The Comparison of Scalp Closure with Staples, Silk, Prolene and Vicryl following a Gillie’s Temporal Approach for Malar / Zygomatic Complex Fracture; a Prospective Study

This study compared the healing, the type of micro-organisms around the suture material, pain score during removal of suture / staple and cost of the closure material per patient. Sixty patients were allocated in 4 groups. Each group had 15 patients, aged 16 to 70 years of age with isolated fractured zygoma. They were prospectively randomly selected to have staple, silk, prolene or vicryl rapide for closure of their scalp incision. Patients returned at a week for staple or suture removal, a culture swab, pain score and evaluation of healing. Patients were then reviewed at 6 to 8 weeks time to re-evaluate the healing of the temple / scalp wound. The wounds in the first group were closed with staples, in the second group with silk, the third group with prolene and the fourth group with vicryl rapide. There were no differences in age, wound length, number of staples / sutures (3), or surgeon experience. There was no difference in wound healing or type of micro-organism around the staples / sutures. Staples resulted in shorter wound closure time but had a higher pain score on the removal (average 2.4 on a visual analogue scale). Staple had a less growth of micro-organisms compared to other groups. The follow up rate was 100%. There was no cosmetic or significant complications problem in any group apart from wound breakdown, one in silk and one in the prolene group that both healed with minor scar formation. There was no difference in healing in all four groups but staples were easier and faster and had less micro-organisms growth around them. Staples are more expensive and more painful on removal when compared to other groups. The main advantage of vicryl rapide was that there was no need for removal and had comparable results. Silk had the same results as the other groups but is considerably cheaper when compared to the other materials.