Comparing Sutures vs. Staples for Leg Wound Closure after Coronary Artery Bypass Grafting: A Randomized Controlled Trial

All articles of this category (opens in new window) Background: Postoperative wound complications following saphenous vein harvesting delay recovery after coronary artery bypass grafting (CABG), increase morbidity, and prolong hospitalization. To date, no clear recommendations exist regarding the optimal surgical wound closure technique in this context. Two methods—conventional intracutaneous suture technique and staple closure—are commonly employed, with the choice primarily depending on the surgeon’s preference. Methods: In this prospective, randomized, single-center study, a total of 301 patients were included in the study. Of these, 151 patients were randomized for leg wound closure with intracutaneous sutures, while 150 were selected to have their leg wound closed with staples. The modified intention to treat population due to intraoperative changes, protocol deviations (cross-over), and exclusions included 122 patients in the staples group and 130 patients in the suture group. The primary endpoint was a composite of surgical site complications and infections within 6 months after the procedure. Results: A surgical site complication within 6 months after the operation, defined as the development of a surgical site infection or disturbance of wound healing, occurred in 31 out of 122 (25.4%) patients in the staples group and in 40 out of 130 patients (30.7%) in the suture group, with no statistically significant difference ( p = 0.728). A surgical site infection was found in 3.3% of patients in the stapler group and 8.5% of patients in the suture group ( p = 0.082). Female gender ( p = 0.357), age ( p = 0.732), and diabetes ( p = 0.266) were not significant risk factors for wound complications. However, an elevated BMI (>25 kg/m 2 ) was significantly associated with an increased incidence of wound complications ( p = 0.004). Among the exogenous risk factors, elevated blood glucose levels 6 hours postoperatively ( p = 0.007) and 12 hours postoperatively ( p = 0.002) were identified as significant risk factors. Additionally, a prolonged ICU stay was associated with the occurrence of surgical site complications ( p = 0.024). Conclusion: The incidence of surgical site complications following conventional saphenous vein harvesting in CABG remains high. While the use of staplers showed a slight advantage in terms of surgical site infections, this effect was not statistically significant for the primary endpoint at follow-up. We were able to show a significant association between elevated blood glucose levels and wound complications, highlighting the importance of postoperative glycaemic control. Therefore, postoperative management may be more important than the choice of the surgical technique. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany