A Randomized Prospective Study of 571 Patients Comparing Continuous vs. Interrupted Suture Techniques

Abstract

A randomized, prospective study was designed to compare a continuous with an interrupted technique for closing an abdominal incision. Five hundred seventy-one patients were randomized between the closure methods and stratified as to type of wound: clean, clean-contaminated, or contaminated. In mid-line incisions, the dehiscence rate was 2.0% (5/244) for the continuous group versus 0.9% (2/229) for the interrupted group. The difference was not statistically significant. Ventral hernias formed in 2.0% (4/201) of the continuous group vs. 0.5% (1/184) of the interrupted group. The type of wound had no influence on the results. In oblique incisions, 0% (0/39) of wounds closed continuously dehised while 2% (1/50) of incisions closed interruptedly dehised. No ventral hernias formed. Further analysis of the data indicated that dehiscence was more likely related to improper surgical technique than to the method of closure. An abdominal incision could be closed with a continuous suture in approximately half the time required for placing interrupted sutures (20 vs. 40 minutes). A continuous closure is preferred because it is more expedient and because it has the same incidence of wound disruption compared with an interrupted closure.

Closure of the rectus sheath with a continuous looped suture and the skin with staples in dogs: Speed, safety, and costs compared to closure of the rectus sheath with interrupted sutures and the skin with a continuous subdermal suture

“…The 17% reduction in abdominal closure time in our study achieved by closing the rectus sheath with a continuous suture is similar to the 18% found by Sahlin et al (30), but less than the 50 to 60% reported by others (18,20,25). These greater reductions in closure time may have been due to the larger incisions in some studies (18,20).…”

“…The rate of abdominal wound dehiscence has been reported to range from 0 to 3.1% (8,15,22,25,30,31,39). Continuous closure is at least as safe as interrupted closure if correctly performed (1, 5,17,18,20,22,25,27,30,33).…”

“…Continuous closure is at least as safe as interrupted closure if correctly performed (1, 5,17,18,20,22,25,27,30,33). This implies that an adequate portion of rectus sheath is included in each suture bite, that the sutures are not tied too tightly, and that the suture material is not grasped by instruments that may damage it (6,22,32).…”

“…The costs per dog in group 1 were nearly two times as high as in group 2 ( (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) were used. The unused staples were discarded.…”

“…A series of interrupted sutures has been the standard procedure for ventral midline closure in this clinic, but more recently many veterinary surgeons have used a continuous suture of polydioxanone for closure of the linea alba (2). The advantages of a continuous suture are speed, an equal distribution of tension, less foreign material in the wound, and less wound trauma (5,17,25,27,33). The safety of continuous sutures has been shown to be equal to that of interrupted closure (5,18,20,27,30).…”