Overweight and healing of midline incisions: the importance of suture technique

Abstract

Objective: To study the effect of body mass index on the healing of midline laparotomy wounds closed with a continuous technique.

Design: Prospective clinical study.

Setting: County hospital, Sweden.

Subjects: 1023 patients who underwent midline laparotomy between September 1991 and June 1993.

Interventions: Body mass index was recorded and overweight was defined as an index above 25.

Main outcome measures: Postoperative wound infection, and incidence of incisional hernia at 12 months.

Results: Overweight patients were sutured with a higher suture length:wound length ratio than others (p < 0.01). Wound infection developed postoperatively in 97 of 1023 patients (10%) and overweight, youth, wound contamination, and reoperation were independent risk factors. However, overweight was not associated with a higher rate of infection if the suture length:wound length ratio was 4.0-4.9. Incisional hernias developed in 118 of 808 patients (15%) and overweight, old age, wound infection, and suture length:wound length ratio less than 4 were independent risk factors. However, overweight was not associated with a higher hernia rate if the suture length:wound length ratio was 4.0-4.9.

Conclusion: Overweight is a risk factor for wound infection and incisional hernia after midline abdominal surgery but these effects may be eliminated if patients are sutured with a suture length to wound length ratio of 4.0-4.9.