Super-tension-reduction suture versus conventional closure for secondary closure of infected abdominal incisions

Surgical site infection is a common complication after abdominal surgery and is associated with delayed wound healing, prolonged hospitalization, and increased healthcare costs. Secondary closure of infected abdominal incisions after debridement and negative pressure wound therapy remains challenging because tissue edema, inflammation, and skin retraction often lead to excessive wound tension. Super-tension-reduction suture has been proposed to redistribute wound tension and improve tissue perfusion, but its effectiveness in abdominal wound salvage remains unclear.

We performed a retrospective cohort study of patients undergoing abdominal wound salvage for superficial/incisional surgical site infection between January 2020 and May 2024. Patients were categorized according to the final closure technique: standard interrupted suture or super-tension-reduction suture using a modified buried vertical mattress technique. Patient demographics, operative characteristics, and postoperative outcomes were collected. Primary outcomes included recurrent surgical site infection, wound breakdown, hematoma, seroma, fat necrosis, and reoperation. Secondary outcomes included operative duration, time to drain removal, time to suture removal, and length of hospitalization. Propensity score matching was used to mitigate the selection bias. Multivariable binary logistic regression identified significant predictors of complications.

We included 89 patients (standard interrupted suture group: 39; super-tension-reduction suture group: 50). In the unmatched cohort, super-tension-reduction suture was associated with lower rates of recurrent surgical site infection (6.0% vs. 23.1%, P = 0.028) and reoperation (4.0% vs. 17.9%, P = 0.039), alongside shorter hospitalization (17.5 vs. 21 days, P < 0.001), despite a modestly longer operative time (24 vs. 20 min, P < 0.001). After 1:1 propensity score matching (n = 58), super-tension-reduction suture group maintained a significantly lower overall complication rate (17.2% vs. 41.4%, P = 0.043). Crucially, multivariable logistic regression identified the super-tension-reduction suture as an independent protective factor against overall complications (aOR: 0.22, 95% CI: 0.08-0.59, P = 0.003) and recurrent surgical site infection (aOR: 0.21, 95% CI: 0.05-0.85, P = 0.028).

The super-tension-reduction suture was associated with favorable clinical outcomes in abdominal wound salvage. Compared with conventional closure, it was associated with lower overall complication rates despite a modest increase in operative time. While clinically promising, these observational associations warrant further validation in prospective, randomized trials.