Absorbable Barbed Continuous versus Nonabsorbable Nonbarbed Interrupted Suturing Methods for Donor-site Closure of the Rectus Abdominis Myocutaneous Flap

Abstract

Abdominal incisional hernia is a complication of the rectus abdominis myocutaneous (RAMC) flap harvest. This study aimed to compare the incidence of abdominal incisional hernia and donor-site closure time between absorbable barbed continuous (ABC) and non-absorbable non-barbed interrupted (nAnBI) methods.

Methods: This study included 145 patients who underwent free RAMC flap reconstruction after head and neck cancer surgery at Kobe University Hospital between January 2012 and March 2020. The nAnBI method was selected between January 2012 and August 2016, and the ABC method was selected between September 2016 and March 2020. The incidence of abdominal incisional hernia and the average time required for donor-site closure were compared between the two groups.

Results: Of the 145 patients surveyed, 116 (57 and 59 in the nAnBI and ABC groups, respectively) were followed-up for at least 90 days after the surgery. The incidence rates of abdominal incisional hernia were 0% and 5.1% (n = 3) in the nAnBI and ABC groups, respectively, with no significant differences (p = 0.244). The average donor-site closure times were 127.6 and 111.3 minutes in the nAnBI and ABC groups, respectively, with no significant differences (p = 0.122).

Conclusions: No significant differences in the incidence of abdominal incisional hernia and donor-site closure time were observed between the nAnBI and ABC groups. However, there was a tendency for increased hernia occurrence and shorter wound closure time in the ABC group. A randomized prospective multicenter study is warranted to validate our findings of the ABC method.

Fig. 1.

nAnBI suture method. A, A vertical rectus abdominis myocutaneous flap is designed on the left abdomen. B, After harvesting the flap, the residual anterior sheath of the rectus abdominis muscle is closed with a nAnBI suture (2-0 Neobraid). C, Scheme of the nAnBI method.

Fig. 2.

ABC suture method. A, A bilobed rectus abdominis myocutaneous flap is harvested from the right abdomen. B, The ABC suture material (0-STRATAFIX Symmetric PDS Plus) has a solid core with unidirectional barbs and a fixation tab (arrow) at the end of the core. C, The residual anterior sheath of the rectus abdominis is approximated using 0-STRATAFIX. D, After tight fascial closure with 0-STRATAFIX, the barbs prevent the loosening of the suture. E, Scheme of the ABC method. F, The closed fascia below the arcuate line is reinforced with polypropylene mesh (yellow square).

Fig. 3.

A case of abdominal incisional hernia (No. 4 in Table 3). A, An abdominal incisional hernia in the right abdominal flap donor-site. B, Left lateral view shows that the right abdomen is highly protruded when compared with the left side. C-D, Abdominal computed tomography showing bowel herniation (arrow) from the right abdominal wall.

Fig. 4.

A case of abdominal bulging (No. 5 in Table 3). A, Abdominal bulging in the right abdominal flap donor-site in the standing position. B, The right lateral view confirms protrusion of the right lower abdomen. C-D, Abdominal computed tomography showing protrusion of the right abdominal wall (arrow). However, there is no bowel herniation outside the abdominal wall.