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Fri Feb 20 17:59:36 GMT 2009

1) fascia
Continuous monofilament mass suture.

Interesting the comments on the 4:1 ratio, Israelsson's PhD thesis. This was
the topic of my Masters of Surgery thesis in 1979, based on the work of TPN
Jenkins (*Brit J Surg* 1976; 63: 873-876). In the 70s, standard abdominal
closure in the British-based school of surgery was continuous catgut for the
peritoneum and interrupted catgut for the fascia. (Some people used
interrupted silk for the fascia, after Halstead, but only in
non-contaminated cases.) Monofilament nylon suture was too expensive at the
time (I worked in the Cairo Cancer Institute) and so I used fishing tackle
(about a No 2 in thickness) and measured off the length of the wound 4-6
times. Prospective study comparing the two techniques (anatomic closure vs
mass suture) in 300 patients undergoing radical cystectomy for squamous cell
carcinoma of the urinary bladder (post-Bilharziasis). Mass suture won out,
obviously, and induced a change in the operative technique of my professors.

Today, I use either a Vicryl No. 1 or fishing tackle still. (Can't find a
monofilament nylon thick enough.)

2) no tension sutures
3) no intraperitoneal drain, simple penrose in the subcutaneous tissues if
very thick, removed after 24 hours usually

-- 
christos giannou
Monemvasia Lakonia
23070 Greece
tel & fax: (++30) 27320-61772
mob: (++30) 69 74 83 28 18

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