Effect of Tension Suture on Healing Quality of Incision after Abdominal Surgery: A Meta-Analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LILi-fa ^1,2 ,  ZHOUTong ^1,2 , XIAOYun-feng ³ , ZHANGJin-xiao ² , ZHANGGuang-jun ¹ , ZHOUHe ² , LIYu ¹

1. Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China;
2. Institute of Hepato-Biliary-Pancreas and Intestinal Disease, North Sichuan Medical College, Nanchong 637000, Sichuan Province, China;
3. Department of Clinical Medicine, North Sichuan Medical College, Nanchong 637000, Sichuan Province, China;

Corresponding author：

ZHOUTong, Email: zhoutong0088@163.com

Keywords：

Tension suture; Conventional suture; Abdominal surgery; Healing quality of abdominal incision; Meta-analysis

DOI：

10.7507/1007-9424.20160081

Video：

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Objective To investigate the effect of tension suture on healing quality of incision after abdominal surgery, and to provide a theoretical basis for reducing post-operative wound complications. Method Literatures on the tension suture in the application of abdominal incision were searched from January 2005 to January 2015, and then a Meta-analysis was carried out based on the data obtained from CBM, CNKI, and WanFang database. Results Eight articles involving 2 001 patients with abdominal surgery, including 1 044 cases in tension suture group, and 957 cases in the conventional suture group, were incorporated. The Meta analysis results showed that, the technique of tension suture could reduce the incidence of post-operative wound infection (OR=0.40, 95% CI: 0.28-0.57, P<0.05), fat liquefaction (OR=0.51, 95% CI: 0.37-0.69, P<0.05), incisional hernia (OR=0.11, 95% CI: 0.04-0.34, P<0.05), wound dehiscence (OR=0.13, 95% CI: 0.07-0.25, P<0.05), and second stage surgery (OR=0.16, 95% CI: 0.09-0.30, P<0.05). But, it would also augment the risk of post-operative skin incision necrosis (OR=15.14, 95% CI: 2.79-82.08, P<0.05). On the other hand, the method of tension suture had no effect on the subcutaneous hemorrhage in the incision area (OR=0.58, 95% CI: 0.30-1.13, P>0.05). Conclusions Compared with conventional suture, tension suture can reduce the hazard of wound infection, fat liquefaction, incisional hernia, wound dehiscence, and reoperation after abdominal surgery. In contrast, it can also increase the risk of post-operative skin incision necrosis.

Citation： LILi-fa, ZHOUTong, XIAOYun-feng, ZHANGJin-xiao, ZHANGGuang-jun, ZHOUHe, LIYu. Effect of Tension Suture on Healing Quality of Incision after Abdominal Surgery: A Meta-Analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(3): 297-303. doi: 10.7507/1007-9424.20160081 Copy

