Q. A patient who had undergone coronary artery bypass surgery (CABG) presented to the ER with major bleeding through staples from the incision site on his chest. In addition, he had a large incision site along his thigh that was also closed with staples. If he had undergone coronary artery bypass surgery (dealing with the heart), then why was there a large incision site on his leg? In addition, in what circumstances do surgeons choose to close with staples over sutures?
A. Coronary artery bypass grafting is used to treat individuals with severe coronary heart disease, a condition in which a waxy substance called plaque builds up inside the coronary arteries. Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. In addition, the plaque can rupture, forming a blood clot that can completely block blood through through a coronary artery. CABG is a type of surgery that improves blood flow to the heart. A healthy artery or vein from the body is grafted to the blocked coronary artery. The grafted artery or vein will bypass the blocked portion of the coronary artery, creating a new path for oxygen-rich blood to flow to the heart muscle. In this patient’s case, the great saphenous vein (large superficial, subcutaneous vein in the leg) was harvested and used as the graft. Surgeons can bypass multiple coronary arteries during one surgery if they have a large vein to work with — hence, why the patient had an incision site and why the incision site was so large. Regarding the use of sutures vs staples: staples are often used because of the ease of use, speed of the procedure, and the enablement of closing deeper incisions. Especially in patients who undergo the CABG procedure, stapling saves a lot of time when there are two large incisions that need to be closed. However, there have been multiple studies showing that there are higher rates of wound complications and infections when staples are used to close wounds over sutures — these studies are not comprehensive, however, so more testing would need to be conducted before a definitive statement can be made. Resources: