Skin flap graft closure with modified negative pressure drainage: A new approach

Skin flap graft closure with modified negative pressure drainage: A new approach | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Skin flap graft closure with modified negative pressure drainage: A new approach Jiazhi Wang, Huacong Huang, Xiaoying Ye, Manzhao Ouyang, Jiaxuan Liu, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7233404/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Stoma closure is linked to a high occurrence rate of surgical site infections, and the most suitable incision closure method is still a matter of debate. This study compared the short - and long - term outcomes between conventional linear incision closure (CLIC) and skin flap graft closure (SFGC) combined with modified negative pressure drainage in enterostomy for ileostomy reduction. Methods : Data were prospectively collected from 65 patients who underwent stoma closure by CLIC or SFGC at a single institution between January 2022 and December 2023. Twelve independent clinical variables, including sex, age, body mass index, smoking habits, history of cardiopulmonary disease, history of diabetes, preoperative hemoglobin level, preoperative albumin level, American Society of Anesthesiologists (ASA) score, primary disease, initial surgical treatment, and duration of surgery, were examined using univariate and multivariate analyses. Results : There was no significant difference in the median operative time between the two groups. However, the postoperative incision infection rate (24.2% vs. 3.1%; P = 0.035) and the median hospital stay (9 days vs. 14 days; P = 0.035) were significantly lower in the SFGC group than in the CLIC group. Conclusion : This study revealed that the main complications associated with stoma closure after CLIC were incisional infection. SFGC with modified negative pressure drainage is superior to CLIC, leading to fewer incisional infections, shorter hospital stays, and a more aesthetically pleasing abdominal shape. Surgery skin flap graft closure modified negative pressure drainage surgery enterostomy reduction surgery Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction Enterostomy is a common procedure in gastrointestinal surgery and is extensively applied in treating prophylactic stomas for lower rectal cancer, intestinal perforation, and intestinal necrosis 1 . Clinically, for prophylactic ileocecal stomas, stoma closure is routinely carried out 3 months after the surgery. However, taking into account the long-term contact with intestinal contents, the presence of pathogenic microorganisms around the stoma, the high tension of the incision resulting from conventional linear incision closure (CLIC) of the abdominal incision, and the likelihood of causing scar hyperplasia, the postoperative infection rate of the incision after CLIC of the abdominal incision is quite high 2 , 3 . According to previous studies, incisional infection (II) is one of the most common postoperative complications 4 , 5 , and the II rate of CLIC after enterostomy reduction is 7.8–25.0% 6–8 . Skin flap graft closure (SFGC) is a classic procedure for superficial wound repair that involves less surgical trauma. However, its use in abdominal incision repair for ileostomy reduction has not yet been reported. The closure of the skin flap graft can effectively reduce the suture tension of the incision, produce good cosmetic results, and promote patient satisfaction with scarring 9 – 11 . Negative pressure drainage is widely used in superficial wound repair, especially in infected wounds, where continuous negative pressure drainage can significantly promote incision healing. Negative pressure drainage for incisions has mainly been associated with the center of negative pressure suction, which limits the patient's postoperative range of movement, affecting the patient's postoperative recovery of gastrointestinal function and increasing the risk of postoperative complications, which is not conducive to postoperative recovery 12 , 13 . Modified negative pressure drainage involves the use of inexpensive materials that are easy to carry, clean, and replaceable, and do not interfere with incision healing(Fig. 1). Based on previous studies, we hypothesized that subcutaneous SFGC with modified negative pressure drainage for repair of abdominal incisions in enterostomy reduction could reduce the tension of the incision and postoperative scar proliferation, improve the internal wound environment, and reduce the incidence of II. To test our hypothesis, we designed a clinical trial to explore II, the median hospital stay in patients treated with CLIC or SFGC. Methods Patients Between January 2022 and December 2023, 65 patients underwent enterostomy reduction surgery at our institution. This study was approved by the Ethics Committee of Shunde Hospital, Southern Medical University (First People’s Hospital of Shunde) (Review No. KYLS20220726). Written informed consent was obtained from all participants. The patients were divided into two groups according to surgical treatment. Thirty - three patients underwent CLIC. The remaining patients underwent SFGC with modified negative pressure drainage (Fig. 2). Patients with American Society of Anesthesiologists (ASA) grades I to II, aged 18–80 years, and having poor nutritional status, without tumor recurrence, metastasis, anastomotic stenosis, anastomotic fistula, or intestinal obstruction before surgery, were included in the study. In addition, the surgeries were performed 3 months after the first surgery. Patients with severe systemic abnormalities, such as cardiopulmonary disease, poor physical condition, and ASA grade III or IV disease, were excluded from the study. Patients who did not complete the surgery or experienced tumor recurrence or metastasis, anastomotic stenosis, anastomotic fistula, or intestinal obstruction before surgery were also excluded. The following data were prospectively collected: age, sex, body mass index (BMI), smoking habits, history of diabetes, history of cardiopulmonary disease, preoperative hemoglobin level, preoperative albumin level, ASA score, primary morbidities, initial surgical procedure, surgical duration14–19, and postoperative data, including hospital stay, duration of retention of the incisional drain, incisional suture removal, and surgical incision complications. To minimize potential differences in intestinal preparation, antibiotic prophylaxis, and surgical techniques, all patients underwent standard procedures. These included adequate enemas, proper intestinal anastomosis techniques, and systemic prophylactic administration of third - generation cephalosporin antibiotics preoperatively, 12 hours, and 24 hours postoperatively, carried out by surgeons with similar levels of experience. Independent variables Twelve independent clinical variables were analyzed. Characteristics assessed as categorical variables included sex (male or female), age (< 60 years, ≥ 60 years), body mass index (< 24, ≥ 24), smoking habits (smokers or nonsmokers), history of cardiopulmonary disease, history of diabetes, preoperative hemoglobin level (< 110 g/L, ≥ 110 g/L), preoperative albumin level (< 35 g/L, ≥ 35 g/L), ASA score, primary disease (intestinal malignancy or intestinal perforation), initial surgical treatment (ileostomy or colostomy), and duration of surgery (< 180 minutes, ≥ 180 minutes). Diabetes was defined as a preoperative HbA1c level ≥ 6.0%. Cardiopulmonary disease was defined as preoperative history of hypertension or chronic obstructive pulmonary disease (COPD). Dependent variables The results of interest were hospital stay; duration of retention of incisional drain retention; incisional suture removal; and surgical incision complications, including II, incisional bleeding. However, we ultimately focused on IIs because almost all complications during the study period were incisional. Briefly, the standard for II was infection at the incision site within 30 days after surgery, involving only the skin and subcutaneous tissues, and at least one of the following: purulent drainage from the incision, isolation of organisms from secretions of the incision, incisional pain or tenderness, localized swelling, redness, or heating, and incisional fissure. Surgical technique At admission, all patients underwent mechanical bowel preparation. Preoperatively, antibiotic prophylaxis was administered to all patients. Ceftazidime was administered intravenously 30 min before surgery, and another antibiotic was administered the day after surgery. All patients received general anesthesia. In the control group, a shuttle - shaped skin incision was made; in the experimental group, a circular skin incision was made, the diameter of the incision was measured with a ruler, and the diameter was used as the length to design a rhombic flap incision with an angle of 60°. The length - to - width ratio of the rhombic flap incision did not exceed 2:1. The stoma removal procedure consisted of partial bowel resection and intestinal anastomosis after bowel removal. Intestinal anastomosis was performed in vitro using functional end - to - end anastomosis. After flushing the abdominal cavity, the peritoneum was appropriately freed and the peritoneum and rectal sheath were closed continuously with absorbable sutures. To prevent surgical site infection, the peritoneum and rectus sheath were sutured and the subcutaneous tissues were repeatedly washed with hydrogen peroxide, saline, and amyl iodine III, and scrubbed with disposable cotton pads, and gloves were routinely changed. In the CLIC group, a conventional negative - pressure drainage bottle was placed under the incision site, the subcutaneous tissues were closed with interrupted 3 − 0 absorbable sutures, and the skin was closed with interrupted 4 − 0 silk sutures. In the SFGC group, a rhombic flap incision was designed before surgery and made along the design line until the rhombic flap was freed. The flap was then grafted to the defect area, and negative - pressure suction tubes were placed at both the upper and lower ends of the incision. The sides of the flap were then stung to observe the blood supply. The subcutaneous suture was closed with a 4 − 0 absorbable suture and the skin was closed with a 5 − 0 Prolene suture (Fig. 3). Statistical analysis: Statistical analyses were performed using SPSS version 22.0. Student's t test, the Mann‒Whitney U test, and the χ2 test were used to compare continuous and categorical variables as appropriate, with two - sided P < 0.05 indicating statistical significance. One - to - one matching was performed without replacement using a caliper width of 0.2 standard deviations of the logit of the estimated propensity score. After propensity score matching (PSM), the two matched groups were handled as unpaired independent groups. After univariate analysis, multivariate logistic regression analysis was performed using a stepwise (forward selection/backward elimination) method (significance level to enter = 0.15; significance level to stay = 0.1). Results A total of 65 patients underwent enterostomy reduction at our hospital. Thirty-three patients underwent CLIC, and the remaining 32 patients underwent SFGC with modified negative pressure drainage. There were no significant differences in characteristics, comorbidities, or risk factors, including sex, age, BMI, diabetes status, smoking history, cardiorespiratory disease status, ASA score, primary disease, initial surgical treatment, albumin level, and hemoglobin level, between the CLIC and SFGC groups(Table 1). There were no significant differences in the median operative duration between the two groups. Postoperative complications such as II rate (24.2 vs. 3.1%; P = 0.035) were comparable between the CLIC and SFGC groups (Table 2). The median hospital stay in the SFGC group (9 days) was shorter than that in the CLIC group (14 days; P = 0.035). The median duration of incisional drainage duration in the SFGC group was shorter (5 days) than that in the CLIC group (9 days; P = 0.031). II occurred after stoma closure in 9 (13.8%) of 65 patients. On univariate analysis, the II group and the non - II group were comparable with regard to sex (P = 0.485), age (≥ 60 years, P = 1.000), BMI (≥ 24, P = 0.282), diabetes (P = 0.137), smoking history (P = 0.175), cardiopulmonary disease (P = 0.105), serum albumin (< 35g/L, P = 1.000), hemoglobin (< 110g/L, P = 1.000), and incisions (CLIC, P = 0.035)(Table 3). Multivariate analyses revealed that only the type of incision (CLIC) was an independent risk factor for Type II(Table 4). Discussion In the past decade, our institution has conducted around 60 enterostomy reduction surgeries annually, and the incidence of incisional infection (II) has soared up to 20%. Multiple randomized controlled trials have revealed that patients undergoing skin flap graft closure (SFGC) have a substantially lower incidence of incisional infection compared to those receiving conventional linear incision closure (CLIC), with the II rate dropping to 3.1%. This finding underscores that enhancing the incision-closure method can bring about a statistically significant decline in the incidence of incisional infection. Notably, the SFGC group had significantly shorter hospital stays and a shorter duration of incision drain retention when contrasted with the CLIC group. Additionally, patients in the SFGC group expressed significantly greater satisfaction with the appearance of their scars than those in the CLIC group. In the experimental group, two instances of incisional capillary bleeding occurred, leading to persistent bleeding from the incisions. Immediately, we applied consistent pressure on the incisions and implemented standardized venous hemostasis protocols. Consequently, the incisions achieved grade A healing, and the patients were highly satisfied with the aesthetic outcome of the scars after treatment (Fig. 4). Moreover, there was one case of incisional infection (II) in the experimental group. This infection originated from fecal leakage during the operation, which inflicted bowel injury. Considering the patient's peritoneal adhesion situation, fecal leakage was identified as the primary culprit for the incisional infection in this particular case. Rather than reopening the surgical site for drainage, we employed two drainage tubes with constant negative pressure. This approach not only facilitated grade A healing but also ensured high patient satisfaction with the scars, highlighting a remarkable advantage of the skin flap graft closure (SFGC) technique (Fig. 5). Throughout the study, we