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Tension of knotted surgical sutures shows tissue specific rapid loss in a rodent model.

Klink CD, Binnebösel M, Alizai HP, Lambertz A, Vontrotha KT, Junker E, Disselhorst-Klug C, Neumann UP, Klinge U - BMC Surg (2011)

Bottom Line: It can be regarded as cutting through damage of the tissue.Phase 3 is characterized by a plateau representing the remaining structural stability of the tissue.Further studies have to confirm, whether reduced tissue compression and less local damage permits improved wound healing.

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Affiliation: Department of Surgery, RWTH Aachen, Germany. cklink@ukaachen.de

ABSTRACT

Background: Every surgical suture compresses the enclosed tissue with a tension that depends from the knotting force and the resistance of the tissue. The aim of this study was to identify the dynamic change of applied suture tension with regard to the tissue specific cutting reaction.

Methods: In rabbits we placed single polypropylene sutures (3/0) in skin, muscle, liver, stomach and small intestine. Six measurements for each single organ were determined by tension sensors for 60 minutes. We collected tissue specimens to analyse the connective tissue stability by measuring the collagen/protein content.

Results: We identified three phases in the process of suture loosening. The initial rapid loss of the first phase lasts only one minute. It can be regarded as cutting through damage of the tissue. The percentage of lost tension is closely related to the collagen content of the tissue (r = -0.424; p = 0.016). The second phase is characterized by a slower decrease of suture tension, reflecting a tissue specific plastic deformation. Phase 3 is characterized by a plateau representing the remaining structural stability of the tissue. The ratio of remaining tension to initial tension of phase 1 is closely related to the collagen content of the tissue (r = 0.392; p = 0.026).

Conclusions: Knotted non-elastic monofilament sutures rapidly loose tension. The initial phase of high tension may be narrowed by reduction of the surgeons' initial force of the sutures' elasticity to those of the tissue. Further studies have to confirm, whether reduced tissue compression and less local damage permits improved wound healing.

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Used forced sensor for tension measurements developed by Applied Medical Engineering, Helmholtz Institute, RWTH Aachen, Germany.
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Figure 1: Used forced sensor for tension measurements developed by Applied Medical Engineering, Helmholtz Institute, RWTH Aachen, Germany.

Mentions: In 3 female rabbits with a mean bodyweight of 3500 g 3/0 monofilament polypropylene single sutures (Prolene®) were placed in skin, muscle, liver, stomach and small intestine. In total up to seven separate single sutures were placed in each organ receiving 6 measurements for each organ without specific consecutive order of placement. Measurements were performed twice in each animal. Dynamic of suture tension was documented in each suture for 60 minutes. The suture tension was measured by a customised force sensor, which was developed by the Institute of Applied Medical Engineering, RWTH Aachen University, Germany. The patent application of the force sensor is still in progress. The analogue force data have been digitised by a 16 bit A/D converter and stored on a PC with a sampling frequency of 250 Hz. The resolution of the measurement set-up was 0,077g and due to the mechanical set up (Figure 1 and 2) the measured force was proportional to the suture tension. After measuring force data have been processed with the signal acquisition toolbox of Matlab® MathWorks.


Tension of knotted surgical sutures shows tissue specific rapid loss in a rodent model.

Klink CD, Binnebösel M, Alizai HP, Lambertz A, Vontrotha KT, Junker E, Disselhorst-Klug C, Neumann UP, Klinge U - BMC Surg (2011)

Used forced sensor for tension measurements developed by Applied Medical Engineering, Helmholtz Institute, RWTH Aachen, Germany.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3275509&req=5

Figure 1: Used forced sensor for tension measurements developed by Applied Medical Engineering, Helmholtz Institute, RWTH Aachen, Germany.
Mentions: In 3 female rabbits with a mean bodyweight of 3500 g 3/0 monofilament polypropylene single sutures (Prolene®) were placed in skin, muscle, liver, stomach and small intestine. In total up to seven separate single sutures were placed in each organ receiving 6 measurements for each organ without specific consecutive order of placement. Measurements were performed twice in each animal. Dynamic of suture tension was documented in each suture for 60 minutes. The suture tension was measured by a customised force sensor, which was developed by the Institute of Applied Medical Engineering, RWTH Aachen University, Germany. The patent application of the force sensor is still in progress. The analogue force data have been digitised by a 16 bit A/D converter and stored on a PC with a sampling frequency of 250 Hz. The resolution of the measurement set-up was 0,077g and due to the mechanical set up (Figure 1 and 2) the measured force was proportional to the suture tension. After measuring force data have been processed with the signal acquisition toolbox of Matlab® MathWorks.

Bottom Line: It can be regarded as cutting through damage of the tissue.Phase 3 is characterized by a plateau representing the remaining structural stability of the tissue.Further studies have to confirm, whether reduced tissue compression and less local damage permits improved wound healing.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, RWTH Aachen, Germany. cklink@ukaachen.de

ABSTRACT

Background: Every surgical suture compresses the enclosed tissue with a tension that depends from the knotting force and the resistance of the tissue. The aim of this study was to identify the dynamic change of applied suture tension with regard to the tissue specific cutting reaction.

Methods: In rabbits we placed single polypropylene sutures (3/0) in skin, muscle, liver, stomach and small intestine. Six measurements for each single organ were determined by tension sensors for 60 minutes. We collected tissue specimens to analyse the connective tissue stability by measuring the collagen/protein content.

Results: We identified three phases in the process of suture loosening. The initial rapid loss of the first phase lasts only one minute. It can be regarded as cutting through damage of the tissue. The percentage of lost tension is closely related to the collagen content of the tissue (r = -0.424; p = 0.016). The second phase is characterized by a slower decrease of suture tension, reflecting a tissue specific plastic deformation. Phase 3 is characterized by a plateau representing the remaining structural stability of the tissue. The ratio of remaining tension to initial tension of phase 1 is closely related to the collagen content of the tissue (r = 0.392; p = 0.026).

Conclusions: Knotted non-elastic monofilament sutures rapidly loose tension. The initial phase of high tension may be narrowed by reduction of the surgeons' initial force of the sutures' elasticity to those of the tissue. Further studies have to confirm, whether reduced tissue compression and less local damage permits improved wound healing.

Show MeSH
Related in: MedlinePlus