Suture length to wound length ratio and healing of midline laparotomy incisions

The effect of suture length to wound length ratio on the healing of midline laparotomy wounds closed with a continuous suture was evaluated in a prospective clinical trial. All patients undergoing abdominal procedures through a midline incision were included except those with an incisional hernia after previous midline operation. The total incidence of wound infection was 36 of 454 patients (7·9 per cent) and wound dehiscence requiring reoperation occurred in three patients (0·7 per cent). Incisional hernia was found in 18.7 per cent of 363 patients alive 12 months after surgery. Multivariate analysis identified the suture length to wound length ratio, age and major wound infection as independent risk factors for the development of hernia, which occurred in 9.0 per cent of patients when the suture length to wound length ratio was ≧ 4 and in 23·7 per cent (P = 0·001) when it was <4. The suture length to wound length ratio is an important parameter for healing of midline incisions closed with a continuous suture technique. The incidence of incisional hernia is lower when such wounds are sutured with a ratio ≧ 4.

[1]  T. van Vroonhoven,et al.  Fascia closure after midline laparotomy: Results of a randomized trial , 1987, The British journal of surgery.

[2]  M. Keighley.  Single-Layer Mass Closure of Major Laparotomies by Continuous Suturing , 1980, Journal of the Royal Society of Medicine.

[3]  D. Leaper,et al.  Abdominal wound closure: A trial of nylon, polyglycolic acid and steel sutures , 1977, The British journal of surgery.

[4]  C. Balch,et al.  Abdominal wound closure. A randomized prospective study of 571 patients comparing continuous vs. interrupted suture techniques. , 1983, Annals of surgery.

[5]  M. Evans,et al.  Does mass closure of midline laparotomies stand the test of time? A random control clinical trial. , 1985, Annals of the Royal College of Surgeons of England.

[6]  F. Lacaine,et al.  Abdominal midline incision closure. A multicentric randomized prospective trial of 3,135 patients, comparing continuous vs interrupted polyglycolic acid sutures. , 1985, Archives of surgery.

[7]  Wilkinson Lh,et al.  The chain stitch knot. , 1974 .

[8]  A. Estefan,et al.  Transhepatic intubation in benign and malignant lesions of the biliary ducts. , 1985, Current problems in surgery.

[9]  H. Sugerman,et al.  Continuous absorbable vs interrupted nonabsorbable fascial closure. A prospective, randomized comparison. , 1986, Archives of surgery.

[10]  H. Ellis,et al.  Incisional hernia in re‐opened abdominal incisions: An overlooked risk factor , 1988, The British journal of surgery.

[11]  H. Ellis,et al.  Abdominal wound closure--a comparison of monofilament nylon and polydioxanone. , 1984, Surgery.

[12]  H. Ellis,et al.  Abdominal wound closure--a comparison of monofilament nylon and polyglycolic acid. , 1981, Surgery.

[13]  Archie Jp,et al.  Primary abdominal wound closure with permanent, continuous running monofilament sutures. , 1981 .

[14]  A. Askew.  A COMPARISON OF UPPER ABDOMINAL WOUND CLOSURE WITH MONOFILAMENT NYLON AND POLYGLYCOLIC ACID , 1983 .

[15]  T. Welin-Berger,et al.  Incisional hernias. A comparison between midline, oblique and transrectal incisions. , 1972, Acta chirurgica Scandinavica.

[16]  F. Stelzner.  [Theory and practice of continuous laparotomy suture (abdominal wound dehiscence and incisional hernia)]. , 1988, Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen.

[17]  H. Ellis,et al.  Abdominal incisions and their closure. , 1985, Current problems in surgery.

[18]  P. Guillou,et al.  Suture length to wound length ratio and the integrity of midline and lateral paramedian incisions , 1991, The British journal of surgery.

[19]  D. Schoetz,et al.  Closure of abdominal wounds with polydioxanone. A prospective study. , 1988, Archives of surgery.

[20]  M. Evans,et al.  Early prediction of late incisional hernias , 1989, The British journal of surgery.

[21]  M. Evans,et al.  Compression suture of the abdominal wall: A controlled trial in 302 major laparotomies , 1981, The British journal of surgery.

[22]  T. Fabian,et al.  Abdominal Incisions: Transverse vs Vertical Placement and Continuous vs Interrupted Closure , 1983, Southern medical journal.

[23]  N. Matheson,et al.  Polydioxanone or polypropylene for closure of midline abdominal incisions: A prospective comparative clinical trial , 1987, The British journal of surgery.

[24]  G. V. Poole.  Mechanical factors in abdominal wound closure: the prevention of fascial dehiscence. , 1985, Surgery.

[25]  T. P. Jenkins.  The burst abdominal wound: A mechanical approach , 1976, The British journal of surgery.