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Reducing Wound Tension with Undermining or Imbrication-Do They Work?

Naveen M Krishnan1, Benjamin J Brown1, Steven P Davison1

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Wound undermining is superior to imbrication for primary wound closure, as it reduces skin tension while preserving greater dermal perfusion. This technique should be preferred by surgeons.

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Area of Science:

  • Surgical techniques
  • Wound healing
  • Dermal perfusion

Background:

  • Achieving tension-free primary wound closure is crucial for noncolonized wounds.
  • Surgeons debate whether tissue imbrication or undermining better reduces tension and preserves dermal perfusion.
  • This study compares these two closure methods.

Purpose of the Study:

  • To determine which surgical technique, undermining or imbrication, more reliably reduces wound tension.
  • To assess which technique better preserves dermal perfusion at the wound edge.

Main Methods:

  • Full thickness wounds were created in Duroc swine.
  • Wound tension was measured using a Tyrolean tensiometer.
  • Dermal perfusion was assessed with a speckle contrast imager.

Main Results:

  • Both undermining and imbrication significantly reduced wound tension compared to raw tension.
  • No significant difference in tension reduction was found between undermining and imbrication.
  • Both techniques significantly reduced dermal perfusion, with a greater relative decrease observed with imbrication.

Conclusions:

  • Neither undermining nor imbrication significantly differed in reducing wound tension.
  • Both techniques decreased dermal perfusion, but undermining resulted in greater relative dermal perfusion.
  • Wound undermining is recommended over imbrication for standard primary wound closure due to better perfusion preservation.