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.	吳華平, 張永川, 汪飚, 等. 急診腹部手術切口縫合方式對切口愈合的影響. 中國普外基礎與臨床雜志, 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. 腹部手術切口感染的調查與對策. 中華醫院感染學雜志, 2008, 18(8): 1091-1092.
5.	范文, 黃娥, 段六生. 腹部手術切口感染病原菌分布與耐藥性調查. 中華醫院感染學雜志, 2008, 18(11): 1562-1563.
6.	閆立昆, 王小強, 龍延濱, 等. 應用預防性減張縫合對腹部切口愈合質量的影響觀察. 外科理論與實踐, 2005, 10(2): 172-174.
7.	揭志剛, 謝小平, 武彪, 等. 減張縫合預防高齡病人切口裂開的體會. 外科理論與實踐, 2005, 10(1): 94-95.
8.	王春泉, 高勇, 袁玉華, 等. 腹膜外全層水平褥式減張縫合預防老年人腹部切口裂開的體會. 云南醫藥, 2006, 27(2): 138-139.
9.	高峰, 彭健, 劉海龍. 預防性減張縫合對影響高齡患者腹部切口愈合質量的臨床研究. 中國醫藥指南, 2009, 7(14): 11-13.
10.	朱笑寒, 桂世濤, 王亮. 全層連續加減張縫合預防高齡患者腹部切口裂開. 中國醫學創新, 2009, 6(32): 35-37.
11.	曲義坤, 楊婷, 徐劍, 等. 預防性減張縫合對老年結直腸癌患者腹部切口愈合質量的影響. 中國老年學雜志, 2010, 30(10): 1423-1424.
12.	李群, 李斌, 于安星. 預防性內減張縫合在腹部外科手術中的應用. 中華疝和腹壁外科雜志: 電子版, 2012, 6(3): 850-852.
13.	周龍根. 皮下內減張縫合法在防治腹部手術切口裂開的應用研究. 醫學信息, 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.	陳歡, 王葳, 陳婉珺, 等. 剖宮產術后手術部位感染監測及干預研究. 川北醫學院學報, 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.	尹集東. 術前一次性和術后多次使用抗生素預防切口感染的療效觀察. 川北醫學院學報, 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. 一種腹壁切口減張縫合術式介紹. 腹部外科, 2005, 18(1): 64.
21.	M?kel? 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.	陳燕花, 翁雨雄, 王錕, 等. 免打結可吸收線減張縫合傷口在閉合四肢創面中的應用. 臨床急診雜志, 2014, 15(12): 728-730.
26.	楊培民, 趙濱, 楊靜. 長條雙墊片減張縫合法預防腹壁切口裂開的體會. 中國現代手術學雜志, 2007, 11(5): 360-362.
27.	彭亮, 厲周, 楊少華, 等. 改良減張縫合法在腹部切口的臨床應用及對比研究. 重慶醫學, 2015, 44(3): 391-392.

1. 吳華平, 張永川, 汪飚, 等. 急診腹部手術切口縫合方式對切口愈合的影響. 中國普外基礎與臨床雜志, 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. 腹部手術切口感染的調查與對策. 中華醫院感染學雜志, 2008, 18(8): 1091-1092.
5. 范文, 黃娥, 段六生. 腹部手術切口感染病原菌分布與耐藥性調查. 中華醫院感染學雜志, 2008, 18(11): 1562-1563.
6. 閆立昆, 王小強, 龍延濱, 等. 應用預防性減張縫合對腹部切口愈合質量的影響觀察. 外科理論與實踐, 2005, 10(2): 172-174.
7. 揭志剛, 謝小平, 武彪, 等. 減張縫合預防高齡病人切口裂開的體會. 外科理論與實踐, 2005, 10(1): 94-95.
8. 王春泉, 高勇, 袁玉華, 等. 腹膜外全層水平褥式減張縫合預防老年人腹部切口裂開的體會. 云南醫藥, 2006, 27(2): 138-139.
9. 高峰, 彭健, 劉海龍. 預防性減張縫合對影響高齡患者腹部切口愈合質量的臨床研究. 中國醫藥指南, 2009, 7(14): 11-13.
10. 朱笑寒, 桂世濤, 王亮. 全層連續加減張縫合預防高齡患者腹部切口裂開. 中國醫學創新, 2009, 6(32): 35-37.
11. 曲義坤, 楊婷, 徐劍, 等. 預防性減張縫合對老年結直腸癌患者腹部切口愈合質量的影響. 中國老年學雜志, 2010, 30(10): 1423-1424.
12. 李群, 李斌, 于安星. 預防性內減張縫合在腹部外科手術中的應用. 中華疝和腹壁外科雜志: 電子版, 2012, 6(3): 850-852.
13. 周龍根. 皮下內減張縫合法在防治腹部手術切口裂開的應用研究. 醫學信息, 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. 陳歡, 王葳, 陳婉珺, 等. 剖宮產術后手術部位感染監測及干預研究. 川北醫學院學報, 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. 尹集東. 術前一次性和術后多次使用抗生素預防切口感染的療效觀察. 川北醫學院學報, 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. 一種腹壁切口減張縫合術式介紹. 腹部外科, 2005, 18(1): 64.
21. M?kel? 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. 陳燕花, 翁雨雄, 王錕, 等. 免打結可吸收線減張縫合傷口在閉合四肢創面中的應用. 臨床急診雜志, 2014, 15(12): 728-730.
26. 楊培民, 趙濱, 楊靜. 長條雙墊片減張縫合法預防腹壁切口裂開的體會. 中國現代手術學雜志, 2007, 11(5): 360-362.
27. 彭亮, 厲周, 楊少華, 等. 改良減張縫合法在腹部切口的臨床應用及對比研究. 重慶醫學, 2015, 44(3): 391-392.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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

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