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A randomized controlled trial of closure or non-closure of subcutaneous fatty tissue after midline vertical incision

Background/Aim: There are limited studies that evaluate the closure of subcutaneous tissue, particularly among gynecologic oncology patients, a group with a high rate of obesity and more co-morbidities. This prospective randomized controlled study aimed to assess the effects of subcutaneous closure versus non-closure on wound complication rate in patients with subcutaneous tissue thicknesses of more than >4 cm. Methods: All patients with a subcutaneous tissue depth≥4 cm measured with ultrasonography and undergoing gynecologic surgery via a midline vertical incision from February 2019 to March 2020 in the gynecologic oncology department at a teaching hospital were considered for inclusion. Patients were intraoperatively and sequentially randomized as 1:1 only when the measurement of subcutaneous tissue depth was verified to be 4 cm or more. Results: A total of 82 patients who underwent randomization were assigned to undergo or not undergo subcutaneous closure with sutures (41 patients each). Subcutaneous wound depth (mean: 6.36 cm, range: 4-11 cm), vertical incision length (mean: 24.32 cm, 12-36 cm), body mass index (33.82 kg/m2, 19.6-33.82 kg/m2) were similarly distributed between the groups (P>0.05 for all). Wound complications were observed in 17 (20.7%) patients. Wound infection occurred in two patients in the closure group as compared to three patients in the control group (P=0.644). Seroma and wound dehiscence were seen more often in the control group, but neither of these findings reached statistical significance (P=0.077, P=0.284). Conclusion: We found no significant differences in the rate of surgical wound complications with suture approximation of the subcutaneous tissue in patients with 4 cm or more subcutaneous thickness undergoing gynecologic surgery via a vertical midline incision.