Overweight and healing of midline incisions: the importance of suture technique.

OBJECTIVE

To study the effect of body mass index on the healing of midline laparotomy wounds closed with a continuous technique.

DESIGN

Prospective clinical study.

SETTING

County hospital, Sweden.

SUBJECTS

1023 patients who underwent midline laparotomy between September 1991 and June 1993.

INTERVENTIONS

Body mass index was recorded and overweight was defined as an index above 25.

MAIN OUTCOME MEASURES

Postoperative wound infection, and incidence of incisional hernia at 12 months.

RESULTS

Overweight patients were sutured with a higher suture length:wound length ratio than others (p < 0.01). Wound infection developed postoperatively in 97 of 1023 patients (10%) and overweight, youth, wound contamination, and reoperation were independent risk factors. However, overweight was not associated with a higher rate of infection if the suture length:wound length ratio was 4.0-4.9. Incisional hernias developed in 118 of 808 patients (15%) and overweight, old age, wound infection, and suture length:wound length ratio less than 4 were independent risk factors. However, overweight was not associated with a higher hernia rate if the suture length:wound length ratio was 4.0-4.9.

CONCLUSION

Overweight is a risk factor for wound infection and incisional hernia after midline abdominal surgery but these effects may be eliminated if patients are sutured with a suture length to wound length ratio of 4.0-4.9.