Burst abdomen and incisional herniation are continuing problems for the general surgeon. A prospective study was carried out to define the extent of the problem. Over five years from 1975 to 1980 a total of 1129 major laparotomy wounds in adults were assessed at regular intervals for 12 months after operation. There were 19 burst abdomens (1-7%) and 84 incisional hernias (74%). The introduction of the mass-closure technique reduced the

Local infection was introduced into rat abdominal wounds using a 10(8) bacterial/ml inoculum. Three groups of infection were used: Staphylococcus aureus, Pseudomonas aeruginosa and a combination group of Escherichia coli and Proteus mirabilis. Infection was shown to delay healing as judged by bursting tests. Fibroblast proliferation was depressed at the wound edges but there was an increase in the total amount of hydroxyproline present. Small vessel angiogenesis was increased in areas of abscess formation but larger vessels were commonly blocked by thrombus or distorted by surrounding inflamed tissue. The possible causes of these effects are discussed.

Burst abdomen, incisional hernia and sinus formation continue to bedevil the surgeon. Significant associated factors include postoperative wound infection and the suture material used. A series of experiments was therefore designed to test suture materials for their use in infected abdominal wound closure. The nearest to the ideal, is a monofilament non-absorbable suture (monofilament nylon). It has a low infectivity, resulted in satisfactory wound tissue strength when used in infected wounds, and retained its strength. Infected, braided sutures of silk, nylon and polyglycolic acid even after 70 days were seen to contain bacteria and polymorphonuclear cells when examined electron microscopically. Absorption of silk and polyglycolic acid and encapsulation of non-absorbable braided nylon was delayed by the presence of infection. Monofilament nylon, in contrast, was unaffected, a fibrous capsule having formed by 10 days even in the infected state.

SummaryThis double-blind, randomised, multicentre trial in 513 patients having elective surgery for intra-abdominal or intrathoracic malignancy compared the efficacy and safety of venous thrombosis (VT) prophylaxis using 750 anti-factor Xa units of Orgaran (a mixture of low molecular weight heparinoids) given subcutaneously (sc) twice-daily with that of twice-daily injections of 5,000 units Standard heparin. The main study endpoints were the development of postoperative VT detected by 125I-fibrinogen leg scanning, and the onset of clinically significant venous thromboembolism or bleeding. “Intent to treat” analysis showed a statistically non-significant trend towards less VT during Orgaran prophylaxis (10.4%) than after heparin (14.9%) and there was no difference in bleeding complications between the two study groups. Results remained similar if only patients who completed the intended course of therapy (“compliant patients”) were analysed. Other trials have shown that Orgaran prevents VT after hip surgery and stroke. We now show it is also safe and effective in patients having major surgery for cancer.