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Suture to wound length ratio in abdominal wall closure: how well are we doing?

Authors
  • Williams, Z. F.1
  • Tenzel, P.1
  • Hooks, W. B. III1
  • Hope, W. W.1
  • 1 New Hanover Regional Medical Center, Department of Surgery, 2131 South 17th Street, Wilmington, NC, 28401, USA , Wilmington (United States)
Type
Published Article
Journal
Hernia
Publisher
Springer Paris
Publication Date
Sep 23, 2017
Volume
21
Issue
6
Pages
869–872
Identifiers
DOI: 10.1007/s10029-017-1667-y
Source
Springer Nature
Keywords
License
Yellow

Abstract

PurposeResearch has established that a ≥4:1 suture to wound (S:W) length ratio decreases incisional hernias. We evaluated our ability to obtain a 4:1 S:W length ratio in a surgery residency program.MethodsConsecutive abdominal wall closures from 12/1/2013 through 4/9/2015 were reviewed. The length of the incisions and amount of suture used were measured. Patient demographics and operative variables were documented and compared related to inability to obtain a 4:1 ratio.ResultsOne hundred patients underwent abdominal closure with S:W length measurements. Average wound length was 18.3 cm; average suture length used was 84.5 cm; and average S:W length ratio was 4.6:1. An S:W length ratio of ≥4:1 was achieved in 76% of cases. There was no difference in race, age, gender, BMI, type of procedure, or resident level in obtaining a 4:1 S:W length ratio. There was a significantly higher rate of not achieving a 4:1 ratio when two residents closed. Postoperative infection rate and hernia rate increased when a 4:1 S:W length ratio was not achieved compared with an adequate S:W length ratio.ConclusionsDespite the known importance of achieving a 4:1 S:W length ratio for abdominal closure, it was only achieved in 76% of study patients. Improved education on the importance of fascial closure is needed.

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