Date Published: April 26, 2019
Publisher: Public Library of Science
Author(s): Moriz E. Klonner, Brigitte Degasperi, Barbara Bockstahler, Gilles Dupré, Vincenzo Miragliotta.
This study aimed to investigate the suture length to wound length ratio (SL:WL) in an in vitro model of abdominal wall closure. Effects of the surgeon’s experience level on the SL:WL ratio were evaluated, hypothesizing that small animal surgeons do not spontaneously apply SL:WL ratios equal to or larger than 4:1.
Three groups of surgeons with varying levels of experience performed 4 simple continuous sutures before (3 sutures) and after (1 suture) being educated on principles of the SL:WL ratio. All sutures were evaluated for their gaping, number of stitches, stitch intervals, tissue bite size and suture length.
No significant differences in suture parameters or SL:WL ratios were found among the 3 groups, and 60.5% of control sutures and 77.0% of test sutures had SL:WL ratios above 4:1. There was a significant improvement in the mean ratio after the information was provided (p = 0.003). Overall, the SL:WL ratios ranged from 1.54:1 to 6.81:1, with 36.3% falling between 4:1 and 5:1 (5.17 mm mean stitch interval, 5.52 mm mean tissue bite size). A significant negative correlation was observed between the SL:WL ratio and the stitch interval to tissue bite ratio (r = -0.886). Forty-nine of 120 sutures fulfilled the current recommendations for abdominal wall closure with a mean SL:WL ratio of 4.1:1.
A SL:WL ratio larger than 4:1 was achieved in 60% of the control sutures and in 77% of test sutures. Additional animal studies are necessary to evaluate the SL/WL ratio in small animal surgery.
Incisional hernias are a frequent and unpredictable complication after midline laparotomy surgeries on humans; depending on the definition, their incidence rate in humans ranges from 4–23%. The most common causes of incisional hernias are improper suturing techniques and wound infection, but suture breakage, knot slippage and untying are also possible causes.[2–4]
Three groups of ten participants each were assembled: group A (European College of Veterinary Surgery and European College of Animal Reproduction diplomates with more than 5 years of experience in small animal soft tissue surgery), group B (junior veterinary staff surgeons and residents in small animal veterinary surgery) and group C (small animal interns of veterinary medicine and surgery).
In total, 120 sutures were analyzed, and 8,747 measurements were taken.
To our knowledge, this is the first study to assess the surgical techniques of small animal surgeons performing abdominal wall closures and evaluating their SL:WL ratios using an in vitro model. We explored how the surgeon’s level of experience affected the suturing technique and how the surgeon’s techniques changed after being educated on the SL:WL ratio.
By following the current textbook recommendations and applying a stitch interval close to the tissue bite size, an SL:WL ratio equal to or larger than 4:1 can be achieved using an in vitro laparotomy closure model.