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Small bites for fascial closure

Discussion in 'Surgery and Surgical Subspecialties' started by DoctwoB, Jul 28, 2015.

  1. DoctwoB

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  3. ThoracicGuy

    Physician 5+ Year Member

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    Never had concern for fascia strangulation, the concern was also hernia formation. We were taught the 1 cm/1 cm rule, but never told to make it even closer together because of that worry. It would make sense that you would have less hernia with a tighter closure.
     
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  4. thedrjojo

    Physician 10+ Year Member

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    A well designed study, albeit I find their hernia rate in the large bite group a little high, and their rate in the small bite group is higher than what they predicted in the power calculation (they powered for 15% in the large bite and 7.5% in the small bite group), and most of these hernias were diagnosed radiologically only (upwards of 50%) and we're close to significantly smaller (2cm vs 4cm, p was like 0.065, so likely a type 2 error). Still, if I get to make the decision on suture type (which I will next year as a chief, and maybe on a rare occasion this year) I may use a 2-0 pds and do small bits instead of the large bites with #2 looped pds which is our programs standard (the paper used #1 looped pds, tied it to itself and then possibly to each other. We just tie them to each other and not to itself, which somewhat defeats the looped part).
     
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  5. vhawk

    vhawk 2K Member
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    Using ultrasound to diagnose is weird but I suppose the idea was to sort of substitute that for longer follow up. Timely thread as we reviewed this paper in journal club last night. I think if you combine this paper with the Israelsson paper the preponderance of evidence seems to be on the side of small bites though. As painful as that may be.
     

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