The healing of laparotomies: review of the literature

Summary Closure of laparotomy incisions continues to be followed by complications such as infection, granuloma and fistula formation, and most particularly burst abdomen and incisional hernia. In spite of technological progress in the matter of suture materials, the incidence of burst abdomen remains unchanged. This study has the object of examining in the first place the physiological and pathological processes of scar tissue formation, in order to establish what are the best means of opening and closing the abdomen, as well as giving some guidelines as to the best suture materials. Normal healing is a complex process which comprises three phases which are fundamentally the same for all tissues. However, the speed with which they develop depends on the regenerative potential and repair of the damaged tissue. Healing of a wound may be considered to be complete when it has succeeded in re-establishing the function of the tissue which was injured. Aponeuroses, the function of which is mechanical, have weak powers of regeneration, and take a long time to repair. The abdominal wall only regains its preoperative resistance and strength at the fourth post operative month. Several general and local factors may interfere with the normal healing process of a laparotomy.