A randomized comparison of continuous versus interrupted mass closure of midline incisions in patients with gynecologic cancer.
ABSTRACT To address the incidence of deep wound dehiscence and incisional hernia formation with two types of mass closure after vertical midline laparotomy performed in patients with gynecologic cancer.
Continuous and interrupted mass closures were compared randomly in 632 patients. Both methods were performed with absorbable material. Of the 614 subjects who could be evaluated, 308 underwent a continuous, non-locking closure with looped polyglyconate suture, and 306 were closed with interrupted polyglycolic acid according to the Smead-Jones technique.
Three (1%) subjects with the continuous closure and five (1.6%) with the interrupted closure had an abdominal wound infection (P = .50). One patient whose incision was closed with continuous suturing had a deep wound dehiscence (without evisceration). The follow-up period was 6 months to 3 years. No patient had evidence of chronic sinus drainage. Thirty-two (10.4%) of the patients who had the continuous closure and 45 (14.7%) of those who were closed with the interrupted method had evidence of incisional hernia (P = .14). No hernia developed in any patient with a wound infection. Four (1.3%) hernias after the continuous closure and eight (2.6%) after the interrupted closure required surgical repair because of patient discomfort (P = .38).
The interrupted closure was not superior to the continuous closure for short- and long-term wound security. The continuous method was preferable because it was more cost-efficient and faster.
- Clinical Obstetrics and Gynecology 10/1988; 31(3):754-60. · 1.84 Impact Factor
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ABSTRACT: Mass closure of midline incisions with a running large-bore permanent monofilament polypropylene suture has been used in general surgery and gynecology patients with a reported small incidence of fascial dehiscence. Late-occurring wound sinus formation is one problem reported with the use of this permanent suture material. Over a 22-month period, 285 patients had midline incisions closed with a continuous, running no. 1 polyglyconate monofilament delayed absorbable suture. Closely spaced bites (about 1.5 cm apart) were taken and placed 2 cm lateral to the fascial edge. Over 60% of the patients had surgery because of gynecologic cancer. Other high-risk factors included obesity in 62%, diabetes in 19%, and previous irradiation or chemotherapy in 22%. An ovarian cancer staging procedure was done in 16% of the patients. Of the remaining patients, almost half had extensive operative procedures that ranged from exenterations to hysterectomies with lymph node dissection. Wound complications were noted in nine patients (3.2%). Seven had superficial infections, one had an evisceration, and one developed a ventral hernia. Wound sinuses did not occur. The closure technique is safe and expedient and distributes tension equally over a continuous line. It has the additional advantage of eventual absorption of the suture material, thereby avoiding the wound sinus problems occasionally reported with large-bore permanent sutures.Obstetrics and Gynecology 12/1990; 76(5 Pt 1):872-5. · 4.80 Impact Factor
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ABSTRACT: The incidence of fascial disruption after major abdominal operations is 1% to 3%, and dehiscence is associated with a mortality rate of 15% to 20%. Although several systemic factors (e.g., malnutrition, increased age, male sex, and chronic treatment with steroids) have been associated with an increased risk of wound disruption, their clinical importance has been overstated. Local, mechanical factors such as wound infections, abdominal distention, and pulmonary complications appear to be more important and should be prevented or treated aggressively should they occur. Paramedian wounds are less secure than are midline wounds, but the latter, when closed properly, are probably equivalent to transverse wounds. The peritoneum need not be closed, but the fascia should be sutured securely. Monofilament suture materials are preferred, and the continuous suturing technique has theoretic and practical advantages. Retention sutures are unnecessary if the fascia is closed properly, and the wound itself should not be violated by a drain or stoma. Although fascial dehiscence may not be eliminated, its incidence can certainly be reduced with proper attention to the mechanics of fascial closure.Surgery 07/1985; 97(6):631-40. · 3.37 Impact Factor