Primary mass closure of midline incisions with a continuous polyglyconate monofilament absorbable suture
D G Gallup1, T E Nolan, R P Smith
1Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta.
Abstract:
Mass closure of midline incisions with a running large-bore permanent monofilament polypropylene suture has been used in general surgery and gynecology patients with a reported small incidence of fascial dehiscence. Late-occurring wound sinus formation is one problem reported with the use of this permanent suture material. Over a 22-month period, 285 patients had midline incisions closed with a continuous, running no. 1 polyglyconate monofilament delayed absorbable suture. Closely spaced bites (about 1.5 cm apart) were taken and placed 2 cm lateral to the fascial edge. Over 60% of the patients had surgery because of gynecologic cancer. Other high-risk factors included obesity in 62%, diabetes in 19%, and previous irradiation or chemotherapy in 22%. An ovarian cancer staging procedure was done in 16% of the patients. Of the remaining patients, almost half had extensive operative procedures that ranged from exenterations to hysterectomies with lymph node dissection. Wound complications were noted in nine patients (3.2%). Seven had superficial infections, one had an evisceration, and one developed a ventral hernia. Wound sinuses did not occur. The closure technique is safe and expedient and distributes tension equally over a continuous line. It has the additional advantage of eventual absorption of the suture material, thereby avoiding the wound sinus problems occasionally reported with large-bore permanent sutures.
Insights
This study found that using a delayed absorbable suture for midline incisions in high-risk patients significantly reduced wound complications, including eliminating wound sinus formation common with permanent sutures.
Area of Science:
- Surgical Innovation
- Wound Healing Research
- Gynecologic Oncology
Background:
- Midline incisions are common in general surgery and gynecology.
- Permanent polypropylene sutures for mass closure can lead to fascial dehiscence and late wound sinus formation.
- Alternative closure methods are needed for high-risk patients.
Purpose of the Study:
- To evaluate the safety and efficacy of a delayed absorbable suture for mass closure of midline incisions.
- To compare complication rates, specifically wound sinus formation, with permanent sutures.
- To assess the technique in a high-risk surgical population.
Main Methods:
- A continuous, running No. 1 polyglyconate monofilament delayed absorbable suture was used for midline incision closure in 285 patients over 22 months.
- Bites were closely spaced (1.5 cm apart) and placed 2 cm from the fascial edge.
- Patients included those with gynecologic cancer, obesity, diabetes, and prior radiation/chemotherapy.
Main Results:
- Overall wound complications occurred in 3.2% of patients (9 out of 285).
- Superficial infections (7), evisceration (1), and ventral hernia (1) were the noted complications.
- No instances of wound sinus formation were reported.
Conclusions:
- Mass closure with a running delayed absorbable suture is a safe and effective technique for midline incisions.
- This method avoids the late-occurring wound sinus issues associated with permanent sutures.
- The technique offers expedient closure with even tension distribution and eventual suture absorption.
