Department of Surgery, Rhenish-Westphalian Technical University of Aachen, Aachen, Germany.
Fraunhofer Institute for Production Technology, Aachen, Germany.
J Surg Res. 2019 Jan;233:207-212. doi: 10.1016/j.jss.2018.07.043. Epub 2018 Aug 31.
Inadequate suture tension is a risk factor for the failure of laparotomy closure. Suture tension dynamics in the abdominal wall are still obscure due to the lack of measuring devices. To answer the questions if intra-abdominal hypertension (IAH) influences suture tension in midline laparotomies and if IAH leads to a permanent loss of suture tension, microsensors were applied in a porcine model of IAH.
Microsensors measuring suture tension "on the thread" with a frequency of 1/s were developed and implanted in the suture lines of midline laparotomies in four pigs. During a 23-h experiment under general anesthesia, two intervals of IAH (30 mm Hg) were applied, interrupted by a 3-h interval without elevated intra-abdominal pressure.
All sensors showed an immediate and reproducible response to changes of intra-abdominal pressure. The two 9-h periods of IAH resulted in a significant elevation of suture tension (P = 0.003 and P = 0.0009, respectively). Reducing the IAH lead to a significant loss of suture tension (P = 0.0005 and P = 0.0001, respectively). After the second interval with IAH, a complete loss of mean suture tension was observed. A statistically significant "recovery" of suture tension in the interval between the two phases with IAH was not observed.
Intervals with elevated intra-abdominal pressure have a direct influence on suture tension in midline laparotomy wounds. Intervals with IAH lead to a significant loss of suture tension in the suture line and to a complete loss of mean suture tension at the end of this experiment. A subsequent gaping of the fascia might contribute to either acute or chronic failure of laparotomy closure.
缝合张力不足是剖腹手术关闭失败的一个风险因素。由于缺乏测量设备，腹壁内缝合张力的动态变化仍然不清楚。为了回答以下问题：腹腔内高压（IAH）是否会影响中线剖腹手术中的缝合张力，以及 IAH 是否会导致缝合张力永久丧失，我们在 IAH 的猪模型中应用了微传感器。
开发了一种测量缝合线张力的微传感器（“在线”），频率为 1/s，并将其植入四只猪的中线剖腹手术缝合线中。在全身麻醉下进行了 23 小时的实验中，施加了两个 30 毫米汞柱的 IAH 间隔，中间有 3 小时没有升高的腹腔内压力的间隔。
所有传感器对腹腔内压力的变化均立即且可重复地作出响应。两次 9 小时的 IAH 期导致缝合张力显著升高（分别为 P=0.003 和 P=0.0009）。降低 IAH 导致缝合张力显著丧失（分别为 P=0.0005 和 P=0.0001）。在第二次 IAH 间隔后，观察到平均缝合张力完全丧失。在 IAH 的两个阶段之间的间隔中，没有观察到缝合张力的统计学显著“恢复”。
升高的腹腔内压力间隔对中线剖腹手术伤口的缝合张力有直接影响。IAH 间隔导致缝合线中的缝合张力显著丧失，并在实验结束时导致平均缝合张力完全丧失。随后的筋膜裂开可能导致剖腹手术关闭的急性或慢性失败。
