Wound strength in abdominal incisions: a comparison of two continuous mass closure techniques in rats

Biplanar Lipoabdominoplasty: Introducing the Subscarpal Lipo Aponeurotic System

Preservation of Scarpa’s fascia in abdominoplasty has been previously presented. Herein we introduce the subscarpal lipo aponeurotic system (SLAS) and the technique of preserving the SLAS and its tightening in lipoabdominoplasty.

Simple continuous suture versus continuous horizontal mattress suture for plication of abdominal fascia: which is better?

BACKGROUND

Abdominal fascia plication using a simple continuous suture can sometimes cause tears in the fascia. This problem can be circumvented when the continuous horizontal mattress suture is used. No data exist from comparing the two suturing techniques. The aim of this study was to examine which technique can potentially cause greater tissue damage. The time required to perform each type of suture was also recorded.

METHODS

Wound closure pads were plicated using the simple continuous and continuous horizontal mattress techniques performed by a single operator using Ethilon 2-0 nylon sutures. To verify their resilience, plastic bags were inflated beneath the pads to 30, 60, and 120 mmHg and tears were recorded. The time needed to perform the procedures was recorded using a stopwatch.

RESULTS

Mean time for the continuous vertical mattress suture was 87 s and for the simple continuous suture 116 s. Tears in the pad that was plicated with the simple continuous pattern were significantly longer than those in the pad plicated with the continuous horizontal mattress pattern (fissure mean length ± SD = 3.958 ± 0.157 vs. 2.736 ± 0.157, respectively, p < 0.001). This finding was true for each of the three measured pressures (fissure mean length for 30 mmHg was 3.40 ± 1.807 vs. 2.12 ± 1.709 cm; for 60 mmHg, 3.94 ± 2.90 vs. 2.90 ± 1.893 cm; and for 120 mmHg, 4.54 ± 1.924 vs. 3.19 ± 2.110 cm; p < 0.001).

CONCLUSIONS

Continuous horizontal mattress pattern sutures were found to be superior to simple continuous pattern sutures in the suggested model, in terms of suturing time and damage to the pad. Further research in human subjects is still required.

LEVEL OF EVIDENCE II

This journal requires that authors assign a level of evidence to each article.

Comparative study of the healing process of the aponeurosis of the anterior abdominal wall of rats after wound closure using 3-0 nylon suture and N-butil-2-cyanoacrylate tissue adhesive

PURPOSE: To investigate the healing process of the aponeurosis of the anterior abdominal wall of rats, comparing two different materials for wound closure: 3-0 nylon suture and tissue adhesive N-butyl-2-cyanoacrylate. METHODS: Forty-four Wistar rats were randomly divided into four groups according to the type of material used (suture or adhesive) and the number of days until reoperation (seven or 14 days). After a 4 cm incision in the aponeurosis, 22 rats underwent wound closure using 3-0 nylon suture and the other 22, the tissue adhesive. After seven days, 11 rats from each group were weighed again, submitted to reoperation and then euthanized. The same procedure was carried out after 14 days with the remaining rats. The surgical wound was macroscopically examined, the tensile strength was measured and the tissue edges were histologically examined. The statistical analysis was performed using analysis of variance and Cox's proportional hazards model. Significance level was set at p < 0.05. RESULTS: The animals lost on average 20 g over the period between the two operations. Wound closure was faster using the tissue adhesive. Only one animal, from the tissue adhesive group, had a small abscess with wound dehiscence. With regard to tensile strength, the best results were obtained with the tissue adhesive 14 days after the first surgery. The results of the histological examination showed no significant difference between groups. CONCLUSIONS: Upon morphological evaluation, the two types of material analyzed in this study (3-0 nylon suture and N-butyl-2-cyanoacrylate, a tissue adhesive) were not significantly different with regard to the healing process of the aponeurosis of the anterior abdominal wall of rats. Wound closure using the tissue adhesive was faster. Higher tensile strength was observed in the tissue adhesive group 14 days after the first surgery.

