One-Layer Closure of the Abdominal Wall

Abstract

In debilitated patients with low preoperative albumin and long abdominal incisions, retention sutures are often advisable, but surgeons generally avoid them because in order to bring the fascia together, they have to tie the sutures tightly. The postoperative result can be ulceration of the skin and pressure necrosis, with infection and a painful wound. Retention sutures in midline incisions must be tied tightly because often the skin protrudes more medially than the underlying fascia, which tends to retract away from the line of closure. Therefore, when the retention sutures are placed in a through-and-through manner, the skin edges come together first and each suture must be tightened further in order for the fascia to come together.