BACKGROUND With a growing interest in the primary prevention of incisional hernias, it has been hypothesized that different suturing techniques may cause various levels of tissue ischemia. Using ICG laser-induced fluorescence angiography (ICG-FA), we studied the effect of different suture materials and closure techniques on abdominal wall perfusion. METHODS Fifteen porcine subjects underwent midline laparotomy, bilateral skin flap creation, and three separate 7 cm midline fascial incisions. Animals underwent fascial closure with 5 different techniques: (1) Running 0-PDS® II (polydioxanone) Suture with large bites; (2) Running 0-PDS II Suture with small bites; (3) Interrupted figure-of-eight (8) PDS II Suture, (4) Running 0-barbed STRATAFIX™ Symmetric PDS™ Plus Knotless Tissue Control Device large bite; (5) Running 0-STRATAFIX Symmetric PDS Plus Device small bites. ICG-FA signal intensity was recorded prior to fascial incision (baseline), immediately following fascial closure (closure), and at one-week (1-week.). Post-mortem, the abdominal walls were analyzed for inflammation, neovascularity, and necrosis. RESULTS PDS II Suture with small bites, fascial closure at the caudal 1/3 of the abdominal wall, and the 1-week time period were all independently associated with increased tissue perfusion. There was also a significant increase in tissue perfusion from closure to 1-week when using small bites PDS II Suture compared to PDS II Suture figure-of-8 (p < 0.001) and a trend towards significance when compared with large bites PDS II Suture (p = 0.056). Additionally, the change in perfusion from baseline to 1 week with small bites was higher than with figure of 8 (p = 0.002). Across all locations, small bite PDS II Suture has greater total inflammation than figure of 8 (p < 0.001). CONCLUSIONS The results suggest that the small bite technique increases abdominal wall perfusion and ICG-FA technology can reliably map abdominal wall perfusion. This finding may help explain the reduced incisional hernia rates seen in clinical studies with the small bite closure technique.

中文翻译：

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使用不同的缝合技术检查腹壁灌注以进行中线腹部剖腹手术闭合。

背景技术随着对切口疝一级预防的关注不断增加，已经假设不同的缝合技术可能导致不同程度的组织缺血。使用 ICG 激光诱导荧光血管造影 (ICG-FA)，我们研究了不同缝合材料和闭合技术对腹壁灌注的影响。方法 15 名猪受试者接受了中线剖腹手术、双侧皮瓣创建和三个独立的 7 cm 中线筋膜切口。动物采用 5 种不同的技术进行筋膜闭合：(1) 运行 0-PDS® II（聚二恶烷酮）大口缝合；(2) 运行 0-PDS II 小口缝合线；(3) 中断的八字形 (8) PDS II 缝合，(4) Running 0-barbed STRATAFIX™ Symmetric PDS™ Plus 无结组织控制装置大咬合；(5) 运行 0-STRATAFIX Symmetric PDS Plus Device small bites。ICG-FA 信号强度在筋膜切开前（基线）、筋膜闭合后立即（闭合）和一周（1 周）时记录。验尸后，分析腹壁的炎症、新生血管和坏死。结果 PDS II 小口缝合、腹壁尾部 1/3 处的筋膜闭合以及 1 周的时间段均与组织灌注增加独立相关。与 PDS II 8 字形缝合相比，使用小口 PDS II 缝合时从闭合到 1 周的组织灌注也有显着增加 (p < 0.001)，并且与大口 PDS II 缝合相比有显着性趋势(p = 0.056)。此外，从基线到 1 周的小口灌注变化高于数字 8 (p = 0.002)。在所有位置，小咬合 PDS II 缝合线的总炎症高于数字 8 (p < 0.001)。结论 结果表明，小咬合技术增加了腹壁灌注，ICG-FA 技术可以可靠地绘制腹壁灌注图。这一发现可能有助于解释在临床研究中使用小咬合闭合技术观察到的切口疝发生率降低的原因。