Síntese da parede abdominal: avaliação de dois tipos de sutura contínua em ratos

OBJETIVO: Comparar a sutura simples contínua e a sutura contínua em oito vertical no fechamento da parede abdominal de ratos. MÉTODOS: Quarenta e oito ratos machos Wistar, foram submetidos a laparotomia padronizada e fechamento da parede abdominal com sutura simples contínua (n=24) e sutura contínua em oito-vertical (n=24), com fio de polipropileno. No 7° e 14° pós-operatório foram submetidos a eutanásia 12 animais de cada grupo e deles retirados a camada músculo-aponevrótica da parede abdominal envolvendo a cicatriz operatória e preparados para exames histológico e imunohistoquímico. Os segmentos levados ao exame histológico foram corados por Hematoxilina-eosina sendo feita observação qualitativa do processo cicatricial e Picrosirius red F3BA, para avaliação quantitativa do colágeno. Também foram estudadas as porcentagens de macrófagos na linha de sutura por imunohistoquímica. Para a quantificação de macrófagos e fibras colágenas foi utilizado avaliação histológica por digitalização de imagem, baseados nos princípios de espectrofotometria. Os dados encontrados foram analisados estatisticamente pelos testes qui-quadrado, exato de Fisher e Mann-Whitney (p< 0,05). RESULTADOS: A análise qualitativa, nos parâmetros necrose, fibrose, neovascularização, presença de abscesso, reação de corpo estranho e coaptação das bordas de sutura, não mostrou dados significantes nos dois grupos aos 7 ou 14 dias. A porcentagem de fibras colágenas foi significantemente maior, apenas no 7° dia, na sutura contínua em oito-vertical. A porcentagem de macrófagos mostrou-se significantemente maior na sutura simples contínua no 7º. dia. CONCLUSÃO : No 7° dia de pós-operatório a parede abdominal suturada em oito vertical apresenta significantemente, maior quantidade de fibras colágenas e menor quantidade de macrófagos do que a suturada por técnica contínua. Aos 14 dias de observação as suturas mostraram-se morfologicamente semelhantes.

Comparison of PTFE, pericardium bovine and fascia lata for repair of incisional hernia in rat model, experimental study

Incisional hernia is a frequent complication of abdominal surgery developing in 11-20 % of patients undergoing an abdominal operation. Regarding morbidity and loss of manpower, incisional hernias continue to be a fundamental problem for surgeons. In this experimental study, three commonly used mesh materials (Goretex PTFE; Tutoplast Fascia lata; Tutopatch Pericardium bovine) were compared according to effectiveness, strength, adhesion formation, histological changes, and early complications. Three groups, each consisting of 14 rats, have been formed as group A: polytetrafluoroethylene (PTFE), group B: pericardium bovine and group C: fascia lata. Evaluations were achieved at the end of the first and second postoperative week, respectively. Adhesion formation, wound maturation, bursting pressure, and tensile strength were evaluated. No statistically significant difference regarding adhesion formation was observed between groups although adhesion formation was less significant in PTFE and pericardium bovine groups than in the fascia lata group. Bursting pressure and tensile strength values were significantly higher in PTFE group than in the fascia lata group ( P<0.05). No statistically significant difference was observed between groups regarding wound maturation. In this experimental model, PTFE and pericardium bovine were found to be superior to fascia lata in abdominal wall repair.

Síntese da parede abdominal: sutura contínua ou com pontos separados? Revisão da literatura

Uma revisão da literatura foi realizada para atualização sobre o fechamento da parede abdominal. São relatados historicamente as controvérsias inerentes ao tema. Atualmente considera-se que o fechamento em massa do plano peritônio-músculo-aponeurótico é o mais adequado, com menor risco de complicações do que o fechamento por planos anatômicos. O tipo de fio utilizado, apesar de existirem várias opções, também está estabelecido, sendo melhor empregado os fios inabsorvíveis, ou os absorvíveis de longa duração, preferencialmente monofilamentares. Quanto fechar as laparotomias com sutura contína ou sutura com pontos separados, permanecem divergências, sendo que várias publicações, com diferentes amostras e meios de avaliação, referem vantagens para uma ou outra técnica, ou concluem pela similaridade de resultados entre elas. Sobre essas divergências, os autores discutem a sutura contínua e a sutura com pontos separados no fechamento da parede abdominal, abordando os aspectos técnicos de ambas.

Estudo comparativo entre a sutura contínua e a com pontos separados na parede abdominal de ratos

O objetivo deste experimento foi comparar a sutura contínua e a sutura com pontos separados no fechamento da parede abdominal. Foram utilizados 48 ratos machos Wistar, submetidos a laparotomia com técnica de diérese padronizada, 24 submetidos a sutura da parede abdominal por técnica contínua e 24 com pontos separados, com fio polidioxanona. No 7º e 14º dia de pós-operatório foram submetidos a eutanásia 12 animais de cada grupo e deles retirados a camada músculo-fascial abdominal envolvendo a cicatriz operatória e dividida aleatoriamente em dois segmentos (cranial e caudal), um para ser submetido a avaliação da força de rotura mediante o uso de tensiômetro e outro para exame histológico, onde foi realizada a avaliação quantitativa de colágeno na linha de sutura. Os resultados encontrados foram analisados estatisticamente. Concluiu-se que no 7º dia de pós-operatório a parede abdominal suturada com pontos separados é mais resistente, porém sem diferenças significantes na quantidade de colágeno, do que a suturada por técnica contínua, e no 14º dia, ambas se equivalem nos dois parâmetros estudados, em ratos.