Prevention of superficial wound separation with subcutaneous retention sutures

The objective of this prospective study was to determine the efficacy of subcutaneous retention sutures in the prevention of superficial wound separation in obese women undergoing gynecologic surgery. From 1985 to 1990, 80 women with subcutaneous tissue of 5 cm or greater undergoing laparotomy were randomly assigned to either standard wound closure (37 patients) or closure including subcutaneous retention sutures (43 patients). We examined the relationship of the following factors to the development of superficial wound dehiscence: malnutrition (total protein < 6.0 mg/dl, albumin < 3.0 mg/dl), minidose heparin (5000 U subcutaneously every 8 hr for 5 days), diabetes mellitus, prolonged operative time (> 180 min), intraoperative spillage of enteral contents, and subcutaneous retention sutures. In a univariate analysis, malnutrition (P = 0.02), the use of heparin (P = 0.03), and the absence of retention sutures (P = 0.02) were associated with an increased risk of separation. In a multivariate analysis, malnutrition (P = 0.02), low-dose heparin (P = 0.03), and the absence of retention sutures (P = 0.04) retained their independent association with superficial wound separation. This study suggests that the use of subcutaneous retention sutures reduces the incidence of superficial wound separation in obese women undergoing gynecologic surgery.