Fascia anchor

FASCIA ANCHOR* WILLIAM DELUE ANDERSON, M.D. PORTLAND, MAINE

M

originated the fascia anchors, tried many of the things mentioned.

ANY things have been used in the past with which to tie siIkworm with the idea of gut, mostIy

after I had heretofore

FIG. 1. Fascia anchors in position, with double strands of silkworm gut ready for tying.

preventing the cutting of skin and subcutaneous tissues, without much thought of hoIding in apposition and fortifying the fascia. Some of the things used have been tong and short foIds of gauze, buttons, denta roIIs, gIass rods and rubber tubing of various kinds, sizes, etc. In my efforts in the past to prevent postoperative hernia, aIso to produce a narrow, weII-approximated wound, with as IittIe fibrous tissue scar as possibIe, * Submitted

FIG. 2. Silkworm strands tied. This gives splendid apposition of incised Iayers with eIevatIon. DESCRIPTION

The Iengths, IO cm., 4 mm. sIiding grooves rustIess

fascia anchors are made in various but those commonIy used are the 16 cm. and 20 cm. Iengths. Diameter They are grooved to prevent the of siIkworm gut, each space between measuring 2 cm., and are made of stee1, chromed.

for pubIication October 27, 1930. 282

NEW

SERIES VOL. XII, No

Anderson-Fascia

2

The anchors may be used to measure the size of any pathoIogica1 growth, Iength of incision etc., as we11 as for fixation of siIkworm gut, to bring into cIose apposition the fascia Iayer, particuIarIy of the abdomina waI1; aIso in the cIosing of a wound foIIowing a radicIe mastectomy and in any other part of the body where siIkworm might be used. ADVANTAGES

A wound is easiIy cared for with the fascia anchors in pIace and the surgeon may use any technique in cIeaning wound when changing dressings, as there is no absorption of serum or puruIent discharge, as in the gauze, rubber and other things used, which cause fouI-smeIIing conditions. The fascia anchors eIiminate dead space of wounds, air bubbIes, assist in hemostasis, better apposition of wounds, with Iess fibrous tissue scar, aid in preventing postoperative wound opening, due to strain, etc. ; they aIso heIp to prevent postoperative hernia. It is not necessary to pIace siIkworm tight enough on fascia anchors to produce necrosis. The anchors prevent the cutting into tissue that so often occurs when tied over incision, causing discomfort to patient and aggravating the wound, increasing the tendency toward infection. TECHNIQUE

There

is nothing

mysterious

about

the *E#+

Anchor

American

JournaI of Surgery

283

use of these fascia anchors. The surgeon may use ordinary siIkworm, as he does in his everyday method to cIose the wound,

FIG. 3. Transverse section of Fig. 2. Silkworm strands pass through skin, subcutaneous tissue and fascia. Marked approximation gives Iess scar tissue as endresuIt.

using two strands in each needIe, in pIace of one, grasping the free ends with hemostats. The fascia anchors are passed between the doubIe strands on each side, tying one side, then the other, tying first the middIe doubIe strands, foIIowing with proxima1 and dista1 strands. If the strands are carefuIIy tied with gentIe approximation of waI1 Iayers, a spIendid apposition wiI1 be brought about, with sIight eIevation of incision between the anchors. Gauze may be pIaced beIow each end of fascia anchors to prevent pressure, and the gauze changed with dressing by gentIy Iifting the anchor ends with mousetooth thumb forceps or AIIis cIamp. It is advisabIe to use the fascia anchor just a IittIe Ionger than incision, as the pressure is much better equaIized. Two to three centimeters are a good distance to pIace fascia anchors IateraIIy to incision.