Principles of Abdominal Wound Closure

Surgical implantation techniques for electronic tags in fish

“…Sutures spaced too far apart do not provide adequate apposition and lead to dehiscence of the wound (Swaim 1980). Sanders et al (1977) found sutures placed 6-7 mm apart with 5-mm facial bites (i.e., entry point of the needle from the wound margin) created the best apposition and subsequent abdominal wound strength in rats with 6-cm incisions, 4-6 days post-surgery. In general, sutures should be spaced Roussel et al (2000) Chinook salmon 95-121 10-24 Absorbable monofilament 5-0 PS-2 cutting Deters et al (2010) Chinook salmon 95-121 10-24 Non-absorbable monofilament 5-0 FS-2 cutting Deters et al (2010) Chinook salmon 95-121 10-24 Non-absorbable braided 5-0 PC-1 cutting Deters et al (2010) Chinook salmon 95-121 10-24 Braided silk 5-0 FS-2 cutting Deters et al (2010) Chinook salmon 95-121 10-24 Absorbable, braided 5-0 FS-2 cutting Deters et al (2010) Chinook salmon 95-121 10-24 Absorbable braided 5-0 P-3 cutting Deters et al (2010) Chinook salmon 95-121 10-24 Absorbable braided 5-0 RB-1 tapered Deters et al (2010) Chinook salmon 95-160 10-45 Absorbable braided 5-0 RB-1 tapered Adams et al (1998) Chinook salmon 122-198 22-99 Absorbable braided 5-0 SH tapered Anglea et al (2004) Atlantic salmon 144 32 Braided silk 4-0 C-13 cutting Robertson et al (2003) Atlantic salmon 146 36 Non-absorbable monofilament 4-0 FS-2 cutting Lacroix et al (2004) Atlantic salmon 161 46 Braided silk 4-0 C-13 cutting Robertson et al (2003) Atlantic salmon 165 39…”

“…It is important to not tie the sutures too tightly because this can cause strangulation of the tissue, leading to ischemic necrosis (Whipple and Elliott 1938) as well as a lack of apposition of the tissue layers. Tight sutures also are a common error in human abdominal wound closure, resulting in lower wound strengths compared to wounds in which the edges are approximated (Nelson and Dennis 1951;Haxton 1965;Sanders et al 1977).…”

Prevention of Incisional Hernias

“…20,21,23 A proliferative phase follows the inflammatory phase, and lasts for approximately 3 weeks. 20,24 The collagen deposition leads to an increase in the strength of the wound,…”

“…1 A high SL to WL ratio can be accomplished with large stitches or with small stitches placed at closer intervals. Based entirely on experimental studies, 24,57,69 it has long been recommended to place large stitches at least 1 cm from the wound edge. 6,70,71 A clinical report actually pointed in the opposite direction and indicated a higher rate of incisional hernia with large stitches.…”

“…The tensile strength is higher in wounds approximated with low tension than in wounds closed with high tension. 24,56 In a randomized trial including 737 patients, the effect on the rate of incisional hernia was studied with small stitches in comparison with large stitches. Closure with small stitches was made with a polydioxanone suture USP 2/0 mounted on a needle so small that stitches could not be placed more than 5 to 8 mm from the wound edge, only incorporating the aponeurosis.…”