Tape-closed and sutured wounds: A comparison by tensiometry and scanning electron microscopy

Abstract

SUMMARYI . The ability of a wound to resist rupture (energy absorption or 'toughness') is calculated from its tensile strength and extension ('give '). This property of the wound is only half that of normal tissue after 5 months of healing.2. A biomechanical study shows that tape-closed wounds develop greater tensile strength than sutured wounds. However, they are more brittle and have, as a result, no greater ability to resist rupture. Other considerations such as obliteration of dead space, prevention of infection, and cosmetic result may therefore be used in choosing between them.3. The rate of collagen synthesis is the same in both wound types. It reaches its peak between 20 and 40 days and returns to normal by 150 days.4. The scanning electron microscope demonstrates how the structure of the wound evolves from random fibril patterns to large collagen masses. Mechanical behaviour can be related to collagen fibre weave and variations in fibre alinement. Differences in organization are observed between tape-closed and sutured wounds and a hypertrophic scar (keloid). 5.The scanning electron microscope appearance of a hypertrophic scar supports the view that its existence may depend on repeated rupturing and rehealing of small fibrils in a brittle scar. 6. It may be possible to control the structural organization of collagen during healing, thus improving ' scar performance ' and making possible the 'cultivation' of collagen shapes and materials for repair purposes.THIS study was prompted by the observation that the apparently well-healed skin wound was remarkably weak at the end of IOO days (Douglas, Forrester, and Ogilvie, 1969).Since local factors play an important part in determining the quality of repair (Halsted, 1913;Whipple, 1940;Sandblom, 1944;Dunphy and Jackson, 1962) we decided to further our investigations by a comparison of tape-closed and suture-closed wounds healing synchronously in the same animal.We adopted this approach because there are indications that tape-closure produces better healing conditions. Suture-closure causes a local inflammatory response (Howes, 1933; Postlethwaite, Schauble, Dillon, and Morgan, 1959) and immobilizes the wound, whereas careful tape-closure reduces inflammation and improves the cosmetic result (Dunphy and Jackson, 1962; Ordman and Gillman, 1966; Conolly, Hunt, Zederfeldt, Cafferata, and Dunphy, 1969). In addition, the exposure to adjacent soft-tissue forces appears to improve the strength of repair (Brunius and Ahrkn, 1969).A further consideration is that strength measurements, although undoubtedly providing valuable information on the healing process, incompletely describe repair. The extension or 'give' is just as important and the mechanical behaviour before rupture is of considerable theoretical and practical significance.Over 500 wounds were examined between 10 and 150 days using a bio-engineering technique previously reported (Forrester, Zederfeldt, and Hunt, 1969). Standard, die-cut specimens of skin and scar were tested to their breaking points. The specim...

Randomized Controlled Comparison of Cosmetic Outcomes of Simple Facial Lacerations Closed With Steri Strip??? Skin Closures or Dermabond??? Tissue Adhesive

“…12 Wounds closed with adhesive strips have been shown to have equal or superior tensile strength compared with sutured wounds 10 days after wound closure. 23 In a comparison of 7 adhesive strips, Steri Strip Skin Closures showed the best adhesion time when an artificial force was applied. 24 The theoretical disadvantages of adhesive tapes are that they frequently fall off, have lower tensile strength than sutures, have the highest rate of dehiscence, require the use of toxic adjuncts, cannot get wet, and cannot be used in areas of hair.…”

Cutaneous wound closure materials: An overview and update

“…Moreover, this technique allows for faster restoration of tensile strength equal or superior at 10 days than with sutured wounds. [20] Skin tension is equal throughout the length of the incision and this method avoids post-operative “railroad track” scarring from sutures. [17] Microporous strips allow the passage of gas and water from the skin surface, which make the environment unsuitable for bacterial proliferation and therefore lead to less wound infections.…”

Closure of abdominal wounds by adhesive strips: a clinical trial.

“…The rationale for the closure of wounds by tapes instead of sutures has been reviewed by Golden et al6 The studies of Ordman and Gillman7 and Forrester et al 8 give an experimental and theoretical basis for expecting improvements after a change to this method of skin closure. Forrester et al8 in their study of collagen in skin wounds showed that taped wounds had greater tensile strength than sutured wounds and that this difference was still appreciable at 150 days.…”