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

Biplanar Lipoabdominoplasty: Introducing the Subscarpal Lipo Aponeurotic System

Preservation of Scarpa’s fascia in abdominoplasty has been previously presented. Herein we introduce the subscarpal lipo aponeurotic system (SLAS) and the technique of preserving the SLAS and its tightening in lipoabdominoplasty.

A new aesthetic pretrichial approach for upper third-facial fractures and pathologies: The "Crown incision"

BACKGROUND

The coronal incision represents the cornerstone for the treatment of upper-third maxillofacial pathologies. However, this approach leaves long scars that in numerous patients, it can cause extensive surrounding alopecia and sensory skin deficits. This clinical evidence prompted the authors to propose a full pretrichial incision, the crown incision, in order to overcome these drawbacks.

METHODS

A retrospective study was performed to investigate and report the aesthetic and functional outcomes of 15 patients treated with this new approach.

RESULTS

In the postoperative period, no major or minor complications were detected. The aesthetic evaluation of the scar by the operator and the patient showed overlapping results. The overall rating was 2.93 for the patient and 2.87 for the surgeon, on a scale from 0 (as normal skin) to 10 (very different from normal skin). The recovery of sensitivity in the innervation territories of the supratrochlear and supraorbital nerves was found to be complete in 14 patients. In one case, the sharp/blunt discriminative sensitivity was absent in all three points assessed.

CONCLUSIONS

This study showed the crown incision to be a safe approach with an optimal recovery of scalp sensitivity and excellent aesthetic results even in bald patients. Therefore, it can be considered a valid aesthetic and effective alternative to the classic coronal approach and should form part of the craniomaxillofacial surgical armamentarium.

Measuring Forces in Suture Techniques for Wound Closure

BACKGROUND

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.

MATERIALS AND METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

Simple continuous suture versus continuous horizontal mattress suture for plication of abdominal fascia: which is better?

BACKGROUND

Abdominal fascia plication using a simple continuous suture can sometimes cause tears in the fascia. This problem can be circumvented when the continuous horizontal mattress suture is used. No data exist from comparing the two suturing techniques. The aim of this study was to examine which technique can potentially cause greater tissue damage. The time required to perform each type of suture was also recorded.

METHODS

Wound closure pads were plicated using the simple continuous and continuous horizontal mattress techniques performed by a single operator using Ethilon 2-0 nylon sutures. To verify their resilience, plastic bags were inflated beneath the pads to 30, 60, and 120 mmHg and tears were recorded. The time needed to perform the procedures was recorded using a stopwatch.

RESULTS

Mean time for the continuous vertical mattress suture was 87 s and for the simple continuous suture 116 s. Tears in the pad that was plicated with the simple continuous pattern were significantly longer than those in the pad plicated with the continuous horizontal mattress pattern (fissure mean length ± SD = 3.958 ± 0.157 vs. 2.736 ± 0.157, respectively, p < 0.001). This finding was true for each of the three measured pressures (fissure mean length for 30 mmHg was 3.40 ± 1.807 vs. 2.12 ± 1.709 cm; for 60 mmHg, 3.94 ± 2.90 vs. 2.90 ± 1.893 cm; and for 120 mmHg, 4.54 ± 1.924 vs. 3.19 ± 2.110 cm; p < 0.001).

CONCLUSIONS

Continuous horizontal mattress pattern sutures were found to be superior to simple continuous pattern sutures in the suggested model, in terms of suturing time and damage to the pad. Further research in human subjects is still required.

LEVEL OF EVIDENCE II

This journal requires that authors assign a level of evidence to each article.

Effect of different suture techniques on tension dispersion in cutaneous wounds: A pilot study

BACKGROUND/OBJECTIVES

Wound tension plays an integral role in both wound healing and cosmesis. The use of W-plasty has been shown to evenly distribute tension, but is difficult to use in cutaneous surgery. This pilot study aimed to review suture techniques that may give the same wound-tension distribution as W-plasty.

METHODS

Porcine skin mounted on a standard board was used. A standard grid was superimposed onto the tissue, and an incision was made which was digitally photographed. The defect was then sutured using three suture techniques: simple interrupted sutures, mattress sutures and mattress sutures with knots on alternate sides. Subcutaneous sutures were also used in conjunction with each of these suturing techniques. The grid points were compared and the variation from baseline recorded. These variations were then graphed.

RESULTS

The simple interrupted and mattress sutures showed bias of tension opposite to the side of the knot. The alternate mattress suture demonstrated a more even distribution of tension.

CONCLUSION

The mattress suture with alternating knots had a tension pattern that distributed the forces equally across the wound. This is similar to the pattern of W-plasty, suggesting the technique may be used for improved wound healing and cosmesis in areas of tension.

Initial wound management

A wounded patient can be presented to the veterinary surgeon under a number of circumstances. The wound could result from external trauma,such as vehicle trauma or an animal fight, or it could have been created by surgical intervention, such as the removal of a mass. A wound could also be secondary to a failed initial attempt at wound closure. No matter what the cause, initial wound management often follows similar pathways. A successful wound closure and healing outcome is often dependent on adherence to basic principles of wound assessment, appropriate care, and reassessment. This article covers the approach to and specific options for the initial stages of wound management.