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Suture technique and wound healing in midline laparotomy incisions
L A Israelsson1, T Jonsson, A Knutsson
1Department of Surgery, Sundsvall County Hospital, Sweden.
Objective:
To study the influence of suture technique on healing of midline laparotomy wounds.
Design:
Prospective clinical study.
Setting:
County hospital, Sweden.
Subjects:
467 patients who underwent midline laparotomy between September 1991 and June 1993.
Interventions:
Wounds were sutured by a continuous technique. The suture length: wound length ratio, the stitch length, and the interval between stitches were recorded together with the body mass index and operative variables.
Main Outcome Measures:
Incidence of postoperative wound infection and of incisional hernia at 12 months.
Results:
Wound infection developed in 25 of 150 (17%) wounds if the stitch length was 5 cm or more and in 21 of 307 (7%) if it was shorter than 5 cm (p < 0.01). Overweight patients were sutured with a longer stitch and there was a high rate of infection among these patients: 20/253 (14%) compared with 30/211 (8%) (p < 0.05). In a multivariate analysis stitch length 5 cm or more and degree of wound contamination were independent risk factors for wound infection. Incisional hernias developed in 42 of 368 patients (11%). In a multivariate analysis suture length: wound length ratio less than 4, overweight, and wound infection were independent risk factors.
Conclusion:
Suture technique affects both early and late wound complications. The rate of incisional hernia is lower if the suture length: wound length ratio is 4 or more. However, a high ratio should not be achieved by suturing with a stitch length of 5 cm or more as this is associated with an increase in the rate of wound infection.