Class: BE210
Group: W8
Members:

Chintan Desai
Raymond Hsu
Ross Leimberg
Jeffrey Seguritan
Stephen Waid

Date: April 2004

Full Text

Abstract: 

Most recent biomedical advancements in sutures have focused on developing suture materials with enhanced mechanical and chemical properties to better suit specific environments or conditions. Given this research focus, surgeons should give equal importance towards determining the optimal suture type and suture density (number of stitches per unit length) because the performance of a suture material often depends on the technique by which sutures are implemented. A comprehensive study conducted by Thacker et al demonstrates that 25% of surgeons do not use the suture type (knot construction) that is experimentally determined to have the best mechanical properties. The decision to use a suture type that does not have optimal mechanical performance increases the risk of knot slippage, suture rupture and wound reopening. Consequences can often be severe, as massive bleeding may occur when the suture loop surrounding a vessel becomes untied or ruptured. Knot disruption can lead to wound dehiscence or incisional hernia . There exist several types of suturing techniques ranging from continuous running stitches to disconstinuous individually knotted stitches. Primary examples of discontinuous stitches utilize either the square knot or the surgeon’s knot square on the basis of reliability and versatility. A 1990 study conducted by van Rijssel et al concluded that the mechanical performance of surgeon’s knots was not better than that of square knots . Advantages of discontinuous sutures over continuous sutures include greater tensile strength and decreased risk of suture failure. The main mechanical disadvantage is that if all the stitches are not constructed with equal tension, the stress will not be equally distributed. The surgeon’s knot square, also called a friction knot, has the added advantage of allowing the surgeon to control the tension of the suture. Continuous running sutures include the simple continuous suture and locked continuous suture (which is knotted across each stitch). The advantages of the simple suture include uniform distribution of tension across the suture, while potential disadvantages include decreased tensile strength and susceptibility to failure. However, the locked suture has greater tensile strength compared to the simple suture. Aside from suturing technique, important considerations in the mechanical performance of sutures include the degree of vascularization, the tendency to cause crosshatch scars, the relative speed of suturing, and the suture density.