persistently pursued the optimization of this surgical procedure. For example, we substituted double - tube drainage with single - tube drainage, opted for drainage through the incision rather than via a paracutaneous incision, and employed intradermal sutures instead of epidermal sutures for the incisions(Fig. 6). There was no substantial disparity between the pre - modified and modified procedures in terms of the incisional infection (II) rate and incisional bleeding rate. However, the modified procedure offered more pronounced benefits in terms of patient satisfaction with scarring. Additionally, it curbed the duration of the operation. Following a three - year follow - up, patients in the SFGC group exhibited markedly superior outcomes in terms of both wound scar hyperplasia and abdominal wall appearance compared to those in the CLIC group(Fig. 7). The limitation of this study is that it was conducted at a single medical institution in mainland China. However, the demand for temporary stomas for colorectal or rectoanal anastomosis is expected to increase, and SFGC surgery can be considered a routine stoma closure procedure in standard international surgeries. Furthermore, there were only 32 patients in the SFGC group, which was a small sample size. Thus, multicenter studies are needed to confirm that this technique can effectively reduce II after enterostomy. In conclusion, this study revealed that the main complications associated with stoma closure after CLIC were incisional infection. SFGC with modified negative pressure drainage is superior to CLIC, leading to fewer incisional infections, shorter hospital stays, and a more aesthetically pleasing abdominal shape. Declarations Funding This study was supported by the Foshan Science and Technology Bureau Program (Grant number 2320001008775). Consent to Participate Statement In this study, all patients were fully informed of the study's purpose, methods, potential risks, and expected benefits. After understanding the relevant information, the patients voluntarily participated in this study and signed written informed consent forms. This study adhered to the ethical standards stipulated in the Declaration of Helsinki and its subsequent revisions, and it was approved by the Ethics Committee of the Shunde Hospital of Southern Medical University (No. KYLS20220726). During the study, we strictly protected the patients' privacy and personal information, and all data were anonymized. References Tan WS, Tang CL, Shi L, Eu KW (2009) Meta-analysis of defunctioning stoma in low anterior resection for rectal cancer. Br J Surg 96:462–472 Kaidar-Person O, Person B, Wexner SD (2005) Complications of construction and closure of temporary loop ileostomy. J Am Coll Surg 201:759–773 Pokorny H, Herkner H, Jakesz R, Herbst F (2005) Mortality and complications after stoma closure. Arch Surg 140:956e960 Akiyoshi T, Fujimoto Y, Konishi T, Kuroyanagi H, Ueno M, Oya M, Yamaguchi T (2010) Complications of loop ileostomy closure in patients with rectal tumor. World J Surg 34:1937–1942 Yamamoto M, Tanaka K, Masubuchi S, Ishii M, Hamamoto H, Suzuki S, Ueda Y, Okuda J, Uchiyama K (2018) Risk factors for surgical site infection after stoma closure comparison between pursestring wound closure and conventional linear wound closure:propensity score matching analysis. Am J Surg 215:58–61 Kaiser AM, Israelit S, Klastenfeld D, Selvindoss P, Vukasin P, Ault G, Beart RW (2008) Morbidity of ostomy takedown. J Gastrointest Surg 12:437–441 Li LT, Brahmbhatt R, Hicks SC, Davila JA, Berger DH, Liang MK (2014) Prevalence of surgical site infection at the stoma site following four skin closure techniques: a retrospective cohort study. Dig Surg 31:73–78 Berne TV, Griffith CN, Hill J, LoGuidice P (1985) Colostomy wound closure. Arch Surg 120:957–959 Reid K, Pockney P, Pollitt T, Draganic B, Smith SR (2010) Randomized clinical trial of short-term outcomes following purse-string versus conventional closure of ileostomy wounds. Br J Surg 97:1511–1517 Camacho-Mauries D, Rodriguez-Díaz JL, Salgado-Nesme N, González QH, Vergara-Fernández O (2013) Randomized clinical trial of intestinal ostomy takedown comparing pursestring wound closure vs conventional closure to eliminate the risk of wound infection. Dis Colon Rectum 56:205–211 Lee JT, Marquez TT, Clerc D, Gie O, Demartines N, Madoff RD, Rothenberger DA, Christoforidis D (2014) Pursestring closure of the stoma site leads to fewer wound infections: results from a multicenter randomized controlled trial. Dis Colon Rectum 57:1282–1289 Willy C, Agarwal A, Andersen CA, Santis G, Gabriel A, Grauhan O, Guerra OM, Lipsky BA, Malas MB, Mathiesen LL, Singh DP, Reddy VS (2017) Closed incision negative pressure therapy: international multidisciplinary consensus recommendations. Int Wound J 14:385–398 Norman G, Shi CH, Goh EL, Murphy EM, Reid A, Chiverton L, Stankiewicz M, Dumville JC (2022) Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev 4:CD009261 Sharma A, Deeb AP, Rickles AS, Iannuzzi JC, Monson JR, Fleming FJ (2013) Closure of defunctioning loop ileostomy is associated with considerable morbidity. Colorectal Dis 15:458–462 Poskus E, Kildusis E, Smolskas E, Ambrazevicius M, Strupas K (2014) Complications after loop ileostomy closure:A retrospective analysis of 132 patients. Viszeralmedizin 30:276–280 Man VC, Choi HK, Law WL, Foo DC (2016) Morbidities after closure of ileostomy:analysis of risk factors. Int J Colorectal Dis 31:51–57 Saito Y, Takakura Y, Hinoi T, Egi H, Tashiro H, Ohdan H (2014) Body mass index as a predictor of postoperative complications in loop ileostomy closure after rectal resection in Japanese patients. Hiroshima J Med Sci 63:33–38 Martin ET, Kaye KS, Knott C, Nguyen H, Santarossa M, Evans R, Bertran E, Jaber L (2016) Diabetes and Risk of Surgical Site Infection: A Systematic Review and Meta-analysis. Infect Control Hosp Epidemiol 37(1):88–99 Nakamura T, Sato T, Naito M, Yamanashi T, Miura H, Tsutsui A, Watanabe M (2017) Risk factors for complications after diverting ileostomy closure in patients who have undergone rectal cancer surgery. Surg Today 47:1238–1242 Austin PC (2009) Some methods of propensity-score matching had superior performance to others: results of an empirical investigation and Monte Carlo simulations. Biom J 51:171–184 Tables Table 1 . Characteristics of 65 patients who underwent CLIC or SFGC. Variables CLIC (n=33) SFGC (n=32) P value Sex 0.722 Male 25 23 Female 8 9 Age (years) 0.934 < 60 10 10 ≥60 23 22 Body mass index (kg/ m 2 ) 0.485 < 24 28 25 ≥24 5 7 Smoking habits 0.924 Yes 21 20 No 12 12 Diabetes 1.000 Yes 3 2 No 30 30 Cardiopulmonary disease (HTN or COPD) 0.051 Yes 16 8 No 17 24 ASA score 0.934 1 10 10 2 23 22 3 0 0 Primary 0.492 Carcinoma 20 22 Perforation 13 10 Primary surgery 0.085 Ileostomy 18 24 Colostomy 15 8 Duration of operation (min) 0.883 < 180 19 19 ≥180 14 13 Serum albumin concentration (g/L) 0.515 < 35 15 12 ≥35 18 20 Hemoglobin concentration (g/L) 0.485 < 110 28 25 ≥110 5 7 CLIC, conventional linear incision closure; SFGC, skin flap graft closure; HTN, hypertension; COPD, chronic obstructive pulmonary disease. Table 2. Postoperative results of the CLIC and SFGC surgeries. Variables CLIC (n=33) SFGC (n=32) P Incisional infection 8 1 0.035 Hospital stay (days) 14 9 0.035 Incisional drainage stay (days) 9 5 0.031 CLIC: conventional linear incision closure; SFGC: skin flap graft closure. Table 3 . Univariate analysis of risk factors for incisional infection. Variables II (n=9) non-II (n=56) P Sex (male/female) 8:1 40:16 0.485 Age (years) (≥60) (%) 66.7(6/9) 69.6(39/56) 1.000 Body mass index (kg/m 2 ) (≥24) (%) 0(0/9) 21.4(12/56) 0.282 Smoking habits (%) 88.9(8/9) 58.9(33/56) 0.175 Diabetes (%) 22.2(2/9) 5.4(3/56) 0.137 Cardiopulmonary disease (HTN or COPD) (%) 66.7(6/9) 32.1(18/56) 0.105 ASA score ( ≥ III) (%) 0(0/9) 0(0/56) — Serum albumin concentration (g/L) (<35) (%) 44.4(4/9) 41.1(23/56) 1.000 Hemoglobin concentration (g/L) (<110) (%) 77.8(7/9) 82.1(46/56) 1.000 Incision (CLIC) (%) 88.9(8/9) 44.6(25/56) 0.035 II, incisional infection; ASA, American Society of Anesthesiologists; CLIC, conventional linear incision closure. Table 4. Multivariate analysis of risk factors for incisional infection. II risk factors Odds ratio 95% CI P Cardiopulmonary disease (HTN or COPD) (%) 2.86 0.41-19.81 0.205 Incision (CLIC) (%) 4.04 1.34-12.91 0.038 II: incisional infection, 95% CI: 95% confidence interval. