Principles of abdominal wound closure. II. Prevention of wound dehiscence

Among 4,000 abdominal wound closures, there were 11 dehiscences. In eight, the original wound was closed with retention or large figure-of-8 sutures. When the wounds were resutured, the same basic technique of large tissue bites at close intervals was used, but this time the wounds remained intact. Therefore, it was concluded that the cause of the dehiscence was not poor tissues, but poor technique: the first sutures either had too small bites, were placed too far apart, or were tied too tightly. We describe a closure technique using buried figure-of-eight retention sutures tied very loosely. An additional running suture approximates the fascial edges. This method was used in 126 patients, with but one failure, caused by improper knot tying. In a separate clinical study, no difference in wound tension was found between vertical and transverse incisions.