Comparing Skin Closure Techniques in Groin Vascular Surgery: Insights from a Finnish RCT

A recent randomized controlled trial published in the European Journal of Vascular and Endovascular Surgery (2025) evaluated the impact of skin closure methods—metal staples versus intradermal sutures—on the incidence of surgical site infections (SSIs) in groin incisions following elective vascular procedures. Conducted across three Finnish centers, the trial enrolled 300 patients undergoing operations such as femoral endarterectomy, EVAR cutdown, and femoropopliteal bypass, aiming to determine whether intradermal sutures would reduce infection rates.

Participants were randomized to receive either metal staples or continuous intradermal absorbable sutures. The primary endpoint was the 30-day SSI rate, defined according to CDC criteria. Secondary outcomes included wound dehiscence and seroma/lymphatic leakage.

The results showed a non-significant trend favoring intradermal sutures: SSIs occurred in 10.1% of patients in the suture group versus 15.8% in the staple group (RR 0.64; p = 0.15). Similarly, seroma/lymph leak was less frequent in the suture group (12.8% vs. 21.1%; p = 0.06). However, none of these differences reached statistical significance. Multivariable analysis adjusting for age, BMI, and diabetes also failed to demonstrate a significant advantage for either technique.

The study confirms that while intradermal closure may offer cosmetic or logistical advantages, it does not significantly reduce groin SSI rates. Importantly, this work fills a critical evidence gap with robust methodology, although limitations such as center variability and possible underpowering should be acknowledged. Future trials with refined inclusion criteria are warranted to better define best practices in groin incision management.