Application of Abdominal Wall Closure Measure Without Suturing Subcutaneous Fat Layer in Abdominal Surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

GE Wei ,  CHEN Gang , DING Yitao.

Department of General Surgery， Drum Tower Clinical Medical College of Nanjing Medical University， Nanjing 210008， Jiangsu Province， China;

Corresponding author：

CHEN Gang, Email: gulou_hospital@163.com

Keywords：

Suture technique; Subcutaneous fat layer; Abdominal surgery; Randomized control trial

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To compare the efficacy of incision healing by abdominal wall closure measure without suturing subcutaneous fat layer and the traditional abdominal wall closure measure.
Methods 　Four hundreds patients underwent operation of abdominal median incision and abdominal paramedian incision from Sep. 2010 to Sep. 2012 in our department were randomly assigned to observation group （n=199） and control group （n=201）. The patients in obser- vation group underwent abdominal wall closure measure without suturing subcutaneous fat layer， and those of control group were subjected to abdominal wall closure by traditional layer suture technique. Comparison of efficacy of incision healing in the 2 groups was performed.
Results 　The incidences of fat liquefication 〔1 （0.5%） vs.18 （9.0%）〕， incision swelling 〔3 （1.5%） vs.16 （8.0%）〕， incision induration 〔1 （0.5%） vs.15 （7.5%）〕， and dehiscence of wound 〔0 （0） vs.9 （4.5%）〕 in observation group were significantly lower than those of control group （P＜0.01）， but there was no significant difference in incidence of subcutaneous hematoma 〔2 （1.0%） vs.0 （0）， P＞0.05〕. The rate of primary healing in obser-vation group was significantly higher than those of control group 〔199 （100%） vs.186 （92.5%）， P＜0.01〕. Duration of abdominal closure 〔（13.0±1.6） min vs.（18.0±2.2） min〕 and postoperative hospital stay 〔（7.7±1.3） days vs.（9.6±1.9） days〕 were all shorter than those of control group （P＜0.01）.
Conclusion 　The abdominal wall closure measure without suturing subcutaneous fat layer is obviously more effective to the traditional layer suture technique， which is a suture way worthy to spread.

Citation： GE Wei,CHEN Gang,DING Yitao.. Application of Abdominal Wall Closure Measure Without Suturing Subcutaneous Fat Layer in Abdominal Surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(12): 1396-1400. doi: Copy

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13.	Kabon B， Rozum R， Marschalek C， et al. Supplemental posto-perative oxygen and tissue oxygen tension in morbidly obesepatients[J]. Obes Surg， 2010， 20(7)：885-894.
14.	Bakri MH， Nagem H， Sessler DI， et al. Transdermal oxygen does not improve sternal wound oxygenation in patients recoveringfrom cardiac surgery[J]. Anesth Analg， 2008， 106(6)：1619-1626.
15.	朱笑寒，桂世涛，王亮. 全层连续加减张缝合预防高龄患者腹部切口裂开[J]. 中国医学创新， 2009， 6(32)：35-37.
16.	徐世平，张驰. 全层连续加内减张缝合在预防腹壁切口裂开的应用[J]. 河南外科学杂志， 2009， 15(3)：18-19.
17.	Baracs J， Huszár O， Sajjadi SG， et al. Surgical site infections after abdominal closure in colorectal surgery using triclosan-coated absorbable suture (PDS Plus) vs. uncoated sutures (PDS Ⅱ)：a randomized multicenter study[J]. Surg Infect (Larchmt)， 2011， 12(6)：483-489.
18.	Huszár O， Baracs J， Tóth M， et al. Comparison of wound infection rates after colon and rectal surgeries using triclosan-coated or bare sutures—a multi-center， randomized clinical study[J]. Magy Seb， 2012， 65(3)：83-91.
19.	Gupta H， Srivastava A， Menon GR， et al. Comparison of interrupted versus continuous closure in abdominal wound repair：a meta-analysis of 23 trials[J]. Asian J Surg， 2008， 31(3)：104-114.
20.	Chelmow D， Rodriguez EJ， Sabatini MM. Suture closure of subcutaneous fat and wound disruption after cesarean delivery：a meta-analysis[J]. Obstet Gynecol， 2004， 103(5 Pt 1)：974-980.
21.	Fischer JE. The importance of reconstruction of the abdominal wall after gastrointestinal fistula closure[J]. Am J Surg， 2009， 197(1)：131-132.
22.	Berretta R， Rolla M， Patrelli TS， et al. Randomised prospective study of abdominal wall closure in patients with gynaecological cancer[J]. Aust N Z J Obstet Gynaecol， 2010， 50(4)：391-396.
23.	Justinger C， Slotta JE， Schilling MK. Incisional hernia after abdominal closure with slowly absorbable versus fast absorbable， antibacterial-coated sutures[J]. Surgery， 2012， 151(3)：398-403.
24.	van’t Riet M， Steyerberg EW， Nellensteyn J， et al. Meta-analysisof techniques for closure of midline abdominal incisions[J]. Br J Surg， 2002， 89(11)：1350-1356.

