Requirement for an incision

• Allow access

• Can be extended if required

• Will be secure when closed

• Low complication rate

• Minimal pain

• Cosmetic appearance when healed

Wound closure

• Matter of personal preference influenced by experience

Midline abdominal incision

• Mass closure using 0 or 1 non-absorbable monofilament suture
• Take 1 cm bite placed 1 cm apart
• 'Jenkins Rule'  = Suture Length : Wound Length should be 4:1
• For safety avoid hand held needles
• No touch technique of the use of needles should be used
• Deep Tension Sutures – use controversial
• No extra security
• Painful and produce a cosmetically unacceptable scar

Other abdominal incisions

• Layered closure
• Closure of peritoneum not essential

Skin

• Fat stitch reduces dead space
• Adds no strength to wound repair
• No evidence that it reduces risk of wound infection
• Avoid silk sutures as increase risk of stitch abscesses
• No evidence that subcuticular sutures increase infection rate
• If you are worried about wound infection consider leaving the skin wound open

Removal of sutures

• Sutures should be removed:
  • Head and face at 5 days
  • Upper limb at 7 days
  • Abdomen and lower limb at 10 days

Bibliography

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