Abdominal wound closures

The purpose of abdominal wound closure is to restore the anatomy and physiology of the abdominal wall. The end result must be an abdominal wall with sufficient strength and without functional restrictions. The ideal technique for abdominal wound closure is yet to be established. For decades, personal preferences and local traditions, rather than evidence-based medicine, have determined how surgeons perform abdominal wound closures. Abdominal wound closures should be performed in a manner to minimize complications such as acute wound failure, incisional hernia, and persistent sinus. It should be comfortable to the patient and leave a reasonably aesthetic scar. It should also be technically so simple that the results are as good in the hands of a surgical trainee as those of a master surgeon. Furthermore, the procedure should be inexpensive and efficient. This article reviews our knowledge of abdominal wound closures based on a scientific assessment of the different surgical techniques and their effects on the aforementioned complications, and not on personal preferences or local custom. It also presents the options for the management of difficult abdominal wound closures where massive visceral edema precludes primary closure.