A controlled clinical trial of three methods of closure of laparotomy wounds.

A controlled clinical trial was conducted of three methods of closing elective paramedian laparotomy wounds--catgut layer suture alone, catgut layer suture with tension sutures and wire sutures alone. Three hundred and twenty-four patients were entered in the trial. The combined incidence of wound dehiscence and subsequent incisional herniation in patients who did not manifest overt dehiscence in the immediate postoperative period was significantly higher after catgut layer suture alone (14 per cent) than after catgut layer suture with tension stitches (4-8 per cent) or wire sutures alone (0-9 per cent). There seemed to be more wound sespis and sinus formation associated with catgut layer suture and tension sutures than with either of the other methods of closure. In 4 patients a wire suture had to be extracted, because of sinus formation in 2 and on account of pain in 2.