Repair of large and difficult-to-close wounds

Buried Tension Sutures: Force-Tension Comparisons of Pulley, Double Butterfly, Mattress, and Simple Interrupted Suture Patterns

OBJECTIVES

To compare suture patterns (simple interrupted, modified pulley, horizontal mattress, double butterfly) by use of a novel in vitro model that quantifies force required for closure against tension.

STUDY DESIGN

In vitro study.

SAMPLE POPULATION

Suture constructs.

METHODS

An in vitro suturing frame was constructed with extension springs to provide a standard resistance against movement of 2 panels of loops toward each other. Four different suture patterns were applied to the frame in randomized trials. The frame was affixed to a tensiometer that measured the force required for each suture pattern to close a fixed distance (3.81 cm) at a constant rate (5.08 cm/min) against the tension (0.6 kg/cm) of the extension springs. The closure distance and tension were selected subjectively to mimic tension encountered clinically during wound reconstruction oncologic surgical procedures.

RESULTS

The modified pulley suture required the least force to close, followed by the double butterfly, simple interrupted, and horizontal mattress patterns.

CONCLUSIONS

The modified pulley suture and double butterfly suture patterns require less force to close a given distance under tension than either simple interrupted or horizontal mattress suture patterns.

CLINICAL RELEVANCE

Application of tension relieving suture techniques for fascia, subcutaneous, and buried-knot subdermal suturing should be considered to facilitate direct closure of wounds under tension. Modified pulley and double butterfly suture patterns offer some mechanical advantage by requiring less force to achieve closure compared with other suture patterns that might be used in reconstructive surgery.

Techniques for cutaneous sutured closures: variants and indications

Many different suture techniques are routinely used by cutaneous surgeons for the closure of surgical wounds. This paper reviews several common suture techniques and their associated subtypes. In particular, for each technique, we discuss the method for placement, generally accepted indications, controversies regarding utility, and objective evidence of efficacy.

Delayed staged closure with repeated directional suturing of cutaneous defects

BACKGROUND

Postsurgical wound management is traditionally a choice between intraoperative surgical repair or healing by secondary intention. We describe a technique that combines intraoperative and postoperative surgical repair with granulation.

OBJECTIVE

Delayed closure with repeated directional suturing was evaluated as an alternative closure technique for large wounds.

METHODS

Sixty patients had surgical defects partially closed intraoperatively with postoperative staged closures over 2 to 4 weeks. Only those wounds that could not be closed intraoperatively without vascular compromise or anatomic disfigurement were treated.

RESULTS

All wounds were closed using skin from the same anatomic unit. Complications were minimal, and the results were acceptable to both the patients and the surgeon.

CONCLUSION

Delayed closure with repeated directional suturing is a reasonable alternative when primary closure is not possible or when it would cause anatomic disfigurement.