Effect of retention sutures for prevention of abdominal wound dehiscence after laparotomy in high risk patients (A prospective study)

Abstract

Background:Wounds and their management are fundamental to the practice of surgery. Surgical wound dehiscence after laparotomy remains a serious complication. To evaluate the effect of prophylactic retention sutures in patients with a high risk for wound dehiscence  who underwent midline laparotomy. Patients and methods :One hundred fifty(150) cases were randomized to form two groups with 75 patients each: a prophylactic  group by using retention sutures  and an non prophylactic group. A central randomization for both hospitals was performed. Two patients in the non prophylactic  group and three patients in the prophylactic group In the non prophylactic(control) group Standard midline incision and continuous mass closure technique was used in each case using a running looped 1/0 nylon string located 1 cm from the edge of the  linea alba. In the prophylactic group, the fascia was sutured using the same technique as the non prophylactic group; however, retention sutures were added using a 1/0 nylon string every 10 cm and contained 5 cm of the skin, subcutaneous tissue, rectus muscle, and abdominal fascia (except peritoneum) on each side. All fascia closures were performed by tow attending surgeons who adhered strictly to the protocol. Occurrence of abdominal dehiscence  was assessed daily by precise examination of the wound. Results: The incidence of abdominal wound dehiscence was 3 patients (4%) in the prophylactic group and 10 patients (13.3%) in the control (non prophylactic )group (P = 0.007 ) therefore it is significant Conclusion: Our conclusion that prophylactic retention sutures can decrease the incidence of abdominal wound dehiscence but although there is decrease incidence of postoperative evisceration ,wound infection and postoperative pain , there was no significant difference.