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Principles of abdominal wall closure

Jason S Mizell, MD, FACS
Section Editor
Hilary Sanfey, MD
Deputy Editor
Wenliang Chen, MD, PhD


The ideal abdominal wound closure provides strength and a barrier to infection. In addition, the closure should be efficient, performed without tension or ischemia, comfortable for the patient, and aesthetic.

Closure of abdominal incisions will be reviewed here. Incisions for opening the abdomen, wound healing, and wound complications are discussed separately. (See "Incisions for open abdominal surgery" and "Complications of abdominal surgical incisions".)


Sutures — Wounds have less than 5 percent of normal tissue strength during the first postoperative week, thus wound security is dependent solely upon the suture closure. (See "Closure of minor skin wounds with sutures" and "Closure of minor skin wounds with sutures", section on 'Suture materials'.)

Size — Suture should be the smallest caliber that is strong enough to reapproximate the tissue and keep the wound intact during normal postoperative activity [1]. Suture caliber is one factor in minimizing the amount of foreign material in the wound.

Synthetic versus natural — A critical element of effective closure is the choice of suture material. Sutures can be made from natural fibers or produced synthetically. Natural suture materials include silk, linen, and catgut (dried and treated bovine or ovine intestine). Synthetic sutures are made from a variety of textiles such as nylon or polyester, formulated specifically for surgical use.

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Literature review current through: Nov 2017. | This topic last updated: Aug 09, 2017.
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