No abstract

Five hundred and seventy-nine patients undergoing major laparotomy were randomly allocated to have midline or transverse incisions. Transverse incisions took longer to make and caused more bleeding but (in the absence of wound sepsis) no transverse wound burst and there were only 2 incisional hernias. In the midline group, without wound sepsis, there were 2 burst abdomens and 9 incisional hernias. When, however, those patients who suffered wound sepsis were also considered, there were no significant differences between the two groups.

No abstract

Failures after abdominal wound closure (early dehiscences and late incisional hernias) are due to breakage of sutures, slippage of knots or tearing out of sutures from the tissues. The suture-holding capacity of the entire thickness of muscle and aponeurosis is nearly twice that of the anterior rectus sheath, and deep bites (1-0 cm from the cut edges) are nearly twice as secure as bites of 0-5 cm. In a random controlled clinical trial of 357 major laparotomies, closure with either layered monofilament nylon or mass polyglycolic acid or steel resulted in 2 burst abdomens (0-56%), 10 incisional hernias due to suture failure (3-4%) and 8 incisional hernias caused by deep sepsis (2-7%). There were no statistically significant differences among the treatment groups, but 1 patient in the nylon and 3 in the steel groups had persistent sinuses until their sutures were removed.

In a series of 762 general surgical wounds 376 were selected at random to receive three parenteral doses of cephaloridine and 386 remained as untreated controls.In all types of operation, with the exception of wounds in the lower extremities associated with arterial surgery, the rate of wound infection was lowered by the prophylactic use of cephaloridine. The results were statistically significant for total wounds, clean wounds, total contaminated wounds, and contaminated wounds other than in colorectal surgery. We therefore recommend the routine use of three doses of cephaloridine.