To the Editor.—The trauma patient in critical condition requires a rapid and secure operative closure. The technique we use at Denver General Hospital incorporates principles yielding the strongest incision with the least likelihood of disruption. It also facilitates care of stomas, drains, and sumps, and promotes delayed primary closure in contaminated wounds.
The peritoneum is left open. Buried retention sutures of No. 2 nylon are positioned 3 cm apart, encompassing the linea alba and part of the rectus on each side and avoiding subcutaneous tissues (Fig 1). The linea is approximated loosely with 1.5-cm bites of running O-polypropylene suture (Fig 2). Retention sutures are tied sequentially as the polypropylene is placed to prevent a loop of bowel from being caught in the retention. Depending on the degree of contamination, the skin and subcutaneous tissues are either closed primarily or left open for delayed primary closure.
We feel peritoneal closure