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7233404","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":491958251,"identity":"b9f4a57c-959f-47c9-a79d-9bdf420d2a35","order_by":0,"name":"Jiazhi Wang","email":"","orcid":"","institution":"The Eighth Affiliated Hospital of Southern Medical University (The First People’s Hospital of Shunde)","correspondingAuthor":false,"prefix":"","firstName":"Jiazhi","middleName":"","lastName":"Wang","suffix":""},{"id":491958252,"identity":"356c78f2-d401-476d-b322-e60ae75bcda7","order_by":1,"name":"Huacong 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version.\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-7233404/v1/2e2e17b5025c06fc8b9598af.png"},{"id":87901099,"identity":"e941b779-b5b1-4499-bc8d-c0881cde8a0a","added_by":"auto","created_at":"2025-07-30 08:15:12","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":5105271,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"Figure6.png","url":"https://assets-eu.researchsquare.com/files/rs-7233404/v1/19fded4cd18d5070243f7b41.png"},{"id":87901100,"identity":"21722f46-c11a-447a-9806-e0df2bb4c518","added_by":"auto","created_at":"2025-07-30 08:15:12","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":1364369,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"Figure7.png","url":"https://assets-eu.researchsquare.com/files/rs-7233404/v1/13558b90f852514362e54aaf.png"},{"id":87903367,"identity":"fe9b8e22-2c99-4ca2-a7f9-16494511129d","added_by":"auto","created_at":"2025-07-30 08:31:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":33562300,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7233404/v1/f37b716f-460d-4a5f-bd49-7c711e6f4fe2.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eSkin flap graft closure with modified negative pressure drainage: A new approach","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEnterostomy is a common procedure in gastrointestinal surgery and is extensively applied in treating prophylactic stomas for lower rectal cancer, intestinal perforation, and intestinal necrosis\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Clinically, for prophylactic ileocecal stomas, stoma closure is routinely carried out 3 months after the surgery. However, taking into account the long-term contact with intestinal contents, the presence of pathogenic microorganisms around the stoma, the high tension of the incision resulting from conventional linear incision closure (CLIC) of the abdominal incision, and the likelihood of causing scar hyperplasia, the postoperative infection rate of the incision after CLIC of the abdominal incision is quite high\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. According to previous studies, incisional infection (II) is one of the most common postoperative complications\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e, and the II rate of CLIC after enterostomy reduction is 7.8–25.0%\u003csup\u003e6–8\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eSkin flap graft closure (SFGC) is a classic procedure for superficial wound repair that involves less surgical trauma. However, its use in abdominal incision repair for ileostomy reduction has not yet been reported. The closure of the skin flap graft can effectively reduce the suture tension of the incision, produce good cosmetic results, and promote patient satisfaction with scarring\u003csup\u003e\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e–\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Negative pressure drainage is widely used in superficial wound repair, especially in infected wounds, where continuous negative pressure drainage can significantly promote incision healing. Negative pressure drainage for incisions has mainly been associated with the center of negative pressure suction, which limits the patient's postoperative range of movement, affecting the patient's postoperative recovery of gastrointestinal function and increasing the risk of postoperative complications, which is not conducive to postoperative recovery\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Modified negative pressure drainage involves the use of inexpensive materials that are easy to carry, clean, and replaceable, and do not interfere with incision healing(Fig.\u0026nbsp;1).\u003c/p\u003e\u003cp\u003eBased on previous studies, we hypothesized that subcutaneous SFGC with modified negative pressure drainage for repair of abdominal incisions in enterostomy reduction could reduce the tension of the incision and postoperative scar proliferation, improve the internal wound environment, and reduce the incidence of II. To test our hypothesis, we designed a clinical trial to explore II, the median hospital stay in patients treated with CLIC or SFGC.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003ePatients\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBetween January 2022 and December 2023, 65 patients underwent enterostomy reduction surgery at our institution. This study was approved by the Ethics Committee of Shunde Hospital, Southern Medical University (First People’s Hospital of Shunde) (Review No. KYLS20220726). Written informed consent was obtained from all participants. The patients were divided into two groups according to surgical treatment. Thirty - three patients underwent CLIC. The remaining patients underwent SFGC with modified negative pressure drainage (Fig.\u0026nbsp;2).\u003c/p\u003e\u003cp\u003ePatients with American Society of Anesthesiologists (ASA) grades I to II, aged 18–80 years, and having poor nutritional status, without tumor recurrence, metastasis, anastomotic stenosis, anastomotic fistula, or intestinal obstruction before surgery, were included in the study. In addition, the surgeries were performed 3 months after the first surgery. Patients with severe systemic abnormalities, such as cardiopulmonary disease, poor physical condition, and ASA grade III or IV disease, were excluded from the study. Patients who did not complete the surgery or experienced tumor recurrence or metastasis, anastomotic stenosis, anastomotic fistula, or intestinal obstruction before surgery were also excluded.