Wound closure is an essential part of surgery and the ideal closure technique directly affect the outcome of surgery [1]. Complete closure of a surgical or traumatic wound is an important measure to restore the integrity of organs and prevent complications, including Surgical Site Infections (SSIs), dehiscence and impaired healing [2,3]. The main aims of healing a wound are haemostasis, fast and effective closure, controlled scarring and introducing as small risk of infection as possible. For good approximation and alignment of tissues in tension Tensile strength and cosmetic appearance. Besides clinical events, wound closure methods affect patient comfort, postoperative pain, duration of hospitalization, and patient satisfaction [4,5]. Economic factors also play an important role, particularly in resource-poor settings, in which the choice of closure material and method can have a major impact on procedural costs, operating time, and the requirement for postprocedural care [6].

Various closure methods are used in surgical practice, including staples, sutures and tissue adhesives. Surgical Sutures continue to be a traditional and popular modality providing versatility and efficient wound closure for all kinds of surgical incisions [7]. They are available in both absorbable and non-absorbable material and they achieve accurate tissue coaptation, therefore, from superficial to deep, they can be used. Surgical staples offer a quicker alternative, especially when long, simple linear incisions are made such as during abdominal or orthopaedic surgery [8]. They are characterized by decreased operating time and even approximation of the wound edge, but there have been some concerns about the pain during removal and final cosmetic appearance. Tissue adhesives, cyanoacrylate-based products are a newer modality of wound closure [9]. These adhesives provide a protective layer over the wound, eliminate the requirement for suture removal, and are thought to lead to greater patient comfort and possibly improved cosmesis in selected patients [10,11]. Their strength and utility may be relatively lesser in high-tension wounds.

Although widely used, there is a lack of region-specific data comparing the efficacy and complications of these techniques in Punjab. There is often a lack of enough standardized evidence based on the local patient population and with varying clinical practices depending on surgeon preference. Deep Hospital Ludhiana performs a wide spectrum of surgeries, where the study can assess actual results in relation to various forms of closures. Thereby, a structured comparison is required in order to facilitate evidence-based decision-making, cost-effectiveness and patient-centered care in this context.

Objective

• To determine the efficacy of sutures, staples and adhesive in wound closure for surgical patients.
• To assess and compare both rates of complications (including infection, wound dehiscence and other adverse outcomes) between each closure technique.
• To compare time to heal, cosmetic results and procedure duration of sutures, surgical clips and tissue adhesives to determine the most efficient and aesthetically favorable method.

Study Design

This research was a retrospective clinical trial aimed at comparing the efficacy of various wound closure methods and complication rates. This retrospective study allowed to examine data from actual patients for real-world clinical outcomes without interference with treatment decisions. No interventions were made for the present study, and information was gathered retrospectively from the medical records.

Study Setting

The research took place in Deep Hospital, Ludhiana (Punjab), a tertiary care multispecialty hospital offering the complete range of major and minor surgical procedures. Data were collected from Departments of General Surgery, Orthopedics and Obstetrics & Gynecology where elective and emergency surgeries are routinely carried out with wound closure. Departments were chosen because they covered a large number of surgeries and a wide range of types of wounds.

Study Duration

Records from 3-year period, January 2022 to December 2024, were reviewed. This duration was selected to provide a reasonable number of samples and also to compare outcomes for three wound closure techniques.

Inclusion criteria

Patients aged 18 years and above, patients who underwent elective or emergent surgery, where the type of suture, surgical staple, or tissue adhesive for primary closure was documented and documentation postoperatively of at least one follow-up visit.

Exclusion criteria

Patients with incomplete medical records, presence of wound infection prior to surgery, immunocompromised status poorly controlled diabetes mellitus, malignancy being actively treated with chemotherapy and radiotherapy or HIV positive, patients who underwent combined closure methods, and patients lost to follow-up during the immediate postoperative period.

Sample Size

180 eligible patient records were included in this study. Patients were classified into groups according to the technique for closing wounds:

• Sutures group (n = 70)
• Staples group (n = 60)
• Tissue adhesive group (n = 50)

The distribution of treatments did not depart from standard clinical practice during the time of the study.

Data Collection

Information was retrieved from hospital electronic medical records. Demographics such as age and gender, type of surgery, and wound period clean-contaminated were recorded. The procedural details were comprised of the technique of wound closure, time taken for wound closure in minutes, and length of hospital stay in days. Postoperative complications, such as SSI, wound dehiscence, allergy and delayed healing were noted. Period of follow up and recording of wound healing was also recorded.

Outcome Measures

Clinical outcomes evaluated included wound infection rate and incidence of postoperative wound disruption. SSI were diagnosed on the basis of a clinical diagnosis documented in medical records, antibiotic requirement or wound secretion.

Secondary outcomes were time to complete wound healing, cosmetic as recorded in follow-up notes, postoperative pain score based on available pain recording scores and comparison of costs between the closure materials and hospital charges.

