Tragedies of the abdominal incision

Abstract

Under tragedies of the abdominal incision are included disruption of the abdominal wound with protrusion of viscera, deaths due to infections of the abdominal incision, incisional infection and postoperative hernias. At the Joseph Price Hospital we use through-and-through sutures of silkworm gut; the only buried sutures we ever use are silk sutures in incisional ventral and umbilical hernias where there has been wide separation of tissues and occasionally in a very stout woman with abnormally thick abdominal walls. In fifty-six years' experience Dr. Joseph Price and I have had no case of disruption of the abdominal wound nor any death from an infected abdominal incision. The through-and-through suture is void of causing any molecular death in the incisional surface and is a drainage suture. It is preeminently void of all unnecessary trauma. During the last fifteen years at this hospital there has been no closure of an undrained incisional hernia; possibly some unknown hernias exist. The technique depends upon proper insertion of the through-and-through suture. We use the long straight abdominal needle. The correct method is illustrated.