\u003c/p\u003e\u003cp\u003eThe following data were prospectively collected: age, sex, body mass index (BMI), smoking habits, history of diabetes, history of cardiopulmonary disease, preoperative hemoglobin level, preoperative albumin level, ASA score, primary morbidities, initial surgical procedure, surgical duration14–19, and postoperative data, including hospital stay, duration of retention of the incisional drain, incisional suture removal, and surgical incision complications. To minimize potential differences in intestinal preparation, antibiotic prophylaxis, and surgical techniques, all patients underwent standard procedures. These included adequate enemas, proper intestinal anastomosis techniques, and systemic prophylactic administration of third - generation cephalosporin antibiotics preoperatively, 12 hours, and 24 hours postoperatively, carried out by surgeons with similar levels of experience.\u003c/p\u003e\u003cp\u003e\u003cb\u003eIndependent variables\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTwelve independent clinical variables were analyzed. Characteristics assessed as categorical variables included sex (male or female), age (\u0026lt; 60 years, ≥ 60 years), body mass index (\u0026lt; 24, ≥ 24), smoking habits (smokers or nonsmokers), history of cardiopulmonary disease, history of diabetes, preoperative hemoglobin level (\u0026lt; 110 g/L, ≥ 110 g/L), preoperative albumin level (\u0026lt; 35 g/L, ≥ 35 g/L), ASA score, primary disease (intestinal malignancy or intestinal perforation), initial surgical treatment (ileostomy or colostomy), and duration of surgery (\u0026lt; 180 minutes, ≥ 180 minutes). Diabetes was defined as a preoperative HbA1c level ≥ 6.0%. Cardiopulmonary disease was defined as preoperative history of hypertension or chronic obstructive pulmonary disease (COPD).\u003c/p\u003e\u003cp\u003e\u003cb\u003eDependent variables\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe results of interest were hospital stay; duration of retention of incisional drain retention; incisional suture removal; and surgical incision complications, including II, incisional bleeding. However, we ultimately focused on IIs because almost all complications during the study period were incisional. Briefly, the standard for II was infection at the incision site within 30 days after surgery, involving only the skin and subcutaneous tissues, and at least one of the following: purulent drainage from the incision, isolation of organisms from secretions of the incision, incisional pain or tenderness, localized swelling, redness, or heating, and incisional fissure.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSurgical technique\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAt admission, all patients underwent mechanical bowel preparation. Preoperatively, antibiotic prophylaxis was administered to all patients. Ceftazidime was administered intravenously 30 min before surgery, and another antibiotic was administered the day after surgery. All patients received general anesthesia. In the control group, a shuttle - shaped skin incision was made; in the experimental group, a circular skin incision was made, the diameter of the incision was measured with a ruler, and the diameter was used as the length to design a rhombic flap incision with an angle of 60°. The length - to - width ratio of the rhombic flap incision did not exceed 2:1. The stoma removal procedure consisted of partial bowel resection and intestinal anastomosis after bowel removal. Intestinal anastomosis was performed in vitro using functional end - to - end anastomosis. After flushing the abdominal cavity, the peritoneum was appropriately freed and the peritoneum and rectal sheath were closed continuously with absorbable sutures. To prevent surgical site infection, the peritoneum and rectus sheath were sutured and the subcutaneous tissues were repeatedly washed with hydrogen peroxide, saline, and amyl iodine III, and scrubbed with disposable cotton pads, and gloves were routinely changed. In the CLIC group, a conventional negative - pressure drainage bottle was placed under the incision site, the subcutaneous tissues were closed with interrupted 3 − 0 absorbable sutures, and the skin was closed with interrupted 4 − 0 silk sutures. In the SFGC group, a rhombic flap incision was designed before surgery and made along the design line until the rhombic flap was freed. The flap was then grafted to the defect area, and negative - pressure suction tubes were placed at both the upper and lower ends of the incision. The sides of the flap were then stung to observe the blood supply. The subcutaneous suture was closed with a 4 − 0 absorbable suture and the skin was closed with a 5 − 0 Prolene suture (Fig.\u0026nbsp;3).\u003c/p\u003e\u003ch2\u003eStatistical analysis:\u003c/h2\u003e\u003cp\u003eStatistical analyses were performed using SPSS version 22.0. Student's t test, the Mann‒Whitney U test, and the χ2 test were used to compare continuous and categorical variables as appropriate, with two - sided P \u0026lt; 0.05 indicating statistical significance. One - to - one matching was performed without replacement using a caliper width of 0.2 standard deviations of the logit of the estimated propensity score. After propensity score matching (PSM), the two matched groups were handled as unpaired independent groups. After univariate analysis, multivariate logistic regression analysis was performed using a stepwise (forward selection/backward elimination) method (significance level to enter = 0.15; significance level to stay = 0.1).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 65 patients underwent enterostomy reduction at our hospital. Thirty-three patients underwent CLIC, and the remaining 32 patients underwent SFGC with modified negative pressure drainage. There were no significant differences in characteristics, comorbidities, or risk factors, including sex, age, BMI, diabetes status, smoking history, cardiorespiratory disease status, ASA score, primary disease, initial surgical treatment, albumin level, and hemoglobin level, between the CLIC and SFGC groups(Table\u0026nbsp;1). There were no significant differences in the median operative duration between the two groups. Postoperative complications such as II rate (24.2 vs. 3.1%; P\u0026thinsp;=\u0026thinsp;0.035) were comparable between the CLIC and SFGC groups (Table\u0026nbsp;2). The median hospital stay in the SFGC group (9 days) was shorter than that in the CLIC group (14 days; P\u0026thinsp;=\u0026thinsp;0.035). The median duration of incisional drainage duration in the SFGC group was shorter (5 days) than that in the CLIC group (9 days; P\u0026thinsp;=\u0026thinsp;0.031). II occurred after stoma closure in 9 (13.8%) of 65 patients. On univariate analysis, the II group and the non - II group were comparable with regard to sex (P\u0026thinsp;=\u0026thinsp;0.485), age (\u0026ge;\u0026thinsp;60 years, P\u0026thinsp;=\u0026thinsp;1.000), BMI (\u0026ge;\u0026thinsp;24, P\u0026thinsp;=\u0026thinsp;0.282), diabetes (P\u0026thinsp;=\u0026thinsp;0.137), smoking history (P\u0026thinsp;=\u0026thinsp;0.175), cardiopulmonary disease (P\u0026thinsp;=\u0026thinsp;0.105), serum albumin (\u0026lt;\u0026thinsp;35g/L, P\u0026thinsp;=\u0026thinsp;1.000), hemoglobin (\u0026lt;\u0026thinsp;110g/L, P\u0026thinsp;=\u0026thinsp;1.000), and incisions (CLIC, P\u0026thinsp;=\u0026thinsp;0.035)(Table\u0026nbsp;3). Multivariate analyses revealed that only the type of incision (CLIC) was an independent risk factor for Type II(Table\u0026nbsp;4).