Preferences help
enabled [disable] Abstract
Number of results
2014 | 9 | 6 | 849-859
Article title

Sutures in abdominal surgery: biomechanical study and clinical application

Title variants
Languages of publication
The aim of this study is to improve treatment results and SSI prevention by differential usage of the contemporary suture materials and choice of proper suturing technique. To simulate suturing process and compared two suturing techniques, two FE models were developed. Finite-element analysis (FEA) was based on experimental data of contemporary commercial sutures and soft tissue properties. We applied obtained results for abdominal wall closure in rats and compared non-absorbable suture (capron) with absorbable suture (PDS Plus) for chosen technique. Cross-sections were examined by lighting electron microscope. Afterwards, the results of patients’ treatment are also presented. It was shown that running sew was more appropriate for aponeurosis suturing compared to interrupted sew. The optimal parameters of suturing techniques were computed. Single-row running sew by PDS Plus was proved to hold wound edges for 90 days with less inflammatory response compared to other suture in the result of histological analysis. Application of contemporary synthetic absorbable suture materials with antibacterial coating for laparotomic wounds closure and anastomosis decreases local inflammatory reaction and provides the successful tissue regeneration. Application of advanced SSI prophylactics algorithm was shown to decrease risk of post-operative suppurative complications from 14.2 to 1.6 %.
Physical description
1 - 12 - 2014
16 - 8 - 2014
  • Department of General Surgery, Academician E.A. Wagner Perm State Medical Academy, Perm, 614990, Russia
  • Department of Theoretical Mechanics, Perm National Research Polytechnic University, Perm, 614990, Russia
  • Department of General Surgery, Academician E.A. Wagner Perm State Medical Academy, Perm, 614990, Russia
  • [1] Albertsmeier M., Seiler C.M., Fischer L., Evaluation of the safety and efficacy of MonoMax® suture material for abdominal wall closure after primary midline laparotomy-a controlled prospective multicentre trial: ISSAAC [NCT005725079], Langenbecks Arch. Surg., 2012, 397(3), 363–371
  • [2] Sbisbatskaya E.I., Volova T.G., Puzyr A.P., Mogilnaya O.A., Efremov S.N., Tissue response to the implantation of biodegradable polyhydroxyalkanoate sutures, J. Mater. Sci. Mater. Med., 2004, 11(15), 719–728 [Crossref]
  • [3] Vainionpaa S., Rorranen P., Tormala P., Surgical applications of biodegradable polymers in human tissues, Prog. Polym. Sci., 1989, 14, 679–716[Crossref]
  • [4] Marco F., Vallez R., Gonzalez P., Study of the efficacy of coated Vicryl plus antibacterial suture in an animal model of orthopedic surgery, Surg. Infect. (Larchmt), 2007, 8(3), 359–365[Crossref]
  • [5] Nilsson T., Mechanical properties of Prolene and Ethilon sutures after three weeks in vivo, Scand. J. Plast. Reconstr. Surg., 1982, 16(1), 11–15 [Crossref]
  • [6] Justinger C., Slotta J.E., Schilling M.K., Incisional hernia after abdominal closure with slowly absorbable versus fast absorbable, antibacterial-coated sutures, Surgery, 2012, 151(3), 398–403[WoS][Crossref]
  • [7] Israelsson L.A., Wimo A., Cost minimization analysis of change in closure technique of midline incisions, Eur. J. Surg., 2000, 166(8), 642–646[Crossref]
  • [8] Bezwada R.S., Jamiolkowski D.D., Lee In-Y., Agarwal V., Persivale J., Trenka-Benthin S., Emeta M., Suryadevara J., Yang A., Liu S., Monocryl suture, a new ultra-pliable absorbable monofilament suture, Biomaterials, 1995, 16, 1141–1148[Crossref]
  • [9] Chen X., Yang X., Pan J., Wang L., Xu K., Degradation behaviors of bioabsorbable P3/4HB monofilament suture in vitro and in vivo, Journal of Biomedical Materials Research. Part B: Applied Biomaterials, 2010, 3(92), 447–455 [WoS]
  • [10] Garber S.M., Sackier J.M., Suturing and tissue approximation, In: Brooks D.C. (Ed.), Current review of minimally invasive surgery, New York: Springer-Verlag, 1998
