Recommendation ID

Which patient groups, contamination groups and which layers gain the most benefit from the use of triclosan-coated or triclosan-impregnated sutures?

Any explanatory notes
(if applicable)

Why the committee made the recommendations

Overall, the evidence suggested that staples increase the incidence of wound dehiscence when compared with sutures for wound closure across different types of surgery. However, when the studies were analysed according to the type of surgery, many of the studies showing this difference were found to be on wound closure after caesarean section. The committee agreed that there was not enough evidence to recommend sutures over staples in all surgery, and decided to focus the recommendation on caesarean section. The committee agreed that this was important in improving recovery for women having caesarean sections, and that it should be reflected in the recommendations. However, the committee noted that the evidence did not capture all populations, for example obese women. Therefore, the recommendation was made to consider sutures rather than staples.

The committee discussed the evidence for antimicrobial triclosan-coated sutures and agreed that the evidence overall favoured triclosan-coated sutures over standard sutures for reducing surgical site infection. However, they noted that the studies covered many different types of surgery and were of variable quality, meaning that it was difficult to be confident of the benefit. Further analysis by the type of surgery showed a clear benefit of using triclosan-coated sutures only in paediatric surgery. The committee therefore agreed that they should be considered as an option for wound closure in all types of surgery, and that their use in paediatric surgery should be emphasised in particular. The committee also developed a research recommendation to better clarify which patients should have triclosan-coated sutures and which surgical layers they should be used for.

How the recommendations might affect practice

The recommendations are unlikely to have a major effect on current practice. Current practice in wound closure varies, so the new recommendations may help to reduce variation and standardise practice.

Using sutures rather than staples for wound closure in caesarean section may lead to a reduction in the number of women experiencing wound dehiscence following surgery, which may reduce the costs of treatment. However, the committee acknowledged that there may be training implications for those implementing the recommendation.

Use of antimicrobial triclosan-coated sutures may increase, which may have cost implications because they are more expensive than standard sutures. However, it is likely that the increased cost will be outweighed by savings from a reduction in the number of surgical site infections, which are costly to treat.

Full details of the evidence and the committee's discussion are in evidence review D: closure materials and techniques in the prevention of surgical site infection.

Source guidance details

Comes from guidance
Surgical site infections: prevention and treatment
Date issued
April 2019

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 11/04/2019