Stretching skin: undermining is more important than intraoperative expansion

Area of Science:

• Biomedical Engineering
• Dermatology
• Surgical Research

Background:

• Young piglets exhibit skin elasticity similar to humans, making them a suitable model for skin tension studies.
• Wound closure tension is a critical factor in surgical outcomes and patient recovery.

Purpose of the Study:

• To evaluate the efficacy of intraoperative expansion in reducing wound closure tension.
• To compare the effects of undermining versus intraoperative expansion on wound tension.
• To investigate the influence of wound location and undermining extent on closure tension.

Main Methods:

• Standardized wounds were created in 10 young pigs (average weight 11.5 kg).
• Wound closure tension was measured before and after undermining, and after intraoperative expansion.
• The effect of varying undermining extent (62 to 136 cm2) on tension was analyzed.

Main Results:

• Undermining significantly decreased wound closure tension (p < 0.0001).
• Intraoperative expansion did not yield a significant reduction in tension.
• Wound tension varied significantly based on location (back vs. belly, shoulder vs. hip).
• Increased undermining (up to 136 cm2) reduced tension, but further undermining showed no significant benefit.

Conclusions:

• In this porcine model, intraoperative expansion offers no significant advantage over simple undermining for reducing wound closure tension.
• The perceived benefits of intraoperative expansion may stem from increased undermining during expander placement.
• Wound tension is significantly influenced by anatomical location and the extent of tissue undermining.