Optimized wound closure using a biomechanical abdominal model

Cooney, Gerard M.; Kiernan, Aoife C.; Winter, D. C.; Simms, Ciaran

doi:10.1002/bjs.10753

Cited by 11 publications

(6 citation statements)

References 35 publications

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“…On the contrary, the effects of different suture materials, suture configurations and suture length to wound length ratio on the occurrence of incisional hernia have been extensively studied [5,15]. Cooney et al found the best performing bite separation and bite width to be 5 and 16 mm, respectively, in a biomechanical abdominal wall model [16]. As they also state, this is partly in agreement with the findings of the STITCH trial.…”

Section: Discussionmentioning

confidence: 67%

Evaluation of a new suture material (Duramesh™) by measuring suture tension in small and large bites techniques for laparotomy closure in a porcine model

Yurtkap

Hartog

Weteringen³

et al. 2020

Hernia

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Purpose After closure of laparotomies, sutures may pull through tissue due to too high intra-abdominal pressure or suture tension, resulting in burst abdomen and incisional hernia. The objective of this study was to measure the suture tension in small and large bites with a new suture material. Methods Closure of the linea alba was performed with small bites (i.e., 5 mm between two consecutive stitches and 5 mm distance from the incision) and large bites (i.e., 10 mm × 10 mm) with Duramesh™ size 0 (2 mm) and PDS II 2-0 in 24 experiments on six porcine abdominal walls. The abdominal wall was fixated on an artificial computer-controlled insufflatable abdomen, known as the 'AbdoMan'. A custom-made suture tension sensor was placed in the middle of the incision. Results The suture tension was significantly lower with the small bites technique and Duramesh™ when compared with large bites (small bites 0.12 N (IQR 0.07-0.19) vs. large bites 0.57 N (IQR 0.23-0.92), p < 0.025). This significant difference was also found in favour of the small bites with PDS II 2-0 (p < 0.038). No macroscopic tissue failure was seen during or after the experiments. Conclusion Closure of the abdominal wall with the small bites technique and Duramesh ™ was more efficient in dividing suture tension across the incision when compared to large bites. However, suture tension compared to a conventional suture material was not significantly different, contradicting an advantage of the new suture material in the prevention of burst abdomen and incisional hernia during the acute, postoperative phase. HerniaPublisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Section: Discussionmentioning

confidence: 67%

Evaluation of a new suture material (Duramesh™) by measuring suture tension in small and large bites techniques for laparotomy closure in a porcine model

Yurtkap

Hartog

Weteringen³

et al. 2020

Hernia

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“…14 In our study, patients underwent a modified small STITCH approach with a 5 mm separation with a 10 mm width based on evidence that a wider bite may be more beneficial. 26 The authors would now recommend the use of 3/0 PDS to fix the mesh rather than 2/0 Prolene ® as this would be absorbed. Chevrel's classic onlay mesh technique places and fixes the mesh after fascial closures.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic onlay mesh at emergency laparotomy: promising early outcomes with long‐acting synthetic resorbable mesh

Alsaadi

Stephens

Simmons

et al. 2022

ANZ Journal of Surgery

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Background: Careful surgical strategy is paramount in balancing the prevention of fascial dehiscence, incisional hernia (IH) and fear of additional mesh-related wound complications post-laparotomy. This study aims to review early outcomes of patients undergoing an emergency laparotomy with prophylactic TIGR ® mesh, used to reduce early fascial dehiscence and potential subsequent IH. Method: A retrospective, ethically approved review of 24 consecutive patients undergoing prophylactic TIGR ® mesh placement during emergency laparotomies by a single surgeon between January 2017 and June 2021 at a University Hospital. A standardized approach included onlay positioning of the mesh, small-bite fascial closure, and a wound bundle. We recorded patient demographics, operative indications, findings, degree of peritonitis, postoperative complications, and mortality. Result: The study included 24 patients; 16/24 (66.6%) were female and median age was 72.5 (range 31-86); 14/24 patients were ASA grade III or greater; 4/24 patients (16.6%) developed six complications and 3/6 occurred in a single patient. Complications included subphrenic abscess, seroma, intrabdominal hematoma, enterocutaneous fistula leading to deep wound infection and small bowel perforation. Five (20.8%) patients died in hospital; central venous catheter sepsis (n = 1), fungal septicaemia (n = 1) and multiorgan failure (n = 3). Surgical site infection and seroma rates were low, occurring in 2/24 patients (4% each). Conclusion: This study has identified that prophylactic onlay mesh in patients undergoing an emergency laparotomy is not associated with significant wound infection or seroma when used with an active wound bundle. The wider use of TIGR ® to prevent fascial dehiscence and potential long-term IH prevention should be considered. Recent randomized controlled trials have shown PMP to be beneficial during fascial closure, reducing IH rates by at least half. 1,2,9,10 There are numerous potential positions for mesh placement: onlay, inlay, sublay, underlay and intraperitoneal, each with their own