Statistical Analysis

Data was collected and analyzed in SPSS and Microsoft Excel. All variables were described using descriptive statistics. Continuous variables were described as mean (standard deviation (SD)) and categorical prognosis measured by frequency percentage. Chi-square was employed for comparing categorical variables infection and complication. Continuous variables such as healing time and procedure duration were compared using one-way analysis of variance (ANOVA). P-value < 0.05 was considered statistically significant.

Ethical Considerations

The study was approved by the Institutional Ethics Committee of Deep Hospital, Ludhiana before data collection. Because the study had a retrospective design, informed consent was not required. All patients’ identity was anonymized, confidentially preserved and the study has been conducted in accordance with ethical guidelines and institutional policies.

Table 3 Comparison of Postoperative Complications Among Wound Closure Techniques

Overall, though staples had a minimum operation duration, tissue adhesives were correlated with incidence of infection and healed quicker as well provided better cosmetic results. Sutures continued to be a flexible and well-tolerated technique with acceptable complication rates.

This retrospective study conducted at Deep Hospital, Ludhiana, to compare sutures, surgical staples and tissue adhesives in terms of efficacy and complications. The data suggests that tissue adhesives had overall better outcomes in some cases, specifically, less infection, faster healing time and improved cosmetic results. Although the infection rates among the three groups were not significantly different from one another, adhesives appeared to offer a significant clinical reduction in SSI when compared with sutures and staples.

Surgical staples had the shortest mean time to closure and this was statistically significant (p < 0.001), illustrating the speed of use in high-throughput surgical units. However, there was a greater incidence of hypertrophic scarring and late healing in patients treated with staples than with adhesives. Sutures are reliable but are associated with moderate infection and dehiscence rates. There were no significant differences in wound dehiscence between the groups, implying that all three methods of approximation created sufficient strength if properly applied. Overall, the best healing and cosmetic results were achieved using tissue adhesives, while staples proved to be more effective in terms of operation time. Suturing could remain a reasonable choice even with accepted complication rates.

Comparison with Existing Literature

The findings of this study are consistent with other national and international studies describing lesser infections rates, as well as better cosmesis with tissue adhesive use on clean low tension wounds. Cyanoacrylate adhesives maintain a barrier against microorganisms, with the elimination of suture tracks and potential entry points for infection [12]. Staples are faster than sutures, particularly in the closure of abdominal and orthopedic incisions [13].

However, there are some international studies that demonstrated marginally higher infection rates with staples in contaminated wounds, which is not inconsistent with the intermediate complication profile seen in this study. Differences in outcomes across studies may be related to differences in the operatory environment, classification of wound, patient comorbidities and postoperative regimens [14,15]. There’s a considerable difference in wound type and tension; both of these factors are probable to render the outcome of the above techniques vary from institution to institution, being a tertiary care referral centre like Deep Hospital, Ludhiana, where a variety of surgical cases are managed.

Clinical Implications

These results indicate that wound closure method selection should be tailored to the patient's specific wound and its clinical setting. Sutures continue to be preferred in high-tension wounds, irregular lacerations and situations that require multi-layered closure, since they approximate tissues accurately and provide strong tensile strength. Surgical staples benefit long linear incisions, such as those utilized in abdominal or orthopedic procedures where time and speed is important. They have the potential to decrease operative time and exposure to anesthesia, particularly in high-volume practices.

Tissue adhesives appear ideal for to clean, superficial, low-tension wounds or in patients with a concern for cosmetic outcome example obstetric and minor surgical patients. They offer the advantage of decreased patient discomfort due to a lack of retrieval and reduced postoperative pain.

Cost Considerations

Cost analysis are relevant in resource-limited, rural-based health care settings. Sutures are inexpensive and readily available, it a practical choice in smaller hospitals. Although the cost of material may be a higher for staples, reduced operation time could reduce costs in smaller hospitals. Tissue adhesive is more expensive, though it may result in less follow up visits and complications. In hospitals in rural settings, it is important to adopt the most cost-effective and clinically sound method to ensure that patient outcomes are maximized without sacrificing financial viability.

Limitations

This study has many limitations. The retrospective design of the study restricts the ability to adjust for confounders and depends on the accuracy and completeness of medical records. The study being single-centred, Deep Hospital, Ludhiana, may impair the generalizability to other centres/regions. The duration of follow-up was relatively short-term, and long-term evaluation of scar quality and late complications could be performed. Cosmetic results were based on documented with the clinical notes and may be subjective. Furthermore, the sample size might be relatively low to observe small but clinically important differences.

This retrospective study comparison of suture, staples, and tissue adhesives in wound closure and illustrated the features of each. Tissue adhesives were found to have superior cosmetic results and more rapid wound healing in chosen low-tension wounds, whereas stapling reduced the time taken for the procedure. Sutures still represented an efficacious and adaptable alternative, with reasonable complication rates. While infection and dehiscence rates were similar between groups, the adhesives appeared slightly superior in minimizing complications. The decision on wound closure should be personalized of comprehensive factors including the properties of wounds, patterns of surgery, and conditions. More prospective and multicenter studies with more cases and longer follow-up are recommended to confirm these results as well as develop guidelines applicable to wound closure.

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