Mechanics of Wound Closure: Emerging Tape-Based Wound Closure Technology vs. Traditional Methods

Abstract

To date, there is still a lack of understanding of how wound closure methods perform comparatively under daily bodily movement during the course of healing and how they affect the mechanics of healing. The present study is a first step in understanding and objectively quantifying the gap. The study provides both a new method of metrology for noninvasive evaluation of skin mechanics at the onset of wound healing and an emerging tape-based wound closure technology. The latter shows better performance with respect to commonly used staples and sutures, holding the wound intact and providing uniform mechanical support across the incision.

A novel zipper device versus sutures for wound closure after surgery: a systematic review and meta‐analysis

“…The patient demand of acquiring good cosmetic appearance of wound closure is commonly. In a study by Levi et al 25 indicated zipper device provides greater shielding of the wound from perturbation caused by distraction forces than sutures. The zipper device provides precise, adjustable, and tension‐free adaptation of the incision edges for a sufficient time and minimal trauma to the skin and underlying tissues, without resulting in an ischemic condition that could impact healing and scarring, thus make it beneficial to a good cosmetic result 16,26 .…”

Patient Satisfaction and Cosmetic Outcome in a Randomized, Prospective Study of Total Knee Arthroplasty Skin Closure Comparing Zip Surgical Skin Closure with Staples

“…A novel feature of the adjustment mechanism allows loosening the strap if too much tension is applied during closure. Levi et al demonstrated that this apparatus provides greater shielding of the wound from perturbation caused by distraction forces than intradermal sutures [8]. Carli Blue arrows indicate polyurethane strips and green arrows indicate nylon zip-tie-type ratcheting straps.…”

In Vivo Efficacy Study Showing Comparative Advantage of Bacterial Infection Prevention with Zip-type Skin Closure Device vs. Subcuticular Sutures

“…Levi et al. demonstrated that this apparatus provides greater shielding of the wound from perturbation caused by distraction forces than intradermal sutures [ 6 ].…”

“…Sutures and staples serve as intermittently direct means of closure, relying on tissue density or inelasticity to maintain closure between each discreet staple or suture pass. This can result in nonuniform compressive forces at the incision line [ 6 ]. The relatively high compressive forces incident on the local tissue from the wire or suture material has been shown to result in reduced blood flow and ischemia at the wound site [Poster: Davis A, Vaughn M, Piraino J.…”

“…Normal patient movement can create distraction forces on the wound. An acute in vivo study comparing the mechanical forces of a zip-type wound closure to intradermal sutures suggested that the zip-type device resulted in a more uniform distribution of closure forces along the incision while making the incision less vulnerable to distraction forces [ 6 ]. Based on that mechanical analysis and result, we hypothesize that the zip-type device may also reduce bacterial penetration and resulting surgical site infection compared to intradermal sutures, in particular when the wound is subject to distraction forces that may be induced from patient movement during normal recovery.…”