Should we stitch the subcutaneous fat layer following saphenous vein excision for coronary revascularization?

Abstract

We report a prospective trial to establish whether a subcutaneous fat stitch reduces the incidence of haematoma formation, infection and wound dehiscence following saphenous vein excision for coronary revascularization. Two groups of patients undergoing coronary revascularization were studied. In the first group of 100 patients the saphenous vein was harvested from both legs. Legs were randomized to have either a fat stitch or no fat stitch during wound closure. By using both legs of each patient we eliminated the effect of general factors on wound healing, thus the patients acted as their own controls. In the second group of 200 patients, the saphenous vein was harvested from the thigh, and patients randomly allocated to either a fat stitch or no fat stitch during wound closure. The wounds were examined daily for 7 days, and again after 6 weeks at the follow-up. There was no difference in the rate of wound complication in the fat stitch groups (9%) compared with the no fat stitch groups (8%), however, the fat stitch groups required more surgical intervention for skin edge necrosis. It appears that closure of the subcutaneous fat following saphenectomy is unnecessary, and may be detrimental to skin healing.

Effect of subcutaneous suture line and surgical technique on wound infection after saphenectomy in coronary artery bypass grafting: a prospective randomised study

“…This encouraged us to a study design using one single operator. Our results, however, are in accordance with the results from Teebken et al (3) and El Gamel et al (9), showing no effect of subcutaneous closure on the incidence of postoperative wound infection after harvest of the saphenous vein.…”

“…Teebken et al (3) showed in a randomised study that closure of the subcutaneous layer did not impact the incidence of wound complications, although obese patients were excluded from this study. Recently, El Gamel et al (9) demonstrated similar results, however several surgeons were involved in the study; furthermore it has been shown that the infection rates are operator dependent and could accordingly influence the results (10). This encouraged us to a study design using one single operator.…”

Obtenção da veia safena magna através de acesso minimamente invasivo para revascularizações miocárdicas

“…A aterosclerose nos enxertos venosos é a principal causa de reoperação nos pacientes submetidos à revascularização miocárdica, maior do que a própria progressão da aterosclerose no leito coronariano nativo (25) . A obstrução dos enxertos venosos, tanto precoce como tardia, tem a lesão endotelial como parte da patogênese.…”

Grundlagen und Techniken der chirurgischen Naht

“…In randomisierten Studien konnte nach Vena-saphena-Exzision der negative Effekt von subkutanen Nähten gezeigt werden. Eine zusätzliche Naht des Fettgewebes führt hier zu Gewebeischämie sowie Nekrose und damit zu einem erhöhten Infektionsrisiko [9].…”