Chapter 5: Table of Contents
Closure of the abdominal cavity can be performed using a simple interrupted or simple continuous pattern. Studies and clinical experience have shown that a simple continuous closure is as strong as a simple interrupted closure, but only if ist is performed correctly. To perform a successful continuous closure, one must use a suture material that maintains appropriate tensile strength during the healing process and one should choose the appropriate suture size for the size of the patient. The surgeon should ensure that he or she includes the external rectus fascia in all suture bites along the linea alba and takes large enough bites to prevent tissue failure. Square knots are important and each knot should include a sufficient number of throws for the suture material used; typically 4 to 5 throws. When performing a simple continuous closure, place six (6) knots at the beginning of the suture line and seven (7) at the end since the integrity of the continuous closure depends on the knots at the start and at the end of the suture line. If available, use PDS® (polydioxanone) or Biosyn® (glycomere 631). Other options include Maxon® (polyglyconate) and Vicryl® (polyglactin 910). Non-absorbable suture material such as polypropylene (Prolene®) has been recommended in patients expected to have delayed healing due to infection, old age, hypoproteinemia, prednisone or chemotherapy, etc.; this is rarely necessary. Although chromic gut has been used successfully for abdominal closure, it is considered inferior to other available materials for this use due to its rapid loss of tensile strength and the slow healing of the linea alba. Chromic gut is not recommended for abdominal closure, but if it is your only choice, use it in a simple interrupted pattern and make sure to create square knots. Although Monocryl® (poliglecaprone) is used successfully to close feline spay incisions, it undergoes a rapid loss of tensile strength and is not recommended for long, abdominal wall incisions, especially in larger patients.