Evidence from use of different closure methods and internal support
How a wound is closed and the technique and materials used may also influence recovery. Choice of suture material is crucial to maximize healing rates. A balance needs to be struck between absorbable sutures that minimize the foreign body irritation and of non-absorbable sutures that can provide permanent strength to a wound. For abdominal closure many surgeons now use a long-lasting absorbable suture material such as PDS (polydioxanone) that maintains its tensile strength for about 8 weeks. Mass absorption takes about 6 months. Thus, the suture materials provide stability for the wound but eventually disappear, circumventing long-term wound irritation. Where prolonged approximation of tissues is required (e.g. the repair of an incisional hernia), a non-absorbable suture material or mesh of such material as polypropylene may be used. Skin closure adds very little to a wound’s strength, but whether sutures, skin clips, steristrips, or glue is used, the attending clinician needs to pay attention to the nature, the site and the method of closure of any wound in making the recommendation for return to work. There is no reason why a patient may not return to sedentary work even with skin sutures still in situ, but it would be unwise for a patient to undertake heavy manual labour or for the wound to be exposed to water, dust, or abrasive contact.