Horeman Tim, Meijer Evert-Jan, Harlaar Joris J, Lange Johan F, van den Dobbelsteen John J, Dankelman Jenny
Department of Biomechanical Engineering, Technical University Delft, Delft, The Netherlands.
Department of Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
PLoS One. 2013 Dec 23;8(12):e84466. doi: 10.1371/journal.pone.0084466. eCollection 2013.
The tension in a suture is an important factor in the process of wound healing. If there is too much tension in the suture, the blood flow is restricted and necrosis can occur. If the tension is too low, the incision opens up and cannot heal properly. The purpose of this paper is to describe the design and evaluation of the Stitch Force (SF) sensor and the Hook-In Force (HIF) sensor. These sensors were developed to measure the force on a tensioned suture inside a closed incision and to measure the pulling force used to close the incision. The accuracy of both sensors is high enough to determine the relation between the force in the thread of a stitch and the pulling force applied on the suture by the physician. In a pilot study, a continuous suture of 7 stitches was applied on the fascia of the abdominal wall of multiple pigs to study this relationship. The results show that the max force in the thread of the second stitch drops from 3 (SD 1.2) to 1 (SD 0.3) newton after the 4(th) stitch was placed. During placement of the 5(th), 6(th) and 7(th) stitch, the force in the 2(nd) stitch was not influenced anymore. This study indicates that in a continuous suture the force in the thread remains constant up to more than 3 stiches away from the pulled loose end of the suture. When a force feedback tool is developed specially for suturing in surgery on patients, the proposed sensors can be used to determine safety threshold for different types of tissue and sutures.
缝线张力是伤口愈合过程中的一个重要因素。如果缝线张力过大，血流会受到限制，可能会发生坏死。如果张力过小，切口会裂开，无法正常愈合。本文的目的是描述缝线力（SF）传感器和钩入力（HIF）传感器的设计与评估。开发这些传感器是为了测量闭合切口中张紧缝线的受力情况以及测量用于闭合切口的拉力。这两种传感器的精度都足够高，能够确定缝线线体中的力与医生施加在缝线上的拉力之间的关系。在一项初步研究中，在多只猪的腹壁筋膜上连续缝了7针来研究这种关系。结果表明，在缝完第4针后，第2针缝线中的最大力从3（标准差1.2）牛顿降至1（标准差0.3）牛顿。在缝第5针、第6针和第7针的过程中，第2针缝线中的力不再受到影响。这项研究表明，在连续缝合法中，在距离缝线松开端3针以上的位置，缝线中的力保持恒定。当专门为患者手术缝合开发一种力反馈工具时，所提出的传感器可用于确定不同类型组织和缝线的安全阈值。
