Examination of abdominal wall perfusion using varying suture techniques for midline abdominal laparotomy closure
- 27.08.2021
Erschienen in:
- Verfasst von
- Bradley S. Kushner
- Saeed Arefanian
- Jared McAllister
- Wen Hui Tan
- Matthew Grant
- Robert MacGregor
- Arnab Majumder
- Jeffrey A. Blatnik
- Erschienen in
- Surgical Endoscopy | Ausgabe 6/2022
Abstract
Background
With a growing interest in the primary prevention of incisional hernias, it has been hypothesized that different suturing techniques may cause various levels of tissue ischemia. Using ICG laser-induced fluorescence angiography (ICG-FA), we studied the effect of different suture materials and closure techniques on abdominal wall perfusion.
Methods
Fifteen porcine subjects underwent midline laparotomy, bilateral skin flap creation, and three separate 7 cm midline fascial incisions. Animals underwent fascial closure with 5 different techniques: (1) Running 0-PDS® II (polydioxanone) Suture with large bites; (2) Running 0-PDS II Suture with small bites; (3) Interrupted figure-of-eight (8) PDS II Suture, (4) Running 0-barbed STRATAFIX™ Symmetric PDS™ Plus Knotless Tissue Control Device large bite; (5) Running 0-STRATAFIX Symmetric PDS Plus Device small bites. ICG-FA signal intensity was recorded prior to fascial incision (baseline), immediately following fascial closure (closure), and at one-week (1-week.). Post-mortem, the abdominal walls were analyzed for inflammation, neovascularity, and necrosis.
Results
PDS II Suture with small bites, fascial closure at the caudal 1/3 of the abdominal wall, and the 1-week time period were all independently associated with increased tissue perfusion. There was also a significant increase in tissue perfusion from closure to 1-week when using small bites PDS II Suture compared to PDS II Suture figure-of-8 (p < 0.001) and a trend towards significance when compared with large bites PDS II Suture (p = 0.056). Additionally, the change in perfusion from baseline to 1 week with small bites was higher than with figure of 8 (p = 0.002). Across all locations, small bite PDS II Suture has greater total inflammation than figure of 8 (p < 0.001).
Conclusions
The results suggest that the small bite technique increases abdominal wall perfusion and ICG-FA technology can reliably map abdominal wall perfusion. This finding may help explain the reduced incisional hernia rates seen in clinical studies with the small bite closure technique.
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- Titel
- Examination of abdominal wall perfusion using varying suture techniques for midline abdominal laparotomy closure
- Verfasst von
-
Bradley S. Kushner
Saeed Arefanian
Jared McAllister
Wen Hui Tan
Matthew Grant
Robert MacGregor
Arnab Majumder
Jeffrey A. Blatnik
- Publikationsdatum
- 27.08.2021
- Verlag
- Springer US
- Erschienen in
-
Surgical Endoscopy / Ausgabe 6/2022
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218 - DOI
- https://doi.org/10.1007/s00464-021-08701-w
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