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Measuring Forces in Suture Techniques for Wound Closure.

Nick Marsidi¹, Sofieke A M Vermeulen¹, Tim Horeman²

¹Department of Dermatology, Leiden University Medical Center, Leiden, ZA, the Netherlands.

The Journal of Surgical Research

|June 17, 2020

Summary

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The pulley suture technique requires less pulling force than other methods for wound closure. Understanding suture mechanics is crucial for preventing complications like dehiscence and infection.

Area of Science:

Dermatology
Surgical Techniques
Biomechanical Analysis

Background:

Sutures are primary for wound closure, but improper technique can impair healing.
High-tension wound management lacks detailed mechanical property data for various suture techniques.
Preventable complications include dehiscence, infection, and ischemic necrosis due to excessive tension.

Purpose of the Study:

To compare the forces exerted by five common suture techniques.
To evaluate these forces within a standardized wound tension model.
To provide mechanical insights for selecting appropriate suture methods.

Main Methods:

A standardized neoprene wound model was developed using the ForceTRAP system (0-20 N).
Five suture techniques (single, horizontal mattress, vertical mattress, pulley, modified pulley) were tested.

Keywords:

Suture forces Suture technique Wound closure Wound healing

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Pulling forces were measured using a Hook-in-Force sensor, with 10 repetitions per technique by three operator levels.

Main Results:

Mean maximum pulling forces varied significantly: pulley (3.46 N), modified pulley (4.52 N), single (5.69 N), vertical mattress (7.25 N), and horizontal mattress (8.11 N).
The mean force increase on the skin ranged from 0.80 N (pulley) to 0.96 N (vertical mattress).
The pulley suture demonstrated the lowest mean maximum pulling force.

Conclusions:

The pulley suture technique requires significantly less pulling force compared to single, horizontal mattress, and vertical mattress techniques.
Mechanical properties of suture techniques are critical factors in wound healing and complication prevention.
Consideration of these biomechanical properties can guide the selection of optimal suture methods for different wound types.