| 1. |
- Israelsson, Leif A., et al.
(författare)
-
Closing midline abdominal incisions
- 2012
-
Ingår i: Langenbeck's archives of surgery (Print). - : Springer. - 1435-2443 .- 1435-2451. ; 397:8, s. 1201-1207
-
Forskningsöversikt (refereegranskat)abstract
- The most important wound complications are surgical site infection, wound dehiscence and incisional hernia. Experimental and clinical evidences support that the development of wound complications is closely related to the surgical technique at wound closure. The suture technique monitored through the suture length-to-wound length ratio is of major importance for the development of wound complications. The risk of wound dehiscence is low with a high ratio. The ratio must be higher than 4; otherwise, the risk of developing an incisional hernia is increased four times. With a ratio higher than 4, both the rate of wound infection and incisional hernia are significantly lower if closure is done with small stitches placed 5 to 8 mm from the wound edge than with larger stitches placed more than 10 mm from the wound edge. Midline incisions should be closed in one layer by a continuous suture technique. A monofilament suture material should be used and be tied with self-locking knots. Excessive tension should not be placed on the suture. Wounds must always be closed with a suture length-to-wound length ratio higher than 4. The only way to ascertain this is to measure, calculate and document the ratio at every wound closure. A high ratio should be accomplished with many small stitches placed 5 to 8 mm from the wound edge at very short intervals.
|
|
| 2. |
- Israelsson, Leif A., et al.
(författare)
-
Prevention of Incisional Hernias How to Close a Midline Incision
- 2013
-
Ingår i: Surgical Clinics of North America. - : Elsevier. - 0039-6109 .- 1558-3171. ; 93:5, s. 1027-
-
Tidskriftsartikel (refereegranskat)abstract
- The development of wound complications is closely related to the surgical technique at wound closure. The risk of the suture technique affecting the development of wound dehiscence and incisional hernia can be monitored through the suture length to wound length ratio. Mid line incisions should be closed in one layer by a continuous-suture technique using a monofilament suture material tied with self-locking knots. Excessive tension should not be placed on the suture. Closure must always be with a suture length to wound length ratio higher than 4.
|
|
| 3. |
- Millbourn, Daniel, 1970-
(författare)
-
Closure of midline abdominal incisions with small stitches : studies on wound complications and health economy
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background A midline incision inflicts minimal damage to muscles, nerves and blood supply. Postoperative complications cause patients suffering and costs for society. Midline incisions should be closed with a continuous single-layer technique and a suture length (SL) to wound length (WL) ratio over 4. It has been recommended to place stitches at least 10 mm from the wound edge. Recent studies, taking the SL to WL ratio into account, have shown that a stronger wound is produced with small stitches placed closer to the wound edge. Aims The aims were to study the rate of surgical site infection (SSI) and incisional hernia in relation to the use of small or large stitches; to study the effect of the SL to WL ratio and other risk factors for SSI and incisional hernia in relation to the size of stitches; and to study if the use of small stitches generates cost savings. Materials and methods In a non-randomised study, 1991 to 1993, the patients having their midline incisions closed with an SL to WL ratio over 4 were selected. The rate of SSI and incisional hernia was analysed in relation stitch length (SL/number of stitches). In a randomised trial, 2001 to 2006, patients were randomised to closure of midline incisions with small stitches, placed 5 to 8 mm from the wound edge, or large stitches placed at a distance of at least 10 mm. Patient and operative characteristics were recorded. The rate of SSI and incisional hernia was studied and risk factors were analysed. The proportion of patients subjected to an incisional hernia repair was identified. The mean cost for a hernia repair during 2010 was calculated. A cost analysis was performed. Results In the non-randomised study 368 patients were analysed. The lowest rate of SSI and incisional hernia was with a short stitch length. In the randomised trial, 356 patients were closed with small stitches and 381 with large. With small stitches SSI occurred in 17 of 326 patients (5.2%) and with large stitches in 35 of 343 (10.2%) (p=0.02). With small stitches incisional hernia was present in 14 of 250 patients (5.6%) and with large stitches in 49 of 272 (18.0%) (p<0.001). With small stitches, no risk factors could be identified. The rate of incisional hernia was lower with an SL to WL ratio over 4. A very high ratio did not affect the complication rates. With small stitches there was a cost for a longer suturing time, but a cost reduction of 1339 SEK was generated from the societal perspective for each closure compared with large stitches. Conclusions In midline abdominal incisions closed with a continuous single-layer technique the rate of SSI and incisional hernia is lower with small stitches than with large. The rate of incisional hernia is lower with an SL to WL ratio over 4 and increasing the ratio very much above 4 does not increase the rate of complications. With small stitches no risk factors for the development of SSI and incisional hernia can be identified and cost savings are generated. The previous recommendation to use large stitches should be changed to recommend small stitches.
|
|
| 4. |
|
|
| 5. |
- Millbourn, Daniel, et al.
