Do subcutaneous sutures increase risk of laparotomy wound suppuration?
Abstract: Incisional drainage and suppuration occurs commonly following exploratory laparotomy; any technique with the potential to reduce the incidence of this complication warrants investigation. Objective: To determine if abandoning the use of subcutaneous sutures in laparotomy wound closure is safe and whether it reduces the risk of suppuration. Methods: A randomised controlled study was carried out at 2 referral hospitals in the UK, involving 309 horses undergoing exploratory laparotomy; 150 horses underwent '2-layer' closure without a subcutaneous suture, while 159 underwent conventional '3-layer' closure. Information regarding degree of oedema and gross types of discharge was recorded daily; suppuration was defined as discharge of pus. Telephone follow-up was carried out 30 days after hospital discharge to identify those complications occurring after that date and, thereafter, every 3 months. The influence of closure method on risk of wound suppuration was assessed by Chi-squared analysis and by logistic regression. Time to suppuration was modelled using a Cox proportional hazards model. Results: No catastrophic failures of 2-layer closures were recorded. Prevalence of suppuration was not significantly different, being 18.7% and 23.9% for 2- and 3-layer closures, respectively (OR = 1.37, 0.79-2.37, P = 0.263). Conclusions: This study found no significant difference in prevalence or rate of wound suppuration in 2-layer closures compared to conventional 3-layer closure. Two-layer closure is recommended as a safe alternative means of achieving ventral midline abdominal closure in horses.
Publication Date: 2007-10-04 PubMed ID: 17910262DOI: 10.2746/042516407x195123Google Scholar: Lookup
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- Journal Article
- Randomized Controlled Trial
- Research Support
- Non-U.S. Gov't
Summary
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This research study evaluates whether the use of subcutaneous sutures, or stitches beneath the skin, increases the risk of wound suppuration (the production of pus) in horses after exploratory laparotomy, a type of abdominal surgery. The randomized controlled study was undertaken in the UK and found no significant difference in the prevalence or rate of wound suppuration in cases of abdominal closure done with two layers of sutures instead of the conventional three layers.
Methods
- The investigators conducted a randomised controlled study at two UK referral hospitals.
- The study involved 309 horses undergoing exploratory laparotomies.
- Of these, 150 horses underwent a “2-layer” closure method without a subcutaneous suture, while the remaining 159 underwent the conventional “3-layer” closure method.
- The researchers recorded daily information regarding the degree of edema and the types of discharge from the wound.
- Wound suppuration was defined as the discharge of pus from the wound.
- Follow-up calls were conducted 30 days post operation to track any complications that may have occurred after the horse was discharged, and then every three months thereafter.
Statistical Analysis
- Using statistical tools such as the Chi-squared analysis and logistic regression, the researchers assessed the influence of the closure methods on the risk of wound suppuration.
- A Cox proportional hazards model was used to model the time to wound suppuration.
Results
- The results indicated that there were no catastrophic failures of the 2-layer closures.
- The prevalence of suppuration was found to be not significantly different between the two methods, with 18.7% of the 2-layer closures and 23.9% of the 3-layer closures developing wound suppuration.
Conclusion
- The researchers concluded that there was no significant difference in the prevalence or rate of wound suppuration between the 2-layer closures and the 3-layer closures in horses.
- Therefore, the 2-layer closure method was recommended as a safe alternative for achieving ventral midline abdominal closure in horses.
Cite This Article
APA
Coomer RP, Mair TS, Edwards GB, Proudman CJ.
(2007).
Do subcutaneous sutures increase risk of laparotomy wound suppuration?
Equine Vet J, 39(5), 396-399.
https://doi.org/10.2746/042516407x195123 Publication
Researcher Affiliations
- Equine Division, University of Liverpool, Leahurst, Chester High Road, Neston, Cheshire CH64 7TE, UK.
MeSH Terms
- Animals
- Chi-Square Distribution
- Colic / surgery
- Colic / veterinary
- Edema / epidemiology
- Edema / prevention & control
- Edema / veterinary
- Horse Diseases / surgery
- Horses
- Kaplan-Meier Estimate
- Laparotomy / adverse effects
- Laparotomy / methods
- Laparotomy / veterinary
- Logistic Models
- Odds Ratio
- Postoperative Complications / epidemiology
- Postoperative Complications / prevention & control
- Postoperative Complications / veterinary
- Prevalence
- Proportional Hazards Models
- Prospective Studies
- Risk Factors
- Suppuration / epidemiology
- Suppuration / prevention & control
- Suppuration / veterinary
- Surgical Wound Infection / epidemiology
- Surgical Wound Infection / prevention & control
- Surgical Wound Infection / veterinary
- Suture Techniques / adverse effects
- Suture Techniques / veterinary
- Time Factors
- Wound Healing
Citations
This article has been cited 7 times.- Griessel TS, Muñoz Morán JA, Byaruhanga C, Smit Y. A single-centre retrospective study of surgical site infection following equine colic surgery (2013‒2021). Vet Rec 2025 May 17;196(10):e5227.
- Isgren CM, Pinchbeck GL, Salem SE, Hann MJ, Townsend NB, Cullen MD, Archer DC. Evaluation of a stent dressing and abdominal bandage on surgical site infection following emergency equine laparotomy: A randomised controlled trial. Equine Vet J 2025 Nov;57(6):1466-1477.
- Rockow M, Griffenhagen G, Landolt G, Hendrickson D, Pezzanite L. The Effects of Antimicrobial Protocols and Other Perioperative Factors on Postoperative Complications in Horses Undergoing Celiotomy: A Retrospective Analysis, 2008-2021. Animals (Basel) 2023 Nov 19;13(22).
- Rockow M, Griffenhagen G, Landolt G, Hendrickson D, Pezzanite L. Current Antimicrobial Use in Horses Undergoing Exploratory Celiotomy: A Survey of Board-Certified Equine Specialists. Animals (Basel) 2023 Apr 22;13(9).
- Stöckle SD, Kannapin DA, Kauter AML, Lübke-Becker A, Walther B, Merle R, Gehlen H. A Pilot Randomised Clinical Trial Comparing a Short-Term Perioperative Prophylaxis Regimen to a Long-Term Standard Protocol in Equine Colic Surgery. Antibiotics (Basel) 2021 May 16;10(5).
- Scharner D, Gittel C, Winter K, Blaue D, Schedlbauer C, Vervuert I, Brehm W. Comparison of incisional complications between skin closures using a simple continuous or intradermal pattern: a pilot study in horses undergoing ventral median celiotomy. PeerJ 2018;6:e5772.
- Rousseau M, Anderson DE, Rozell TG, Hand JM, Faris BR. Comparison of polyglactin-910 and polydioxanone for closure of the linea alba following caudal ventral midline laparotomy in sheep. Can Vet J 2015 Sep;56(9):959-63.
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