Should we still stitch the subcutaneous fat layer? A clinical and ultrasound assessment in 50 hip operations

Wound haematoma is an undesirable complication of surgery. We report a prospective trial to establish whether a subcutaneous fat stitch affects haematoma formation in hip surgery. A series of 50 patients undergoing hip surgery were randomised to have either a fat stitch or no fat stitch during wound closure. The wounds were assessed clinically with a minimum follow-up of 5 weeks. Subcutaneous haematomas were seen more easily with the patient standing. As clinical assessment for haematoma formation may be unreliable, each patient also had an ultrasound scan. Although the incidence of subcutaneous haematoma was slightly higher in the no fat stitch group (36% compared with 24% in the fat stitch group) this difference was not statistically significant (chi 2 test, P < 0.5). There were no significant differences in the incidence of wound infection and healing rate. From our study we also showed that ultrasound examination was twice as sensitive as clinical examination in diagnosing subcutaneous haematomas and that subcutaneous haematomas are common after hip surgery.