Introduction Emerging evidence has shown that using smaller more frequent sutures close to the fascial wound edge is associated with a lower incidence of incisional hernia, dehiscence and surgical site infection compared to conventional wound closure.1However in implementing this practice we have experienced difficulty due to concerns regarding sutures below 1–0 grade allowing increased rates of early dehiscence and incisional hernia. We sought to demonstrate the safety of this method of wound closure.
Method Un-selected patients undergoing abdominal surgery (elective and emergency) were prospectively collected from within the practice of a single surgeon in a regional teaching hospital. All wounds greater than four centimetres (fascia defect length) were included. All patients underwent closure of abdominal fascial wounds using a suture to wound length ratio of at least 4:1. Suture material was 2–0 PDS. Risk of death from surgery was preoperatively calculated using the P-POSSUM score. Initial follow up period was 30 days from procedure. Study end points were length of stay, morbidity and mortality within 30 days, dehiscence and hernia formation rate.
Results 34 patients underwent fascial closure as described above, 17 cases were patients undergoing emergency laparotomy. Average fascial defect length was 13.8 cm (median 14.5 cm); average length of suture used was 98.5 cm (median 82 cm). Average ratio of suture length to wound length was 7.5. Mean length of stay in this group was 5.4 days. Average BMI was 28.9; average calculated risk of death was 11.6%. A single patient died from overwhelming sepsis shortly after emergency laparotomy. Three patients developed chest sepsis post operatively (emergency group) and two elective patients were readmitted within 30 days with chest infection and hypocalcaemia respectively.
Conclusion We have demonstrated that using a small, frequent suture does not give rise to increased rates of early dehiscence, incisional hernia or major wound complications in the early post operative period.
Disclosure of interest None Declared.
Israelsson L, Millbourn D. Prevention of incisional hernias. How to close a midline incision. Surg Clin North Am. 2013;93:1027–1040
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