Small tissue bites and wound strength - An experimental study

Hypothesis: Placing stitches close to the cut wound edge does not produce l ow wound bursting strength in midline laparotomy incisions closed with a su ture length: wound length ratio of 4. Design: Experimental study in rats. Methods: Midline incisions were closed with a running suture in 51 Sprague- Dawley rats. A suture length: wound length ratio of 4 was used and stitches were placed at a distance of 3, 6, or 10 mm from the wound edge. Wound bur s ting strength was studied immediately after and 4 days after wound closur e. Results: Immediately after wound closure, bursting pressure was higher viit h stitches placed 10 mm from the wound edge than those at a distance of 3 m m. After 4 days, bursting pressure and bursting volume were lower with stit ches placed 10 mm from the wound edge than those at a distance of 3 or 6 mm . The abdominal wall ruptured outside the suture line in 14 of 17 wounds cl osed with 21 stitches, in 11 of 17 wounds closed with 16 stitches, and in 6 of 17 wounds closed with 11 stitches (P=.02). Conclusions: Four days after closure of midline laparotomy incisions using a suture length-wound length ratio of 4, wound bursting strength is higher with stitches placed 3 to 6,mm from the wound edge than those at a distance of 10 mm. Wound bursting strength increases with the number of stitches us ed.