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the past decade, our institution has conducted around 60 enterostomy reduction surgeries annually, and the incidence of incisional infection (II) has soared up to 20%. Multiple randomized controlled trials have revealed that patients undergoing skin flap graft closure (SFGC) have a substantially lower incidence of incisional infection compared to those receiving conventional linear incision closure (CLIC), with the II rate dropping to 3.1%. This finding underscores that enhancing the incision-closure method can bring about a statistically significant decline in the incidence of incisional infection. Notably, the SFGC group had significantly shorter hospital stays and a shorter duration of incision drain retention when contrasted with the CLIC group. Additionally, patients in the SFGC group expressed significantly greater satisfaction with the appearance of their scars than those in the CLIC group.\u003c/p\u003e\u003cp\u003eIn the experimental group, two instances of incisional capillary bleeding occurred, leading to persistent bleeding from the incisions. Immediately, we applied consistent pressure on the incisions and implemented standardized venous hemostasis protocols. Consequently, the incisions achieved grade A healing, and the patients were highly satisfied with the aesthetic outcome of the scars after treatment (Fig.\u0026nbsp;4). Moreover, there was one case of incisional infection (II) in the experimental group. This infection originated from fecal leakage during the operation, which inflicted bowel injury. Considering the patient's peritoneal adhesion situation, fecal leakage was identified as the primary culprit for the incisional infection in this particular case. Rather than reopening the surgical site for drainage, we employed two drainage tubes with constant negative pressure. This approach not only facilitated grade A healing but also ensured high patient satisfaction with the scars, highlighting a remarkable advantage of the skin flap graft closure (SFGC) technique (Fig.\u0026nbsp;5). Throughout the study, we persistently pursued the optimization of this surgical procedure. For example, we substituted double - tube drainage with single - tube drainage, opted for drainage through the incision rather than via a paracutaneous incision, and employed intradermal sutures instead of epidermal sutures for the incisions(Fig.\u0026nbsp;6). There was no substantial disparity between the pre - modified and modified procedures in terms of the incisional infection (II) rate and incisional bleeding rate. However, the modified procedure offered more pronounced benefits in terms of patient satisfaction with scarring. Additionally, it curbed the duration of the operation. Following a three - year follow - up, patients in the SFGC group exhibited markedly superior outcomes in terms of both wound scar hyperplasia and abdominal wall appearance compared to those in the CLIC group(Fig.\u0026nbsp;7).\u003c/p\u003e\u003cp\u003eThe limitation of this study is that it was conducted at a single medical institution in mainland China. However, the demand for temporary stomas for colorectal or rectoanal anastomosis is expected to increase, and SFGC surgery can be considered a routine stoma closure procedure in standard international surgeries. Furthermore, there were only 32 patients in the SFGC group, which was a small sample size. Thus, multicenter studies are needed to confirm that this technique can effectively reduce II after enterostomy.\u003c/p\u003e\u003cp\u003eIn conclusion, this study revealed that the main complications associated with stoma closure after CLIC were incisional infection. SFGC with modified negative pressure drainage is superior to CLIC, leading to fewer incisional infections, shorter hospital stays, and a more aesthetically pleasing abdominal shape.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Foshan\u0026nbsp;Science and Technology Bureau Program (Grant number 2320001008775).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, all patients were fully informed of the study\u0026apos;s purpose, methods, potential risks, and expected benefits. After understanding the relevant information, the patients voluntarily participated in this study and signed written informed consent forms. This study adhered to the ethical standards stipulated in the Declaration of Helsinki and its subsequent revisions, and it was approved by the Ethics Committee of the Shunde Hospital of Southern Medical University (No. KYLS20220726). During the study, we strictly protected the patients\u0026apos; privacy and personal information, and all data were anonymized.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTan WS, Tang CL, Shi L, Eu KW (2009) Meta-analysis of defunctioning stoma in low anterior resection for rectal cancer. Br J Surg 96:462\u0026ndash;472\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaidar-Person O, Person B, Wexner SD (2005) Complications of construction and closure of temporary loop ileostomy. J Am Coll Surg 201:759\u0026ndash;773\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePokorny H, Herkner H, Jakesz R, Herbst F (2005) Mortality and complications after stoma closure. Arch Surg 140:956e960\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAkiyoshi T, Fujimoto Y, Konishi T, Kuroyanagi H, Ueno M, Oya M, Yamaguchi T (2010) Complications of loop ileostomy closure in patients with rectal tumor. World J Surg 34:1937\u0026ndash;1942\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYamamoto M, Tanaka K, Masubuchi S, Ishii M, Hamamoto H, Suzuki S, Ueda Y, Okuda J, Uchiyama K (2018) Risk factors for surgical site infection after stoma closure comparison between pursestring wound closure and conventional linear wound closure:propensity score matching analysis. Am J Surg 215:58\u0026ndash;61\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaiser AM, Israelit S, Klastenfeld D, Selvindoss P, Vukasin P, Ault G, Beart RW (2008) Morbidity of ostomy takedown. J Gastrointest Surg 12:437\u0026ndash;441\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi LT, Brahmbhatt R, Hicks SC, Davila JA, Berger DH, Liang MK (2014) Prevalence of surgical site infection at the stoma site following four skin closure techniques: a retrospective cohort study. Dig Surg 31:73\u0026ndash;78\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBerne TV, Griffith CN, Hill J, LoGuidice P (1985) Colostomy wound closure. Arch Surg 120:957\u0026ndash;959\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eReid K, Pockney P, Pollitt T, Draganic B, Smith SR (2010) Randomized clinical trial of short-term outcomes following purse-string versus conventional closure of ileostomy wounds. Br J Surg 97:1511\u0026ndash;1517\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCamacho-Mauries D, Rodriguez-D\u0026iacute;az JL, Salgado-Nesme N, Gonz\u0026aacute;lez QH, Vergara-Fern\u0026aacute;ndez O (2013) Randomized clinical trial of intestinal ostomy takedown comparing pursestring wound closure vs conventional closure to eliminate the risk of wound infection. Dis Colon Rectum 56:205\u0026ndash;211\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee JT, Marquez TT, Clerc D, Gie O, Demartines N, Madoff RD, Rothenberger DA, Christoforidis D (2014) Pursestring closure of the stoma site leads to fewer wound infections: results from a multicenter randomized controlled trial. 