Trinity Centre for Bioengineering, Department of Mechanical and Manufacturing Engineering, Trinity College, Dublin, Ireland.
School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
Br J Surg. 2018 Mar;105(4):395-400. doi: 10.1002/bjs.10753.
Suturing techniques for midline abdominal wall incisions vary between surgeons. This study uses a biomechanical abdominal model to assess tissue stretch using different suturing techniques for midline laparotomy closure.
Deformation tests were performed on the linea alba of 48 porcine abdominal walls. Each pattern was tested three times at pressures ranging from 0 to 20 kPa using different continuous suturing techniques and a control.
There was a sevenfold improvement when the best performing bite separation and bite width ([5, 16] mm) was compared with the most poorly performing combination ([15, 4] mm). The traditional bite and width separation ([10, 10] mm) and the recently proposed combination ([5, 5] mm) may not be optimal, and substantial improvements in surgical outcome may be achieved by changing to a [5,16]-mm combination.
These findings suggest using a small bite separation (5 mm) and large bite width (16 mm) during abdominal wound closure may be optimal. Surgical relevance Suturing techniques for midline abdominal wall incisions vary between surgeons. This experimental study suggests substantial potential for improved tissue apposition by changing the suturing approach from the traditional clinical recommendation of 10 mm for both bite separation and bite width to a bite separation of 5 mm and a bite width of 16 mm. These findings support recent European Hernia Society guidelines and the recent randomized STITCH (Suture Techniques to Reduce the Incidence of The inCisional Hernia) trial, which found that small separations are more effective than large separations, but suggest that they should be combined with large bite depths.
不同外科医生的中线腹壁切口缝合技术存在差异。本研究使用生物力学腹部模型，评估不同中线剖腹术关闭缝合技术下组织拉伸情况。
对 48 个猪的腹部白线进行变形测试。每种模式在 0 至 20kPa 的压力下，使用不同的连续缝合技术和对照组进行三次测试。
与表现最差的组合（[15,4]mm）相比，表现最佳的咬合分离和咬合宽度（[5,16]mm）的分离提高了七倍。传统的咬合和宽度分离（[10,10]mm）和最近提出的组合（[5,5]mm）可能不是最佳的，通过改变为[5,16]-mm 组合，手术结果可能会有很大的改善。
这些发现表明，在腹部伤口关闭时使用小的咬合分离（5mm）和大的咬合宽度（16mm）可能是最佳的。手术相关性不同外科医生的中线腹壁切口缝合技术存在差异。这项实验研究表明，通过将缝合方法从传统的临床建议（咬合分离和宽度均为 10mm）改为 5mm 的咬合分离和 16mm 的咬合宽度，组织贴合的效果可能会有显著提高。这些发现支持最近的欧洲疝学会指南和最近的随机 STITCH（缝合技术减少切口疝的发生）试验，该试验发现小的分离比大的分离更有效，但表明它们应该与大的咬合深度结合使用。
