Abstract
Background
Abdominal wound dehiscence (WD) is a postoperative complication with high mortality
and morbidity rates. Retention sutures are often used in surgical take-back for dehiscence.
The aim of this study was to assess the reduced rate of dehiscence in midline laparotomy
using prophylactic retention sutures in high-risk patients.
Materials and methods
Three hundred high-risk patients with at least two risk factors for dehiscence who
underwent midline laparotomy between 2008 and 2010 were randomly divided into two
groups. In the control group, the fascia was continuously repaired using a running
looped #1 nylon suture. For the intervention group, we added retention sutures that
included the skin, subcutaneous tissue, rectus muscle, and abdominal fascia. We compared
the rates of WD, evisceration, wound infection, postoperative pain, postdehiscence
mortality, and late incisional hernia for these two groups.
Results
After accounting for early mortalities, 147 patients were followed in the intervention
group and 148 patients in the control group. WD occurred in 6 patients (4%) in the
intervention group and 20 control patients (13.3%) (P = 0.007). Abdominal evisceration after surgery occurred in 1 patient (0.7%) with
retention sutures and 4 control patients (2.7%) (P = 0.371). There was no significant difference in wound infection and incisional hernia
between the two groups. Postoperative pain scores between the two groups did not differ
significantly during the first 3 d, but did differ on the fourth day.
Conclusion
Prophylactic retention sutures reduce the occurrence of WD following midline laparotomy
in high-risk patients with multiple risk factors for impaired wound healing without
imposing remarkable postoperative complications.
Keywords
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Article info
Publication history
Published online: May 25, 2012
Accepted:
May 3,
2012
Received in revised form:
April 27,
2012
Received:
January 4,
2012
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