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Hiroshima J Med Sci 63:33\u0026ndash;38\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMartin ET, Kaye KS, Knott C, Nguyen H, Santarossa M, Evans R, Bertran E, Jaber L (2016) Diabetes and Risk of Surgical Site Infection: A Systematic Review and Meta-analysis. Infect Control Hosp Epidemiol 37(1):88\u0026ndash;99\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNakamura T, Sato T, Naito M, Yamanashi T, Miura H, Tsutsui A, Watanabe M (2017) Risk factors for complications after diverting ileostomy closure in patients who have undergone rectal cancer surgery. Surg Today 47:1238\u0026ndash;1242\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAustin PC (2009) Some methods of propensity-score matching had superior performance to others: results of an empirical investigation and Monte Carlo simulations. Biom J 51:171\u0026ndash;184\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;1\u003c/strong\u003e. Characteristics of 65 patients who underwent CLIC or SFGC.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"591\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCLIC (n=33)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSFGC (n=32)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e0.722\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Male\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Female\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e0.934\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026lt;\u003c/strong\u003e\u003cstrong\u003e60\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u0026ge;60\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBody mass index (kg/\u003c/strong\u003e\u003cstrong\u003em\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026lt;\u003c/strong\u003e\u003cstrong\u003e24\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u0026ge;24\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking habits\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e0.924\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Yes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;No\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Yes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;No\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCardiopulmonary disease (HTN or COPD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Yes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;No\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASA score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e0.934\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrimary\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e0.492\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCarcinoma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Perforation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrimary surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Ileostomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Colostomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of operation (min)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e0.883\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026lt;\u003c/strong\u003e\u003cstrong\u003e180\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u0026ge;180\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eSerum albumin\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;concentration\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(g/L)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e0.515\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u003c/strong\u003e\u003cstrong\u003e35\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge;35\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHemoglobin concentration\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(g/L)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u003c/strong\u003e\u003cstrong\u003e110\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 36.8866%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u0026ge;110\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2115%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8122%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0897%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCLIC, conventional linear incision closure; SFGC, skin flap graft closure; HTN, hypertension; COPD, chronic obstructive pulmonary disease.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;2.\u003c/strong\u003e Postoperative results of the CLIC and SFGC surgeries.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"553\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.0597%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.5823%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCLIC (n=33)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1573%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSFGC (n=32)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2007%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.0597%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncisional infection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.5823%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1573%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2007%;\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.0597%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital stay (days)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.5823%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1573%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2007%;\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.0597%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncisional drainage stay (days)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.5823%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.1573%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.2007%;\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCLIC: conventional linear incision closure; SFGC: skin flap graft closure.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;3\u003c/strong\u003e. Univariate analysis of risk factors for incisional infection.