at}rikshospitalet.no).

Krishnamoorthy and colleagues [1] present an interesting and well-written article based on a prospective and randomized study comparing two wound closure techniques on postoperative leg complication rates after cardiac surgery.

Morbidity related to impaired leg wound healing associated with traditional saphenous vein harvesting for coronary artery bypass grafting has often caused problems for the patients. As stated in the article, such effects are often underestimated by the surgeons. The harvesting surgical technique in combination with the Dermabond (Ethicon Inc, Somerville, NJ) skin adhesive (2-octylcyanoacrylate), seem to have important benefits according to closure time, increased patient satisfaction, and cosmetic results.

There was no significant difference in total operative time between the two groups (p = 0.43). Closure time was significantly shorter in the Dermabond group (p = 0.017). Patients in the Dermabond group also reported superior cosmetic outcome at weeks 1 (p < 0.001) and 6 (p = 0.001) and improved patient satisfaction (p < 0.001). Comparative analysis of the two groups did not display any significant differences in the incidence of inflammation, haematoma, or exudation from the incision site (p = 0.39), with 6 patients in the suture and 5 in the Dermabond group in total showing signs of inflammation, haematoma, or exudation. Traditional leg wound closure after saphenous vein harvesting in patients undergoing coronary artery bypass grafting is associated with a high incidence of theese complications. The nonsignificance increasing risk in this study may be due to power deficiency.

The article is well written, and was based on a good study design. The results give a clear message and show other advantages in wound closure after vein harvesting. In this way, the report added value to our practice, and the patients can get important information about what to expect. Identification of the problem may identify the mechanism of these complications and also leads to develop other techniques to prevent and treat these problems.

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1. Krishnamoorthy B, Najam O, Khan UA, Waterworth P, Fildes JE, Yonan N. Randomized prospective study comparing conventional subcuticular skin closure with Dermabond skin glue after saphenous vein harvesting Ann Thorac Surg 2009;88:1445-1450.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ivar Risnes Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Risnes, I. Search for Related Content PubMed PubMed Citation Articles by Risnes, I. Related Collections Coronary disease Related Article