What Is Fascial Closure?

The fascia is the fibrous connective tissue that is present throughout the entire body, and there are three main types: superficial fascia (Camper’s fascia), deep fascia (Scarpa’s fascia), and visceral fascia.

The fascia is the fibrous connective tissue that is present throughout the entire body. There are three main types of fascia:

• Superficial fascia (Camper’s fascia): It is associated with the skin and is a thick fatty layer. It is divided into top and bottom layers.
• Deep fascia (Scarpa’s fascia): It is associated with the muscles, bones, nerves, and blood vessels.
• Visceral fascia: It envelops various organs and glands.

Fascial closure is the closure of the inner layers of the abdomen after a major surgery involving an incision on the abdomen. Fascial closure prevents hernia formation.

The fascial closure technique is of two types:

• Layered closure: It is the closure of each fascial layer individually. The primary advantage of this technique is that multiple suture strands exist so that even if a suture breaks, the others remain intact by the remaining sutures.
• Mass closure: It is continuous fascial closure with a single suture. This prevents tissue strangulation due to the even distribution of tension across the entire length of the suture.
• Fascial closure is usually indicated for surgery on the abdominal cavity and trauma.

There are three steps to performing a fascial closure, which includes fascial closure, subcutaneous closure, and skin closure.

Fascial closure

Nonabsorbable sutures are used in fascial closure. The surgeon pulls apart the fascial layer with two clamps. A looped synthetic material known as polydioxanone (PDS) is used for suturing. The surgeon passes the PDS through the tip of the fascia. 

Next, the surgeon passes the needle through the loop to tie the knot. The surgeon then stitches the incision. Sufficient tension should be applied without strangulating the tissues.

Once the center of the incision is reached, the surgeon starts to stitch the opposite end of the incision. When the two ends are at a distance of 1 cm from each other, the surgeon ties 6-10 knots to secure the sutures.

Subcutaneous closure

After closing the fascial layer, the surgeon closes the subcutaneous layer of the abdominal wall. Because the subcutaneous layer has a limited blood supply, there is an increased risk of infection to this layer.

The purpose of subcutaneous closure is to prevent fluid accumulation (seroma). The surgeon may stitch the incision in a continuous or interrupted fashion.

Skin closure

As a final step, the surgeon closes the skin either using a stapler or sutures. The surgeon may also use adhesive tapes or synthetic glues to cover the wound.

The surgeon removes the suture or staples 7-14 days after wound closure. 

The patient should avoid lifting, pushing, or pulling anything heavier than 4.5 kg.

The patient should avoid straining too much for four to six weeks after wound closure.

Complications of fascial closure include the following:

• Wound infection
• Opening of the stitches

Call the surgeon immediately if the following conditions persist:

• Uncontrolled pain
• Redness around the site
• Bulging at the incision
• Pus drainage
• Long-lasting nausea or vomiting
• Bleeding from the incision site

Abdominal fascia generally takes about one to two months to heal completely. The healing completely depends upon successful wound closure. Hence, it is necessary to be vigilant from the start of the closure technique.