Running mass closure using looped polydioxanone sutures in a high-risk population

The authors used a running mass technique using looped N. 1 polydioxanone suture to close the abdominal wall in a series of 149 high-risk gynecologic surgery patients who were either obese or had a diagnosis of gynecologic cancer. A midline vertical incision was used in 146 cases and transverse incision in 3. The first bite was draw through the loop. Linear tissue bites were taken through the peritoneum, muscle, and fascia at equally spaced 1.0-cm to 1.5-cm intervals and placed approximately 1.5 cm to 2.0 cm from the edge of the incision. Minimal pressure was used to pull the suture and approximate the midline. The final knot was made by cutting the suture and tying it to itself. Patients ranged in age from 27 to 83 years and weighed from 75 to 369 lbs. Confounding factors included gynecologic malignancy (109 patients), ascites (20), anemia (3), diabetes (17), and chronic obstructive pulmonary disease (4). Twenty-one cases required bowel resection, including 3 stomas. Two patients had received preoperative pelvic radiation. Six to 9 weeks after surgery, 37 patients were treated with chemotherapy. Twenty-two patients began postoperative pelvic radiation therapy at 6 to 9 weeks after surgery, In this series, 3 patients developed wound infections within 2 weeks after surgery. All responded to antibiotic treatment and wound debridement, Incision hernias developed in 2 patients, 1 of whom required surgical repair. Lastly, 1 woman experienced myocardial infarction postoperatively and developed a severe cough secondary to cardiac catheterization. A fascia dehiscence with evisceration occurred during a course of uncontrollable coughing. At the time of repair, it was noted that the running suture was intact but that the fascia was torn along the line where the sutures were placed.