Clinical Image
A 23-year-old African woman with a large incisional hernia was managed by the Jenkin’s ‘mass closure’ suture repair technique with good outcome (figures 1,2). Primary fascia closure following its search restores the linea alba ( anterior and posterior rectus sheath) and realigns the rectus muscles, and places the abdominal wall muscles under the physiological tension needed for optimal function [1, 2]. The Jenkin’s ‘mass closure’ technique uses a continuous non-absorbable 1-0 nylon suture of a 4-1 suture wound length ratio and in taking big bites of the fascia produces a concertina that creates minimal tension in the deep tissues especially when the wound is stretched in the early post-operative period as the patient coughs and the abdomen is distended [1]. Although the mesh repair of incisional hernia may give best result, the Jenkin’s ‘mass closure’ technique will also allow a ‘cement’ nature of healing similar to mesh. In addition, a bridged repair in which a mesh spans the unclosed fascial defect of the hernia would result in poor function of the abdominal wall. The suture repair technique is known to have a high failure rate if primary fascial closure is not done [2].