(författare)
-
Effect of Stitch Length on Complications Reply
- 2010
-
Ingår i: Archives of surgery (Chicago. 1960). - : American Medical Association (AMA). - 0004-0010 .- 1538-3644. ; 145:6, s. 600-601
-
Tidskriftsartikel (refereegranskat)
|
|
| 6. |
- Millbourn, Daniel, et al.
(författare)
-
Effect of stitch length on wound complications after closure of midline incisions : a randomized controlled trial
- 2009
-
Ingår i: Archives of surgery (Chicago. 1960). - : American Medical Association. - 0004-0010 .- 1538-3644. ; 144:11, s. 1056-1059
-
Tidskriftsartikel (refereegranskat)abstract
- HYPOTHESIS: In midline incisions closed with a single-layer running suture, the rate of wound complications is lower when a suture length to wound length ratio of at least 4 is accomplished with a short stitch length rather than with a long one. DESIGN: Prospective randomized controlled trial. SETTING: Surgical department. PATIENTS: Patients operated on through a midline incision. INTERVENTION: Wound closure with a short stitch length (ie, placing stitches <10 mm from the wound edge) or a long stitch length. MAIN OUTCOME MEASURES: Wound dehiscence, surgical site infection, and incisional hernia. RESULTS: In all, 737 patients were randomized: 381 were allocated to a long stitch length and 356, to a short stitch length. Wound dehiscence occurred in 1 patient whose wound was closed with a long stitch length. Surgical site infection occurred in 35 of 343 patients (10.2%) in the long stitch group and in 17 of 326 (5.2%) in the short stitch group (P = .02). Incisional hernia was present in 49 of 272 patients (18.0%) in the long stitch group and in 14 of 250 (5.6%) in the short stitch group (P < .001). In multivariate analysis, a long stitch length was an independent risk factor for both surgical site infection and incisional hernia. CONCLUSION: In midline incisions closed with a running suture and having a suture length to wound length ratio of at least 4, current recommendations of placing stitches at least 10 mm from the wound edge should be changed to avoid patient suffering and costly wound complications.
|
|
| 7. |
- Millbourn, Daniel, et al.
(författare)
-
Effect of Stitch Length on Wound Complications Reply
- 2010
-
Ingår i: Archives of surgery (Chicago. 1960). - : American Medical Association (AMA). - 0004-0010 .- 1538-3644. ; 145:6, s. 599-600
-
Tidskriftsartikel (refereegranskat)
|
|
| 8. |
- Millbourn, Daniel, et al.
(författare)
-
Risk factors for wound complications in midline abdominal incisions related to the size of stitches
- 2011
-
Ingår i: Hernia. - : Springer Science and Business Media LLC. - 1265-4906 .- 1248-9204. ; 15:3, s. 261-266
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Midline abdominal incisions should be closed continuously with a suture length (SL) to wound length (WL) ratio above 4 using small stitches. The effect on the rate of wound complications of a very high ratio and other potential risk factors when closure is performed with small stitches is unknown. METHODS: Patients operated on through a midline incision were randomised to closure with small stitches, placed 5-8 mm from the wound edge and less than 5 mm apart, or with large stitches, placed more than 1 cm from the wound edge. Patient and operative variables were registered. Surgical site infection and incisional hernia were recorded. RESULTS: Three hundred and twenty-one patients were randomised to closure with small stitches and 370 with large stitches. Infection and herniation were less common with small stitches. With small stitches, no risk factors for infection or herniation were identified. With large stitches, wound contamination and the patient being diabetic were independent risk factors for infection, and long operation time and surgical site infection were risk factors for herniation. A very high SL to WL ratio did not affect the complication rates. CONCLUSIONS: In midline abdominal incisions closed with small stitches, no risk factors for surgical site infection or incisional hernia were identified. Increasing the ratio very much above 4 had no adverse effects on the rate of wound complications. The higher rates of infection and herniation with an SL to WL ratio over 5 and in overweight patients in previous reports were probably related to wounds being closed with large stitches.
|
|
| 9. |
- Millbourn, Daniel, et al.
(författare)
-
Wound complications and stitch length
- 2004
-
Ingår i: Hernia. - : Springer Science and Business Media LLC. - 1265-4906 .- 1248-9204. ; 8:1, s. 39-41
-
Tidskriftsartikel (refereegranskat)abstract
- The effect of suturing with a very short stitch on the development of wound complications in midline incisions was investigated. Three hundred sixty-eight patients were analysed. The suture length to wound length ratio and mean stitch length were calculated. Wound infection occurred in 4% (four of 103) of patients sutured with a mean stitch length of less than 4 cm, in 8% (nine of 117) with stitch length 4-4.9 cm, and in 16% (24 of 148) with a longer stitch ( P=0.004). At 12-month follow up, incisional hernia was present in 3% (two of 76) of patients sutured with a mean stitch length of less than 4 cm and in 12% (25 of 215) sutured with a longer stitch ( P=0.043). In midline incisions closed with a suture length to wound length ratio of at least 4, a short stitch is associated with a lower rate of both wound infection and incisional hernia.
|
|
