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A randomized prospective trial was carried out between September 1987 and February 1989 to compare 3 different absorbable sutures (polyglactine 910, polydioxanone I, polydioxanone II) for closure of the abdominal wall after upper midline laparotomy for elective operations. The technique used to close the fascia was always a continuous suture. The criteria used to assess the results were the development of wound infection and wound dehiscence in the early postoperative period, and the development of suture sinuses and incisional hernia 1 year after operation. The early postoperative results in 235 patients revealed no wound infection and no -wound dehiscence. Suture sinuses developed in 4 patients (2%) 2 months after operation, but resolved spontaneously. We reviewed 203 patients after one year. The total number of incisional hernias detected 1 year postoperatively was 22 cases (11%), (polyglactine 910, 14.2%; polydioxanone I, 11.2%; polydioxanone II, 8.4%). The difference between the 3 groups was not statistically significant. The results of the trial indicate that absorbable sutures have a very low incidence of suture sinuses, and that polydioxanone II seems to be a good choice for closing laparotomies.

In view of the good results of breast reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap, we used this method in 48 patients, but we observed abdominal complications, which are difficult to accept for cosmetic surgery. Hartrampf, one of pioneers of this technique, reports a very low complication, rate by closing the abdominal wall without the use of prosthetic mesh. However his results are not reproducible as numerous authors, following his technique, have reported abdominal hernias and now use prosthetic reinforcement. In the light of our experience, we analyse these complications, not only hernias, but also abdominal weakness, indicating a new operation in some cases (6/9). The quality and duration of the follow-up (52 months) accounts for the fairly high complication rate. A review of literature examines the various means of abdominal wall closure and their results. The functional injury of muscular harvesting must also be considered, especially in sports women.

Post-operative abdominal strapping has proved effective in the prevention of incisional hernia in patients at risk, in the treatment of non-exteriorized incisional hernias and in the deliberate non-closure of the abdominal wall. Its purpose is to avoid deterioration, by a second operation, of an already fragile wall. To be effective, strapping must adhere to the entire abdominal wall rather than to the edges of the incision; it must also be permeable to body fluids and well tolerated. The "nylon stocking" (contensor) glued with the surgical varnish has been used in almost 3000 of our patients, and it has fulfilled these requirements. A glue delivered by aerosol has been tested in 60 patients; it makes gluing easier for the nursing staff, and it facilitates the application, improves the tolerance of the contensor and makes its prolonged wearing more comfortable.