Does skin preparation alter suture strength characteristics? Assessing the effect of chlorhexidine and isopropyl alcohol on common skin closure suture material

Abstract

Sutures are essential to approximate tissues and enable healing by first intention until a wound regains its original tensile strength. The mechanical properties of sutures are well documented, but the effects of exposing sutures to skin preparation solutions used in surgery are not. This study was performed to investigate whether 2% chlorhexidine and 70% isopropyl alcohol skin preparation, commonly used prior to incision and prior to closure, has any effect on the mechanical properties of several commonly used surgical suture types. Four suture types were soaked in either 2% chlorhexidine and 70% isopropyl alcohol or Hartmann's solution for 5 minutes. All sutures were left to dry for 11 days before being tested to failure using an Instron 3367 tensile testing machine. Testing revealed significant differences in failure load, ultimate tensile stress, and Young's modulus between suture types (P < .05). No significant differences in failure load (P = .98), ultimate tensile stress (P = .21), or Young's modulus (P = .22) were observed between the test group and the control group when comparing sutures of the same type. This study demonstrates that chlorhexidine/isopropyl skin preparation solutions do not significantly change the mechanical properties of suture materials exposed to them.

The Effect of Topical Agents on the Tensile Strength of Absorbable and Non‐absorbable Suture Materials—An in Vitro Study

“…We tested the following mechanical properties: The tensile strength (represented as failure load) is defined as the maximal load that could be applied across the suture prior to failure, measured in Newtons (N). Extension is defined as the maximal increase in total suture length prior to failure, measured in millimeters (mm) [1]. …”

“…Following surgical closure and prior to dressing application, the surgeon is faced with an armamentarium of wound care regimens, and the choice is often based on anecdotal experience with a lack of consensus regarding the superiority of a single agent [1][2][3]. In vivo a number of patient-related factors influence the integrity of wound closure, for example, medical co-morbidities, smoking, infection, and prior radiotherapy [3,5,6].…”

“…It is imperative for the competent surgeon to master and employ such skill in a pristine fashion. In wound closure, the role of sutures is to approximate the flap margins and sustain a stable approximation throughout the process of wound healing [1, 2].…”

“…However, minimal research has been performed to investigate the effects of wound care products on the hydrolytic properties of sutures. Since failure to achieve or maintain adequate tissue approximation may lead to delayed healing with subsequent cosmetic and/or functional consequences [1, 2], the question remains whether the commonly applied agents alter the mechanical properties of suture materials and hence the durability of our wound closure.…”

“…Perhaps the simplest way to classify suture materials is based on their degradation potential, into absorbable and non‐absorbable [3]. One of the prime determinants of a durable wound approximation is the tensile strength of the suture material, which represents the maximal load that could be applied across the suture prior to its failure [1]. The ideal suture should possess sufficient tensile strength that can be maintained until healing has progressed and the suture material is no longer required to achieve wound opposition [2, 3].…”