1.	吴华平, 张永川, 汪飚, 等. 急诊腹部手术切口缝合方式对切口愈合的影响. 中国普外基础与临床杂志, 2014, 21(12): 1555-1557.
2.	Poole GV Jr. Mechanical factors in abdominal wound closure-the prevention of fascial dehiscence. Surgery, 1985, 97(6): 631-640.
3.	Van, t Riet M, Steyerberg EW, Nellensteyn J, et al. Meta-analysis of techniques for closure of midline abdominal incisions. Br J Surg, 2002, 89(11): 1350-1356.
4.	Liu LH, 魏全珍, Zhang HZ, 等. 腹部手术切口感染的调查与对策. 中华医院感染学杂志, 2008, 18(8): 1091-1092.
5.	范文, 黄娥, 段六生. 腹部手术切口感染病原菌分布与耐药性调查. 中华医院感染学杂志, 2008, 18(11): 1562-1563.
6.	闫立昆, 王小强, 龙延滨, 等. 应用预防性减张缝合对腹部切口愈合质量的影响观察. 外科理论与实践, 2005, 10(2): 172-174.
7.	揭志刚, 谢小平, 武彪, 等. 减张缝合预防高龄病人切口裂开的体会. 外科理论与实践, 2005, 10(1): 94-95.
8.	王春泉, 高勇, 袁玉华, 等. 腹膜外全层水平褥式减张缝合预防老年人腹部切口裂开的体会. 云南医药, 2006, 27(2): 138-139.
9.	高峰, 彭健, 刘海龙. 预防性减张缝合对影响高龄患者腹部切口愈合质量的临床研究. 中国医药指南, 2009, 7(14): 11-13.
10.	朱笑寒, 桂世涛, 王亮. 全层连续加减张缝合预防高龄患者腹部切口裂开. 中国医学创新, 2009, 6(32): 35-37.
11.	曲义坤, 杨婷, 徐剑, 等. 预防性减张缝合对老年结直肠癌患者腹部切口愈合质量的影响. 中国老年学杂志, 2010, 30(10): 1423-1424.
12.	李群, 李斌, 于安星. 预防性内减张缝合在腹部外科手术中的应用. 中华疝和腹壁外科杂志: 电子版, 2012, 6(3): 850-852.
13.	周龙根. 皮下内减张缝合法在防治腹部手术切口裂开的应用研究. 医学信息, 2013, 26(22): 272-273.
14.	Singer AJ, Thode HC Jr, Chale S, et al. Primary closure of cutaneous abscesses: a systematic review. Am J Emerg Med, 2011, 29(4): 361-366.
15.	陈欢, 王葳, 陈婉珺, 等. 剖宫产术后手术部位感染监测及干预研究. 川北医学院学报, 2015, 30(2): 202-205.
16.	Bickenbach KA, Karanicolas PJ, Ammori JB, et al. Up and down or side to side? A systematic review and meta-analysis examining the impact of incision on outcomes after abdominal surgery. Am J Surg, 2013, 206(3): 400-409.
17.	尹集东. 术前一次性和术后多次使用抗生素预防切口感染的疗效观察. 川北医学院学报, 2005, 20(2): 204-205.
18.	Hodgson NC, Malthaner RA, Ostbye T. The search for an ideal method of abdominal fascial closure: a meta-analysis. Ann Surg, 2000, 231(3): 436-442.
19.	Baracs J, Huszár O, Sajjadi SG, et al. Surgical site infections after abdominal closure in colorectal surgery using triclosan-coated absor-bable suture (PDS Plus) vs. uncoated sutures (PDS Ⅱ): a randomized multicenter study. Surg Infect (Larchmt), 2011, 12(6): 483-489.
20.	左永祥. 一种腹壁切口减张缝合术式介绍. 腹部外科, 2005, 18(1): 64.
21.	Mäkelä JT, Kiviniemi H, Juvonen T, et al. Factors influencing wound dehiscence after midline laparotomy. Am J Surg, 1995, 170(4): 387-390.
22.	Van, t RM, De Vos Van Steenwijk PJ, Bonjer HJ, et al. Incisional hernia after repair of wound dehiscence: incidence and risk factors. Am Surg, 2004, 70(4): 281-286.
23.	Qassemyar Q, Browet F, Robbe M, et al. Dynamic parietal closure: initial experience of an original parietal closure procedure for treatment of abdominal wound dehiscence. Arch Surg, 2011, 146(6): 762-764.
24.	Altman AD, Allen VM, Mcneil SA, et al. Pfannenstiel incision closure: a review of current skin closure techniques. J Obstet Gynaecol Can, 2009, 31(6): 514-520.
25.	陈燕花, 翁雨雄, 王锟, 等. 免打结可吸收线减张缝合伤口在闭合四肢创面中的应用. 临床急诊杂志, 2014, 15(12): 728-730.
26.	杨培民, 赵滨, 杨静. 长条双垫片减张缝合法预防腹壁切口裂开的体会. 中国现代手术学杂志, 2007, 11(5): 360-362.
27.	彭亮, 厉周, 杨少华, 等. 改良减张缝合法在腹部切口的临床应用及对比研究. 重庆医学, 2015, 44(3): 391-392.

