Should we stitch the subcutaneous fat layer following saphenous vein excision for coronary revascularization?

We report a prospective trial to establish whether a subcutaneous fat stitch reduces the incidence of haematoma formation, infection and wound dehiscence following saphenous vein excision for coronary revascularization. Two groups of patients undergoing coronary revascularization were studied. In the first group of 100 patients the saphenous vein was harvested from both legs. Legs were randomized to have either a fat stitch or no fat stitch during wound closure. By using both legs of each patient we eliminated the effect of general factors on wound healing, thus the patients acted as their own controls. In the second group of 200 patients, the saphenous vein was harvested from the thigh, and patients randomly allocated to either a fat stitch or no fat stitch during wound closure. The wounds were examined daily for 7 days, and again after 6 weeks at the follow-up. There was no difference in the rate of wound complication in the fat stitch groups (9%) compared with the no fat stitch groups (8%), however, the fat stitch groups required more surgical intervention for skin edge necrosis. It appears that closure of the subcutaneous fat following saphenectomy is unnecessary, and may be detrimental to skin healing.