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"561\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56.5062%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eII (n=9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e\u003cstrong\u003enon-II (n=56)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.1604%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56.5062%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex (male/female)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e8:1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e40:16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.1604%;\"\u003e\n \u003cp\u003e0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56.5062%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years) (\u0026ge;60) (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e66.7(6/9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e69.6(39/56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.1604%;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56.5062%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBody mass index (kg/m\u003csup\u003e2\u003c/sup\u003e) (\u0026ge;24) (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e0(0/9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e21.4(12/56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.1604%;\"\u003e\n \u003cp\u003e0.282\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56.5062%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking habits (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e88.9(8/9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e58.9(33/56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.1604%;\"\u003e\n \u003cp\u003e0.175\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56.5062%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e22.2(2/9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e5.4(3/56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.1604%;\"\u003e\n \u003cp\u003e0.137\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56.5062%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCardiopulmonary disease (HTN or COPD) (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e66.7(6/9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e32.1(18/56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.1604%;\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56.5062%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASA score (\u003c/strong\u003e\u003cstrong\u003e\u0026ge;\u003c/strong\u003e\u003cstrong\u003eIII) (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e0(0/9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e0(0/56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.1604%;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56.5062%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSerum albumin concentration\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(g/L) (\u0026lt;35) (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e44.4(4/9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e41.1(23/56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.1604%;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56.5062%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHemoglobin concentration\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(g/L) (\u0026lt;110) (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e77.8(7/9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e82.1(46/56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.1604%;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56.5062%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncision (CLIC) (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e88.9(8/9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e44.6(25/56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.1604%;\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eII,\u0026nbsp;incisional infection; ASA, American Society of Anesthesiologists; CLIC, conventional linear incision closure.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e4.\u003c/strong\u003e Multivariate analysis of risk factors for incisional infection.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"567\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56.7901%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eII risk factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3439%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOdds ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.284%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.582%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56.7901%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCardiopulmonary disease (HTN or COPD) (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3439%;\"\u003e\n \u003cp\u003e2.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.284%;\"\u003e\n \u003cp\u003e0.41-19.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.582%;\"\u003e\n \u003cp\u003e0.205\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56.7901%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncision (CLIC) (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3439%;\"\u003e\n \u003cp\u003e4.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.284%;\"\u003e\n \u003cp\u003e1.34-12.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.582%;\"\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eII: incisional infection, 95% CI: 95% confidence interval.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Foshan Science and Technology Bureau Program ","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"skin flap graft closure, modified negative pressure drainage, surgery, enterostomy reduction surgery","lastPublishedDoi":"10.21203/rs.3.rs-7233404/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7233404/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Stoma closure is linked to a high occurrence rate of surgical site infections, and the most suitable incision closure method is still a matter of debate. This study compared the short - and long - term outcomes between conventional linear incision closure (CLIC) and skin flap graft closure (SFGC) combined with modified negative pressure drainage in enterostomy for ileostomy reduction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Data were prospectively collected from 65 patients who underwent stoma closure by CLIC or SFGC at a single institution between January 2022 and December 2023. Twelve independent clinical variables, including sex, age, body mass index, smoking habits, history of cardiopulmonary disease, history of diabetes, preoperative hemoglobin level, preoperative albumin level, American Society of Anesthesiologists (ASA) score, primary disease, initial surgical treatment, and duration of surgery, were examined using univariate and multivariate analyses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: There was no significant difference in the median operative time between the two groups. However, the postoperative incision infection rate (24.2% vs. 3.1%; P = 0.035) and the median hospital stay (9 days vs. 14 days; P = 0.035) were significantly lower in the SFGC group than in the CLIC group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: This study revealed that the main complications associated with stoma closure after CLIC were incisional infection. SFGC with modified negative pressure drainage is superior to CLIC, leading to fewer incisional infections, shorter hospital stays, and a more aesthetically pleasing abdominal shape.\u003c/p\u003e","manuscriptTitle":"Skin flap graft closure with modified negative pressure drainage: A new approach","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-30 08:15:06","doi":"10.21203/rs.3.rs-7233404/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cddcee5d-36a5-4fd7-a911-44e3d4d2b1d3","owner":[],"postedDate":"July 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":52231113,"name":"Surgery"}],"tags":[],"updatedAt":"2025-07-30T08:15:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-30 08:15:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7233404","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7233404","identity":"rs-7233404","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}