Polyglycolic acid (Dexon) versus silk for fascial closure of abdominal incisions

Suture-granulomas were previously found in 6% of patients subjected to colorectal surgery. It was therefore investigated whether the use of polyglycolic acid (Dexon) instead of silk for fascial closure of abdominal incisions would reduce the rate of granulomas without an accompanying increase in rate of wound dehiscences. The two sutures were evaluated in a triple blind, randomized trial, using the paired sample principle in patients subjected to elective gastrointestinal surgery. One gram of Pentrexyl powder was applied to the subfascial space in all the patients and the wounds were examined 10 days, 1 and 3 months after the operations. The trial was terminated when a closed sequential analysis had shown a significantly higher rate of dehiscences after closure with silk (12/163) than after closure with polyglycolic acid (1/163). Seven patients had granulomas after silk and one after polyglycolic acid at that time. Postoperative wound infections occurred in 7 patients after silk and 8 after polyglycolic acid. It is concluced that the use of polyglycolic acid (Dexon) nearly eliminates the risk of suture-granulomas, without increasing the risk of wound dehiscences; on the contrary, the rate of dehiscences was lower after polyglycolic acid.