Principles of abdominal wound closure. II. Prevention of wound dehiscence
R. J. Sanders and D. DiClementi
Among 4,000 abdominal wound closures, there were 11 dehiscences. In eight,
the original wound was closed with retention or large figure-of-8 sutures.
When the wounds were resutured, the same basic technique of large tissue
bites at close intervals was used, but this time the wounds remained
intact. Therefore, it was concluded that the cause of the dehiscence was
not poor tissues, but poor technique: the first sutures either had too
small bites, were placed too far apart, or were tied too tightly. We
describe a closure technique using buried figure-of-eight retention sutures
tied very loosely. An additional running suture approximates the fascial
edges. This method was used in 126 patients, with but one failure, caused
by improper knot tying. In a separate clinical study, no difference in
wound tension was found between vertical and transverse incisions.
