Holmdahl Viktor, Backman Olof, Gunnarsson Ulf, Strigård Karin
Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
Sunderby Research Unit, Department of Surgical and Perioperative Sciences, Umeå University, Luleå, Sweden.
Front Surg. 2019 Dec 4;6:69. doi: 10.3389/fsurg.2019.00069. eCollection 2019.
Parastomal hernia is a common complication of an enterostoma. Current methods of repair have high recurrence rates and are associated with severe complications. Autologous full-thickness skin as reinforcement may reduce the recurrence and complication rates. This study aims to investigates the tensile strength of full-thickness skin; information that is essential if we are to proceed with clinical trials on humans. Full-thickness skin samples from 12 donors were tested for tensile strength, as well as the load tolerated by a suture through the skin. Strips of skin were cut out and stretched until breaking point. Sutures were made through skin samples and traction applied until either the tissue or the suture gave way. All done while recording the forces applied using a dynamometer. Identical tests were carried out on commercially available synthetic and biologic graft material for comparison. The full-thickness skin strips had a median tensile strength of 604 N/cm. This tensile strength was significantly higher than that of the compared materials evaluated in this study. In full-thickness skin, the suture, or tissue endured a median force of 67 N before giving way, which was as high as, or higher than similar sutures through the compared materials. The tensile strength of full-thickness skin vastly exceeds the physiological forces affecting the abdominal wall, and sutures through skin endure high loads before giving way. The tensile strength of a full-thickness skin graft and the strength of sutures through this material will not limit its use for reinforcement in parastomal hernia repair.
造口旁疝是肠造口的常见并发症。目前的修复方法复发率高且伴有严重并发症。自体全层皮肤作为加固材料可能会降低复发率和并发症发生率。本研究旨在调查全层皮肤的抗张强度；如果要对人体进行临床试验，这些信息至关重要。对12名供体的全层皮肤样本进行了抗张强度测试，以及缝线穿过皮肤时所能承受的负荷测试。切下皮肤条并拉伸直至断裂点。将缝线穿过皮肤样本并施加牵引力，直到组织或缝线断裂。所有操作过程中均使用测力计记录所施加的力。对市售的合成和生物移植材料进行了相同测试以作比较。全层皮肤条的中位抗张强度为604N/cm。该抗张强度显著高于本研究中所评估的对比材料。在全层皮肤中，缝线或组织在断裂前承受的中位力为67N，这与穿过对比材料的类似缝线所能承受的力相同或更高。全层皮肤的抗张强度大大超过影响腹壁的生理力，并且穿过皮肤的缝线在断裂前能承受高负荷。全层皮肤移植的抗张强度以及穿过该材料的缝线强度不会限制其在造口旁疝修复中用作加固材料。
