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Suture technique and wound healing in midline laparotomy incisions.

OBJECTIVE
To study the influence of suture technique on healing of midline laparotomy wounds.


DESIGN
Prospective clinical study.


SETTING
County hospital, Sweden.


SUBJECTS
467 patients who underwent midline laparotomy between September 1991 and June 1993.


INTERVENTIONS
Wounds were sutured by a continuous technique. The suture length: wound length ratio, the stitch length, and the interval between stitches were recorded together with the body mass index and operative variables.


MAIN OUTCOME MEASURES
Incidence of postoperative wound infection and of incisional hernia at 12 months.


RESULTS
Wound infection developed in 25 of 150 (17%) wounds if the stitch length was 5 cm or more and in 21 of 307 (7%) if it was shorter than 5 cm (p < 0.01). Overweight patients were sutured with a longer stitch and there was a high rate of infection among these patients: 20/253 (14%) compared with 30/211 (8%) (p < 0.05). In a multivariate analysis stitch length 5 cm or more and degree of wound contamination were independent risk factors for wound infection. Incisional hernias developed in 42 of 368 patients (11%). In a multivariate analysis suture length: wound length ratio less than 4, overweight, and wound infection were independent risk factors.


CONCLUSION
Suture technique affects both early and late wound complications. The rate of incisional hernia is lower if the suture length: wound length ratio is 4 or more. However, a high ratio should not be achieved by suturing with a stitch length of 5 cm or more as this is associated with an increase in the rate of wound infection.