Dodson M K, Magann E F, Sullivan D L, Meeks G R
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson.
Obstet Gynecol. 1994 Jan;83(1):142-5.
To determine closure time, pain experienced during closure, and healing time in patients undergoing deep en bloc closure or superficial skin closure of extrafascial would dehiscence.
Patients with extrafascial wound dehiscence on the obstetrics and gynecology service of the University of Mississippi Medical Center were randomized to deep en bloc closure or superficial skin closure. A 1:2 ratio was used to evaluate superficial skin closure, as deep en bloc closure is known to be effective. The wounds of patients in the deep en block group were closed with no. 1 polypropylene placed through the entire wound thickness as simple interrupted sutures. The wounds of patients in the superficial closure group were closed with 2-0 polypropylene placed through the skin as vertical mattress sutures. The wounds were closed on the patient care unit under local anesthesia. Closure was timed in minutes from initiation of local anesthesia to cutting of the last suture. Patients assessed pain by placing a mark on a 100-mm line (0 = none; 100 = maximum). Time for complete healing was measured from wound disruption to skin reepithelialization.
During an 8-month period, seven patients were randomized to deep en bloc closure and 16 to superficial skin closure. The en bloc group required 27.1 +/- 5.5 minutes (mean +/- standard deviation) for closure, compared with 18.9 +/- 3.4 minutes in the superficial group (P < .001). The mean pain score in the en bloc group was 43.4 +/- 23.2 mm, compared with 16.6 +/- 11.4 mm in the superficial group (P < .001). The en bloc group required 22.7 +/- 7.7 days for complete healing, compared with 19.8 +/- 5.3 days in the superficial group, a nonsignificant difference.
Superficial skin closure of extrafascial wound dehiscence appears to be superior to deep en bloc closure in terms of closure time and pain experienced during the procedure. These benefits are achieved with minimal risk while allowing timely wound healing.
确定筋膜外伤口裂开患者进行深部整块缝合或浅部皮肤缝合时的闭合时间、闭合过程中经历的疼痛以及愈合时间。
密西西比大学医学中心妇产科服务部患有筋膜外伤口裂开的患者被随机分为深部整块缝合组或浅部皮肤缝合组。由于已知深部整块缝合有效，因此采用1:2的比例来评估浅部皮肤缝合。深部整块缝合组患者的伤口用1号聚丙烯缝线以单纯间断缝合的方式穿过整个伤口厚度进行闭合。浅部缝合组患者的伤口用2-0聚丙烯缝线以垂直褥式缝合的方式穿过皮肤进行闭合。伤口在局部麻醉下于患者护理单元进行闭合。从开始局部麻醉到剪断最后一根缝线的时间以分钟为单位记录闭合时间。患者通过在100毫米的线上做标记来评估疼痛程度（0表示无疼痛；100表示最剧烈疼痛）。从伤口裂开至皮肤重新上皮化测量完全愈合的时间。
在8个月的时间里，7例患者被随机分配至深部整块缝合组，16例被分配至浅部皮肤缝合组。整块缝合组闭合伤口需要27.1±5.5分钟（平均值±标准差），而浅部缝合组为18.9±3.4分钟（P<.001）。整块缝合组的平均疼痛评分为43.4±23.2毫米，浅部缝合组为16.6±11.4毫米（P<.001）。整块缝合组完全愈合需要22.7±7.7天，浅部缝合组为19.8±5.3天，差异无统计学意义。
在闭合时间和手术过程中经历的疼痛方面，筋膜外伤口裂开的浅部皮肤缝合似乎优于深部整块缝合。在风险最小的情况下实现了这些益处，同时允许伤口及时愈合。