1. 吴华平, 张永川, 汪飚, 等. 急诊腹部手术切口缝合方式对切口愈合的影响. 中国普外基础与临床杂志, 2014, 21(12): 1555-1557.
2. Poole GV Jr. Mechanical factors in abdominal wound closure-the prevention of fascial dehiscence. Surgery, 1985, 97(6): 631-640.
3. Van, t Riet M, Steyerberg EW, Nellensteyn J, et al. Meta-analysis of techniques for closure of midline abdominal incisions. Br J Surg, 2002, 89(11): 1350-1356.
4. Liu LH, 魏全珍, Zhang HZ, 等. 腹部手术切口感染的调查与对策. 中华医院感染学杂志, 2008, 18(8): 1091-1092.
5. 范文, 黄娥, 段六生. 腹部手术切口感染病原菌分布与耐药性调查. 中华医院感染学杂志, 2008, 18(11): 1562-1563.
6. 闫立昆, 王小强, 龙延滨, 等. 应用预防性减张缝合对腹部切口愈合质量的影响观察. 外科理论与实践, 2005, 10(2): 172-174.
7. 揭志刚, 谢小平, 武彪, 等. 减张缝合预防高龄病人切口裂开的体会. 外科理论与实践, 2005, 10(1): 94-95.
8. 王春泉, 高勇, 袁玉华, 等. 腹膜外全层水平褥式减张缝合预防老年人腹部切口裂开的体会. 云南医药, 2006, 27(2): 138-139.
9. 高峰, 彭健, 刘海龙. 预防性减张缝合对影响高龄患者腹部切口愈合质量的临床研究. 中国医药指南, 2009, 7(14): 11-13.
10. 朱笑寒, 桂世涛, 王亮. 全层连续加减张缝合预防高龄患者腹部切口裂开. 中国医学创新, 2009, 6(32): 35-37.
11. 曲义坤, 杨婷, 徐剑, 等. 预防性减张缝合对老年结直肠癌患者腹部切口愈合质量的影响. 中国老年学杂志, 2010, 30(10): 1423-1424.
12. 李群, 李斌, 于安星. 预防性内减张缝合在腹部外科手术中的应用. 中华疝和腹壁外科杂志: 电子版, 2012, 6(3): 850-852.
13. 周龙根. 皮下内减张缝合法在防治腹部手术切口裂开的应用研究. 医学信息, 2013, 26(22): 272-273.
14. Singer AJ, Thode HC Jr, Chale S, et al. Primary closure of cutaneous abscesses: a systematic review. Am J Emerg Med, 2011, 29(4): 361-366.
15. 陈欢, 王葳, 陈婉珺, 等. 剖宫产术后手术部位感染监测及干预研究. 川北医学院学报, 2015, 30(2): 202-205.
16. Bickenbach KA, Karanicolas PJ, Ammori JB, et al. Up and down or side to side? A systematic review and meta-analysis examining the impact of incision on outcomes after abdominal surgery. Am J Surg, 2013, 206(3): 400-409.
17. 尹集东. 术前一次性和术后多次使用抗生素预防切口感染的疗效观察. 川北医学院学报, 2005, 20(2): 204-205.
18. Hodgson NC, Malthaner RA, Ostbye T. The search for an ideal method of abdominal fascial closure: a meta-analysis. Ann Surg, 2000, 231(3): 436-442.
19. Baracs J, Huszár O, Sajjadi SG, et al. Surgical site infections after abdominal closure in colorectal surgery using triclosan-coated absor-bable suture (PDS Plus) vs. uncoated sutures (PDS Ⅱ): a randomized multicenter study. Surg Infect (Larchmt), 2011, 12(6): 483-489.
20. 左永祥. 一种腹壁切口减张缝合术式介绍. 腹部外科, 2005, 18(1): 64.
21. Mäkelä JT, Kiviniemi H, Juvonen T, et al. Factors influencing wound dehiscence after midline laparotomy. Am J Surg, 1995, 170(4): 387-390.
22. Van, t RM, De Vos Van Steenwijk PJ, Bonjer HJ, et al. Incisional hernia after repair of wound dehiscence: incidence and risk factors. Am Surg, 2004, 70(4): 281-286.
23. Qassemyar Q, Browet F, Robbe M, et al. Dynamic parietal closure: initial experience of an original parietal closure procedure for treatment of abdominal wound dehiscence. Arch Surg, 2011, 146(6): 762-764.
24. Altman AD, Allen VM, Mcneil SA, et al. Pfannenstiel incision closure: a review of current skin closure techniques. J Obstet Gynaecol Can, 2009, 31(6): 514-520.
25. 陈燕花, 翁雨雄, 王锟, 等. 免打结可吸收线减张缝合伤口在闭合四肢创面中的应用. 临床急诊杂志, 2014, 15(12): 728-730.
26. 杨培民, 赵滨, 杨静. 长条双垫片减张缝合法预防腹壁切口裂开的体会. 中国现代手术学杂志, 2007, 11(5): 360-362.
27. 彭亮, 厉周, 杨少华, 等. 改良减张缝合法在腹部切口的临床应用及对比研究. 重庆医学, 2015, 44(3): 391-392.

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Effect of Tension Suture on Healing Quality of Incision after Abdominal Surgery: A Meta-Analysis

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