Abdominal incisions and sutures in obstetrics and gynaecology

M R C O G PA R T 2 · S O S P O C K E T C A R D · K N O W L E D G E A R E A 3 – C O R E S U R G I C A L S K I L L S

Abdominal Incisions and Sutures in Obstetrics and Gynaecology Raghavan R, Arya P, Arya P, China S. Abdominal incisions and sutures in obstetrics and gynaecology. TOG 2014;16:13–18. doi:10.1111/tog.12063

≤5% 7× 1:4 WOUND INFECTION, ALL ABDOMINAL OPS ↑ INFECTION RISK IN MORBID OBESITY MIN. WOUND:SUTURE LENGTH RATIO (MASS CLOSURE)

DO N' T-M IS S FA C TS

1. Skin incisions: never use monopolar electrosurgery – causes blistering/poor healing

2. Joel-Cohen (3 cm below ASIS) > Pfannenstiel for caesarean section – less morbidity, blood loss, time, infection

3. Avoid Maylard incision if impaired lower-limb circulation – inferior epigastric ligation risks ischaemia

4. Mass closure: wound:suture length ratio ≥1:4; avoid subcutaneous sutures (no supportive value)

5. Smead–Jones running mass closure fascial dehiscence rate = 0.4%

6. Morbid obesity: 7× infection risk; staples (not subcuticular) for skin; drain until <50 ml/24h

7. Laparoscopic ports needing formal sheath closure: non-midline >7 mm, midline >10 mm

8. Dermabond® (2-octylcyanoacrylate) = only FDA-approved tissue adhesive; port-wound closure is established use

EVIDENCE TIERS AT A GLANCE

Preferred: Joel-Cohen (CS), mass closure ≥1:4, staples in obesity

Avoid: monopolar skin incision, Maylard if limb ischaemia risk, subcutaneous sutures

ABBREVIATION KEY

ASIS — anterior superior iliac spine V-Loc — self-anchoring barbed absorbable laparoscopic closure device PDS — polydioxanone suture SL:WL — suture length : wound length ratio FDA — US Food and Drug Administration

Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — doi:10.1111/tog.12063

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