Abstract
ObjectiveThis study aimed to investigate the suture length to wound length ratio (SL:WL) in an in vitro model of abdominal wall closure. Effects of the surgeon’s experience level on the SL:WL ratio were evaluated, hypothesizing that small animal surgeons do not spontaneously apply SL:WL ratios equal to or larger than 4:1.ProceduresThree groups of surgeons with varying levels of experience performed 4 simple continuous sutures before (3 sutures) and after (1 suture) being educated on principles of the SL:WL ratio. All sutures were evaluated for their gaping, number of stitches, stitch intervals, tissue bite size and suture length.ResultsNo significant differences in suture parameters or SL:WL ratios were found among the 3 groups, and 60.5% of control sutures and 77.0% of test sutures had SL:WL ratios above 4:1. There was a significant improvement in the mean ratio after the information was provided (p = 0.003). Overall, the SL:WL ratios ranged from 1.54:1 to 6.81:1, with 36.3% falling between 4:1 and 5:1 (5.17 mm mean stitch interval, 5.52 mm mean tissue bite size). A significant negative correlation was observed between the SL:WL ratio and the stitch interval to tissue bite ratio (r = -0.886). Forty-nine of 120 sutures fulfilled the current recommendations for abdominal wall closure with a mean SL:WL ratio of 4.1:1.ConclusionA SL:WL ratio larger than 4:1 was achieved in 60% of the control sutures and in 77% of test sutures. Additional animal studies are necessary to evaluate the SL/WL ratio in small animal surgery.
Highlights
Incisional hernias are a frequent and unpredictable complication after midline laparotomy surgeries on humans; depending on the definition, their incidence rate in humans ranges from 4–23%.[1]
Forty-nine of 120 sutures fulfilled the current recommendations for abdominal wall closure with a mean SL:WL ratio of 4.1:1
Because incisional hernias are a frequent complication after midline surgical laparotomies in humans, many studies have focused on minimizing their risk of occurrence.[1]
Summary
Incisional hernias are a frequent and unpredictable complication after midline laparotomy surgeries on humans; depending on the definition, their incidence rate in humans ranges from 4–23%.[1]. The ratio of suture used to the coeliotomy wound length is related to the incidence of incisional hernias.[7] Jenkins stated that deep wound disruption is associated with SL:WL ratios of 2:1 or lower and that wound disruption can be prevented by applying a SL:WL ratio of 4:1 or higher, as a higher ratio indicates that the tension increases to a lesser extent as the wound stretches Jenkins supported this theory in both clinical trials and a mathematical approach.[7] Since Jenkin’s first approach, the SL:WL ratio has been the subject of many studies, and the risk of incisional hernia was shown to be more than three times higher when the abdomen is closed with an SL:WL ratio below 4:1.[8,9,10]
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