1. Ferguson DJ. Clinical application of experimental relations between technique and wound infection[J]. Surgery， 1968， 63：377-381.
2. Milewski PJ， Thomson H. Is a fat stitch necessary?[J]. Br J Surg， 1980， 67(6)：393-394.
3. Ferris BD， Wickens D， Bhamra M， et al. To stitch or not to stitchthe fat?[J]. Ann R Coll Surg Engl， 1989， 71(2)：115-116.
4. Elson RA. Complications of the wound//Ling RSM. Complica-tions of total hip replacements[M]. Edinburgh：Churchill Livin-gstone， 1984：41-57.
5. Kong K， Jeyagopal N， Davies SJ. Should we still stitch the subcu-taneous fat layer? A clinical and ultrasound assessment in 50 hip operations[J]. Ann R Coll Surg Engl， 1993， 75(1)：23-25.
6. Thomay AA， Daley JM， Sabo E， et al. Disruption of interleukin-1 signaling improves the quality of wound healing[J]. Am J Pathol， 2009， 174(6)：2129-2136.
7. 陈孝平. 外科学[M]. 北京：人民卫生出版社， 2005：236-239.
8. Hunt TK， Hopf HW. Wound healing and wound infection. What surgeons and anesthesiologists can do[J]. Surg Clin North Am， 1997， 77(3)：587-606.
9. Larsson A， Uusijärvi J， Lind F， et al. Hyperbaric oxygen in the treatment of postoperative infections in paediatric patients with neuromuscular spine deformity[J]. Eur Spine J， 2011， 20(12)：2217-2222.
10. Larsson A， Engström M， Uusijärvi J， et al. Hyperbaric oxygen treatment of postoperative neurosurgical infections[J]. Neurosurgery， 2008， 62 Suppl 2：652-671.
11. Korhonen K. Hyperbaric oxygen therapy in acute necrotizing infections. With a special reference to the effects on tissue gas tensions[J]. Ann Chir Gynaecol， 2000， 89 Suppl 214：7-36.
12. Hopf HW， Hunt TK， West JM， et al. Wound tissue oxygen tension predicts the risk of wound infection in surgical patients[J]. Arch Surg， 1997， 132(9)：997-1004.
13. Kabon B， Rozum R， Marschalek C， et al. Supplemental posto-perative oxygen and tissue oxygen tension in morbidly obesepatients[J]. Obes Surg， 2010， 20(7)：885-894.
14. Bakri MH， Nagem H， Sessler DI， et al. Transdermal oxygen does not improve sternal wound oxygenation in patients recoveringfrom cardiac surgery[J]. Anesth Analg， 2008， 106(6)：1619-1626.
15. 朱笑寒，桂世涛，王亮. 全层连续加减张缝合预防高龄患者腹部切口裂开[J]. 中国医学创新， 2009， 6(32)：35-37.
16. 徐世平，张驰. 全层连续加内减张缝合在预防腹壁切口裂开的应用[J]. 河南外科学杂志， 2009， 15(3)：18-19.
17. Baracs J， Huszár O， Sajjadi SG， et al. Surgical site infections after abdominal closure in colorectal surgery using triclosan-coated absorbable suture (PDS Plus) vs. uncoated sutures (PDS Ⅱ)：a randomized multicenter study[J]. Surg Infect (Larchmt)， 2011， 12(6)：483-489.
18. Huszár O， Baracs J， Tóth M， et al. Comparison of wound infection rates after colon and rectal surgeries using triclosan-coated or bare sutures—a multi-center， randomized clinical study[J]. Magy Seb， 2012， 65(3)：83-91.
19. Gupta H， Srivastava A， Menon GR， et al. Comparison of interrupted versus continuous closure in abdominal wound repair：a meta-analysis of 23 trials[J]. Asian J Surg， 2008， 31(3)：104-114.
20. Chelmow D， Rodriguez EJ， Sabatini MM. Suture closure of subcutaneous fat and wound disruption after cesarean delivery：a meta-analysis[J]. Obstet Gynecol， 2004， 103(5 Pt 1)：974-980.
21. Fischer JE. The importance of reconstruction of the abdominal wall after gastrointestinal fistula closure[J]. Am J Surg， 2009， 197(1)：131-132.
22. Berretta R， Rolla M， Patrelli TS， et al. Randomised prospective study of abdominal wall closure in patients with gynaecological cancer[J]. Aust N Z J Obstet Gynaecol， 2010， 50(4)：391-396.
23. Justinger C， Slotta JE， Schilling MK. Incisional hernia after abdominal closure with slowly absorbable versus fast absorbable， antibacterial-coated sutures[J]. Surgery， 2012， 151(3)：398-403.
24. van’t Riet M， Steyerberg EW， Nellensteyn J， et al. Meta-analysisof techniques for closure of midline abdominal incisions[J]. Br J Surg， 2002， 89(11)：1350-1356.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of Abdominal Wall Closure Measure Without Suturing Subcutaneous Fat Layer in Abdominal Surgery

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