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“…Biomechanical testing has also been performed on a variety of suture patterns where suture bite and stitch interval were varied independently (36). This study showed that the use of smaller bites (suture bites) and larger bite widths (stitch interval) provided a stronger celiotomy closure when compared to other combinations (36). In a further study, the combination of a small suture bite and a large stitch interval significantly increased the suture pullout force (35).…”

Section: Other Sbsi Combinationsmentioning

confidence: 97%

“…In this study we evaluated the bursting pressure which we believe provides a better understanding of the mechanical properties of these celiotomy closure techniques in cats. Biomechanical testing has also been performed on a variety of suture patterns where suture bite and stitch interval were varied independently (36). This study showed that the use of smaller bites (suture bites) and larger bite widths (stitch interval) provided a stronger celiotomy closure when compared to other combinations (36).…”

Section: Other Sbsi Combinationsmentioning

confidence: 99%

Small vs. Large Suture Bite-to-Stitch Interval for Closure of Midline Celiotomy in Cats: A Biomechanical Study

Rodriguez¹,

Milgram

Kirby

2020

Front. Vet. Sci.

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The objective of this study was to compare the bursting strength and characterize the mode of failure of cranial and caudal midline celiotomies closed with 2 suture patterns and an absorbable monofilament suture material. Design: Randomized, cadaveric, ex-vivo mechanical testing. Sample: Feline cadavers (n = 32). Methods: Specimens were randomized into two groups based on the closure technique (small 2 × 2 mm or large 5 × 5 mm suture-bite-stitch-interval [SBSI] groups). Cranial or caudal midline celiotomies, 7.5 cm long, were created. A custom-made polyurethane bladder was inserted into the abdomen, and the celiotomies were closed in a simple continuous pattern using 3-0 polydioxanone. The repair was loaded to failure by inflating the bladder with compressed air. Bursting strength and mode of failure were recorded. Effects of body weight, gender, thickness and width of linea alba, suture-bite-stitch-interval, and location of celiotomy were analyzed using a mixed model analysis and an independent t-test, with P < 0.05 considered statistically significant. Results: There was no difference in bursting strength between cranial and caudal celiotomies. Bursting strength was lower for celiotomies closed with a large SBSI (P = 0.003). Bursting strength was greater in males compared to females (P = 0.003). Twenty five specimens failed distant from celiotomy closure, while 4 failed by fascial tearing at the site of needle penetration. Failure by loosening of the suture line with intact knots only occurred in 3 caudal celiotomies closed with a large SBSI. Gender, body weight and SBSI accounted for 61.5% of variability in bursting strength (P = 0.005). Conclusions: Small SBSI technique was mechanically superior to large SBSI when tested under these loading conditions. Clinical relevance: Supraphysiological pressures were required to cause failure in all specimens. Both small and large SBSI may be clinically applicable for midline celiotomy closure in domestic cats.

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Optimized wound closure using a biomechanical abdominal model

Cited by 11 publications

References 35 publications

Evaluation of a new suture material (Duramesh™) by measuring suture tension in small and large bites techniques for laparotomy closure in a porcine model

Evaluation of a new suture material (Duramesh™) by measuring suture tension in small and large bites techniques for laparotomy closure in a porcine model

Prophylactic onlay mesh at emergency laparotomy: promising early outcomes with long‐acting synthetic resorbable mesh

Small vs. Large Suture Bite-to-Stitch Interval for Closure of Midline Celiotomy in Cats: A Biomechanical Study

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