Department of Dermatology, Leiden University Medical Center, Leiden, ZA, the Netherlands.
Department of Dermatology, Leiden University Medical Center, Leiden, ZA, the Netherlands.
J Surg Res. 2020 Nov;255:135-143. doi: 10.1016/j.jss.2020.05.033. Epub 2020 Jun 16.
The use of sutures remains the first choice for wound closure. However, incorrect use of a suture technique can lead to impaired healing. Many techniques are described for high-tension wounds, but not much is known about their mechanical properties. Complications of excessive tension include dehiscence, infection, and ischemic necrosis and could be prevented. This study aimed to compare forces in five techniques (single, horizontal mattress, vertical mattress, pulley, and modified pulley suture) in a standardized wound tension model.
A standardized neoprene wound model was developed on the ForceTRAP system (MediShield B.V., Delft, The Netherlands) to mimic a 5 Newton (N) wound. Five different suture techniques were each repeated 10 times by a student, resident dermatology, and dermsurgeon. The pulling force of the suture's first throw was measured with the Hook-in-Force sensor (Technical University Delft, The Netherlands). Changes in wound tension were measured by the ForceTRAP system. The ForceTRAP is a platform measuring forces from 0 to 20 N in three dimensions with an accuracy of 0.1 N. The Hook-in-Force is a force sensor measuring 0-15 N with an accuracy of 0.5 N. Maximum and mean forces were calculated for each suture technique and operator.
Mean maximum pulling force: 5.69 N (standard deviation [SD], 0.88) single, 7.25 N (SD, 1.33) vertical mattress, 8.11 N (SD, 1.00) horizontal mattress, 3.46 N (SD, 0.61) pulley, and 4.52 N (SD, 0.67) modified pulley suture. The mean force increase on the skin (substitute) ranged between 0.80 N (pulley) and 0.96 N (vertical mattress).
The pulley suture requires less pulling force compared with other techniques. The mechanical properties of sutures should be taken in consideration when choosing a technique to close wounds.
缝线仍然是伤口闭合的首选方法。然而，缝线技术使用不当会导致愈合受损。许多技术都被描述用于高张力伤口，但对其机械性能知之甚少。张力过大的并发症包括裂开、感染和缺血性坏死，可以预防。本研究旨在比较五种技术（单股、水平褥式、垂直褥式、滑结和改良滑结）在标准化伤口张力模型中的力。
在 ForceTRAP 系统（MediShield B.V.，荷兰代尔夫特）上开发了一种标准化的氯丁橡胶伤口模型，以模拟 5 牛顿（N）的伤口。由学生、住院皮肤科医生和皮肤科医生各重复 10 次五种不同的缝线技术。使用 Hook-in-Force 传感器（荷兰代尔夫特技术大学）测量缝线第一针的拉力。ForceTRAP 系统测量伤口张力的变化。ForceTRAP 是一个在三维空间中测量 0 至 20 N 力的平台，精度为 0.1 N。Hook-in-Force 是一个测量 0-15 N 力的力传感器，精度为 0.5 N。计算了每种缝线技术和操作者的最大和平均力。
平均最大拉力：5.69 N（标准差 [SD]，0.88）单股，7.25 N（SD，1.33）垂直褥式，8.11 N（SD，1.00）水平褥式，3.46 N（SD，0.61）滑结，4.52 N（SD，0.67）改良滑结。皮肤（替代物）上的平均力增加在 0.80 N（滑结）和 0.96 N（垂直褥式）之间。
与其他技术相比，滑结缝线需要的拉力更小。在选择缝线技术来闭合伤口时，应考虑缝线的机械性能。
