Cosmetic Results of Lower Midline Abdominal Incision: Donati Stitches versus a Continuous Intracutaneous Suture in a Randomized Clinical Trial

The appearance of a laparotomy scar may be an important legacy of surgery for some patients. This randomized study enrolled 80 patients who required gynecologic surgery through a lower midline vertical incision. It compared 2 approaches: a continuous absorbable intracutaneous suture versus interrupted Donati stitches. A fourth-year resident supervised by a staff gynecologist performed all closures. Three independent observers as well as the patients evaluated the cosmetic outcome after 8 days and 4 to 6 months. They used visual analog scales to score hypertrophy, width, color, and crosshatching; in addition, the patients scored their postoperative pain. Clinical features were similar for the 42 women managed with a continuous intracutaneous suture and the 38 in whom the skin was closed by the Donati technique. Both procedures took approximately 13 to 15 minutes. After 4 to 6 months, wound dehiscence exceeding 1 cm was found in 4 patients in the Donati group and one treated by the single-suture technique. Two wound infections occurred in the Donati group. Observers' scores were lower, signifying a cosmetically superior scar, for the single-suture group at early postoperative assessment, but subsequently, there were no meaningful differences. At 4 to 6 months, there was a slight, insignificant difference in patient scores favoring the intracutaneous suture. The observers' and patients' scores did not differ significantly. At no time were there significant differences in pain scores between the 2 patient groups. The authors recommend using an intracutaneous suture for closing lower midline laparotomy wounds. It is not more time-consuming than using Donati stitches and provides comparable cosmetic results with a somewhat smaller risk of wound dehiscence. Both patients and physicians will appreciate not having to remove stitches. If the risk of wound infection is increased, interrupted Donati stitches may be the best option because removing some of the stitches will facilitate wound drainage, if needed.