Abdominal Incisions From Creation to Closure

Abstract

Many of the techniques involved in creating and closing a surgical incision are based on tradition. Over the last several decades, randomized studies have addressed some of the steps in this process. Animal data and human data often have conflicting results. Randomized trials in human subjects indicate: 1) The incision can be made with one, rather than two, scalpels. 2) There is no advantage to using a laser rather than a scalpel when creating the incision. 3) Subcutaneous Penrose drains carried through the incision increase the infection rate. Closed suction drains in the subcutaneous space are rarely indicated. 4) The surgeon does not need to close peritoneum. 5) Time can be saved by closing the fascia in a continuous rather than interrupted fashion without causing an increase in postoperative wound separation or hernia formation. 6) Closing Camper's fascia after a cesarean delivery reduces the incidence of wound separation. 7) The cosmetic appearance of an incision is not improved by closing skin in a subcuticular rather than interrupted fashion.

Peritoneal Adhesions: Etiology, Pathophysiology, and Clinical Significance

“…In infertility patients and those in whom preservation of childbearing potential is desirable, in order to minimize adnexal or peritubal adhesions, it is sometimes necessary to reapproximate the peritoneum with 3–0 or 4–0 nonreactive absorbable sutures without producing significant tension. The practice of omitting the closure of the peritoneum is well supported in the literature [18, 58, 59, 60, 61]. …”

Myths and Legends in Orthopaedic Practice: Are We All Guilty?

“…However, evidence suggests the practice of changing the blade is unnecessary [26,40,50,57,60,88,102,119]. Investigators cultured skin and deep dissection blades in orthopaedic surgeries and reported no correlations among contaminated skin blades, deep blades, and wound infections [40,102].…”

Healing comparison of porcine cutaneous incisions made with cold steel scalpel, standard electrosurgical blade, and a novel tissue dissector

“…Lasers, for example, are useful at cutting where coagulation is desired, but because of the collateral tissue damage, they are not recommended for primary skin incisions when cosmetic results are important [2,3]. Conventional electrosurgery has similar shortcomings and a number of studies have shown delayed wound healing attributable to thermal damage [4][5][6][7][8].…”