Intestinal suturing. Review of the experimental foundations for traditional doctrines.

The doctrines of intestinal suturing have been handed down from the 19th century. It has been widely accepted that intestinal wounds heal most reliably when an inverting suture line is constructed. The serosal surfaces of the bowel should be apposed by sutures, anchored in the submucosa, forming an inverting suture line. The wound should be kept free of hematoma, necrotic tissue, or infection. Intestinal wounds heal with a pattern similar to that of wounds in other tissues. During the lag period of repair, the wound is cleansed of debris. Excessive tissue injury, foreign body, or infection incite inflammation, prolonging this period of wound healing. Cellular elements proliferate during the phase of fibroplasia. Collagen within the wound assumes its mature form only during the prolonged phase of maturation. The return of wound integrity can be quantified by measuring its tensile strength, bursting strength, or collagen content. Such measurements have shown that, during the lag period, sutures provide almost the entire strength of the wound. During the phase of fibroplasia, new collagen adds to the suture line integrity. The contribution of new collagen to wound strength soon overtakes that of sutures. It is only during the first week of wound healing, the lag period, that surgical technique plays a significant role in ensuring intestinal wound integrity. Surgical techniques developed during the 19th century provide secure closure of intestinal wounds during the lag period of wound healing. After the onset of the period of fibroplasia, newly formed collagen replaces sutures in ensuring wound integrity.