Le Ruyet A, Yurtkap Y, Hartog F P J den, Vegleur A, Turquier F, Lange J F, Kleinrensink G J
Medtronic, Sofradim Production, Trévoux, France.
Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands.
J Mech Behav Biomed Mater. 2020 May;105:103683. doi: 10.1016/j.jmbbm.2020.103683. Epub 2020 Feb 7.
Small bites for the closure of the abdominal wall after midline laparotomy result in significantly less incisional hernias in comparison with large bites. However, fundamental knowledge of underlying biomechanical phenomena remains sparse. The objective of this study was to develop a digital image correlation-based method to compare different suturing techniques in terms of strain pattern after closure of a midline laparotomy in a passive model just after the time of surgery.
A digital image correlation (DIC)-based method was used for the comparison of strain fields on the external surface of the myofascial abdominal wall (skin and subcutaneous fat removed) among six configurations, including an intact linea alba in five post mortem human specimens. The second configuration comprised primary mass closure with small bites (five mm between two consecutive stitches and five mm distance from the incision, 5x5 mm). The third configuration was primary mass closure with large bites (ten mm by ten mm, 10x10 mm). The fourth, fifth and sixth configuration comprised primary mass closure with large bites and the placement of a mesh in onlay position with two different overlaps and the use of glue to simulate the integration of the mesh within the soft tissue.
No visible difference was observed between 5x5 and 10x10 mm closure configurations. However, the use of mesh as suture line reinforcement highlighted a stiffer behavior of the midline area for similar intra-abdominal pressure, which was amplified when a larger mesh overlap was used. However, the whole abdominal wall showed quite similar shapes for the various configurations, except for the configuration with mesh reinforcement and the use of glue.
Mesh reinforcement incited lower opening tension profiles in the midline area of the abdominal wall. following closure of the linea alba in median laparotomy. The next step should be to investigate the impact of mesh location (e.g. retromuscular) and different time points after surgery.
与大针距缝合相比，中线剖腹术后采用小针距缝合关闭腹壁可显著减少切口疝的发生。然而，对潜在生物力学现象的基本知识仍然匮乏。本研究的目的是开发一种基于数字图像相关的方法，以比较在手术刚结束后的被动模型中，中线剖腹术关闭后不同缝合技术在应变模式方面的差异。
采用基于数字图像相关（DIC）的方法，比较六个构型下肌筋膜腹壁外表面（去除皮肤和皮下脂肪）的应变场，其中包括五具尸体标本的完整白线。第二种构型为小针距的一期整块缝合（连续两针间距5毫米，距切口5毫米，5×5毫米）。第三种构型为大针距的一期整块缝合（10×10毫米）。第四、第五和第六种构型包括大针距的一期整块缝合，并在覆盖位置放置具有两种不同重叠度的补片，同时使用胶水模拟补片在软组织中的整合。
5×5毫米和10×10毫米缝合构型之间未观察到明显差异。然而，使用补片作为缝线加固物时，在相似的腹内压下，中线区域表现出更硬的特性，当使用更大的补片重叠度时，这种特性会增强。然而，除了使用补片加固并使用胶水的构型外其他各种构型下整个腹壁的形状相当相似。
在中线剖腹术关闭白线后，补片加固可降低腹壁中线区域的开口张力曲线。下一步应研究补片位置（如肌后）和术后不同时间点的影响。
