title: Primary mass closure of midline incisions with a continuous polyglyconate monofilament absorbable suture.
abstract: Mass closure of midline incisions with a running large-bore permanent monofilament polypropylene suture has been used in general surgery and gynecology patients with a reported small incidence of fascial dehiscence. Late-occurring wound sinus formation is one problem reported with the use of this permanent suture material. Over a 22-month period, 285 patients had midline incisions closed with a continuous, running no. 1 polyglyconate monofilament delayed absorbable suture. Closely spaced bites (about 1.5 cm apart) were taken and placed 2 cm lateral to the fascial edge. Over 60% of the patients had surgery because of gynecologic cancer. Other high-risk factors included obesity in 62%, diabetes in 19%, and previous irradiation or chemotherapy in 22%. An ovarian cancer staging procedure was done in 16% of the patients. Of the remaining patients, almost half had extensive operative procedures that ranged from exenterations to hysterectomies with lymph node dissection. Wound complications were noted in nine patients (3.2%). Seven had superficial infections, one had an evisceration, and one developed a ventral hernia. Wound sinuses did not occur. The closure technique is safe and expedient and distributes tension equally over a continuous line. It has the additional advantage of eventual absorption of the suture material, thereby avoiding the wound sinus problems occasionally reported with large-bore permanent sutures.
authors.affiliation: Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta.
authors.forename: D G
authors.initials: DG
authors.lastname: Gallup
authors.forename: T E
authors.initials: TE
authors.lastname: Nolan
authors.forename: R P
authors.initials: RP
authors.lastname: Smith
mesh_terms: D000328:Adult; D005187:Fallopian Tubes / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D010052:Ovariectomy; D011108:Polymers; D013529:Surgical Wound Dehiscence / Q000517:prevention & control*; D013536:Suture Techniques; D013537:Sutures
chemical_list: D011108:Polymers; C046409:polyglyconate