Langenbeck's archives of surgery
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Langenbecks Arch Surg · Dec 2012
ReviewSurgical evaluation and knowledge transfer--methods of clinical research in surgery.
This article aims to outline the framework of surgical evaluation and knowledge transfer. Therefore, special design issues affecting surgical clinical research will be discussed. Moreover, principles and challenges of knowledge transfer from research into practice will be addressed. ⋯ For a rigorous evaluation of surgical procedures, a basic understanding of research methodology is urgently needed, and to improve methodological expertise, collaboration between surgeons and methodologists is encouraged.
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The most important wound complications are surgical site infection, wound dehiscence and incisional hernia. Experimental and clinical evidences support that the development of wound complications is closely related to the surgical technique at wound closure. ⋯ Midline incisions should be closed in one layer by a continuous suture technique. A monofilament suture material should be used and be tied with self-locking knots. Excessive tension should not be placed on the suture. Wounds must always be closed with a suture length-to-wound length ratio higher than 4. The only way to ascertain this is to measure, calculate and document the ratio at every wound closure. A high ratio should be accomplished with many small stitches placed 5 to 8 mm from the wound edge at very short intervals.