Williams, N., Sweetland, H., Goyal, S., Ivins, N., & Leaper, D.J. (2011). Randomized trial of antimicrobial-coated sutures to prevent surgical site infection after breast cancer surgery. Surgical Infections, 12, 469–474.

The purpose of the study was to assess the use of antimicrobial-coated sutures compared with conventional polyglactin and poliglecaprone for skin closure after breast cancer surgery for the reduction of surgical site infections.

Women diagnosed with breast cancer who were scheduled for primary elective surgery at a single center were approached for participation in the study. Following consent, they were block randomized in groups of 50 using random computer numbers. Sequential sealed envelopes were used and the type of suture to be used was revealed in the surgical suite just prior to surgery. The surgeon, patient, and assessor at follow-up were blinded. Following surgery, surgical sites were assessed at two weeks and six weeks using the Centers for Disease Control and Prevention (CDC) and ASEPSIS definitions for surgical site infections. In addition, patients completed a diary up to six weeks post-op, which included added details by the general practitioner and/or practice nurses. Other wound infection information also was gathered and included delays in radiotherapy or chemotherapy.

• The sample was comprised of 150 participants, all female, and all older than age 18.
• 75 participants were in each study arm
• Patients were included if they had breast cancer that was not inflammatory or did not have skin ulcerations.
• In addition to inflammatory breast cancer or skin ulcerations, patients were excluded if they received neo-adjuvant chemotherapy or radiotherapy, were having surgery for benign or reconstructive reasons, had known immune deficiency or allergy to triclosan, or were unable to give consent or appeared as if they were unlikely to comply with follow-up.

A single site (both inpatient and outpatient) in Wales

Active treatment

Randomized, controlled trial; double-blinded

•  CDC criteria for surgical site infections 
•  ASEPSIS criteria for surgical site infections
•  Southampton wound scores
•  Demographics (age, weight, type of operation)
•  Patient diary
•  Document

The overall rate of surgical site infections was 18.9% at six weeks, with six patients needing an intervention or readmission for the infection. No statistically significant differences were found between types of sutures; however, use of the anti-microbial sutures did show less surgical site infections (15.2% in the anti-microbial group versus 22.9% in the control group).

Anti-microbial sutures may be beneficial in the reduction of surgical site infections in adult women with breast cancer. A larger study is needed to have enough power to show statistically significant differences.

Surgical site infections following breast cancer surgery is prevalent. Careful and frequent evaluation of the surgical site is highly important. Use of anti-microbial sutures may reduce infections.