  • [11] Yazdany T., Yip S., Bhatia N.N., Nguyen J.N., Suture complications in a teaching institution among patients undergoing uterosacral ligament suspension with permanent braided suture, International Urogynecology Journal, 2010, 21(7), 813–818[Crossref][WoS]
  • [12] Unalp H.R., Kamer E., Onal M.A., Analysis of early relaparotomy after lower gastrointestinal system surgery, Surgery Today, 2008, 38(4), 323–328[Crossref][WoS]
  • [13] Karahan M.A., Kulacoglu H., Seker D., Ergul Z., Kiziltay A., Yilmazer D., et al., How safe is the use of prosthetic materials in the repair of abdominalwall defects in malnourished subjects?, Central European Journal of Medicine, 2009, 4(3), 331–336[WoS][Crossref]
  • [14] Hiram C., Polk Jr., Lewis M., Flint M.D., Intraabdominal injuries in polytrauma, World Journal of Surgery, 1983, 7(1), 56–67[Crossref]
  • [15] Chauhan H., Patel U., Effect of intra-abdominal absorbable sutures on surgical site infection, National Journal of Medical Research, 2012, 2(3), 372–376
  • [16] Zhang Z., Zhang H., Fang X., Wang L., Li X., Li Y., Sun X., Carver J., Simpkins D., Shen J., Weisberg M., Cosmetic outcome and surgical site infection rates of antibacterial absorbable (Polyglactin 910) suture compared to chinese silk suture in breast cancer surgery: a randomized pilot research, Chinese Medical Journal, 2011, 124(5), 719–724 [WoS]
  • [17] Leaper D.J., Surgical-site infection, British. Journal of. Surgery, 2010, 97(11), 1601–1602[Crossref]
  • [18] Luijendijk R.W., Hop W.C., van den Tol M.P., de Lange D.C., Braaksma M.M., IJzermans J.N., Boelhouwer R.U., de Vries B.C., Salu M.K., Wereldsma J.C., Bruijninckx C.M., Jeekel J., A comparison of suture repair with mesh repair for incisional hernia, N. Engl. J. Med., 2000, 343, 392–398[Crossref]
  • [19] Katoh T., Kawano K., Furutani A., Katsuki T., Onoda M., Oga A., The use of the continuous suture technique in dunking pancreatojejunostomy without stenting, Surgery Today, 2013, 43(9), 1008–1012[Crossref][WoS]
  • [20] Lian L.L., Chen Y.H., Haptic surgical simulation: an application to virtual suture, Computer-Aided Design & Applications, 2006, 3(1–4), 203–210[Crossref]
  • [21] Aloisio G., Tommaso L., Mongelli A., Provenzano L., Artery soft-tissue modelling for stent implant training system, Systemics, cybernetics and informatics, 2002, 2(4), 7–11
  • [22] Hao L., Predictive surgical simulation for cardiac surgery, Journal of Biomechanics, 2008, 14, 1–53
  • [23] Jones I.A., Becker A.A., Glover A.T., Wang P., Benford S.D., Vloeberghs M., Greenhalgh C.M., Computational mechanics in virtual reality: cutting and tumour interactions in a boundary element simulation of surgery on the brain, Journal of Biomechanics, 2005, 38, 1–8[Crossref]
  • [24] De Novi G., Melchiorri C., Surgery simulations and haptic feedback: a new approach for local interaction using implicit surfaces, Proceedings of International Conference on Applied Bionics and Biomechanics, (14–16 October 2010, Venice, Italy), Italy, 2010
  • [25] Lima M., Melchiorri C., Ruggeri G., De Novi G., Gargano T., Mogiatti M., Mazzero G., A new robotic platform for endoscopic skill training, Proceedings of 17 International Congress on Endoscopic Surgery (17–20 June 2009, Prague, Czech Republic), Springer, 2009
  • [26] Bro-Nielsen M., Finite element modeling in surgery simulation, Proceedings of the IEEE, 1998, 86(3), 490–503[Crossref]
  • [27] Picinbono G., Delingette H., Ayache N., Nonlinear anisotropic elasticity for real-time surgery simulation, Graphical Models, 2003, 65(5), 305–321[Crossref]
  • [28] Misra S., Ramesh K.T., Okamura A.M., Modeling of tool-tissue interactions for computer-based surgical simulation: a literature review presence, Presence (Camb), 2008, 17(5), 463–491
  • [29] Lenoir J., Meseure P., Grisoni L., A suture model for surgical simulation, Lect. Notes Comput. Sci., 2004, 3078, 105–113[Crossref]
  • [30] Patete P., Iacono M.I., Spadea M.F., Trecate G., Vergnaghi D., Mainardi L.T., et al., A multi-tissue mass-spring model for computer assisted breast surgery, Medical Engineering & Physics, 2013, 35, 47–53[Crossref][WoS]
  • [31] LeDuc M., Payandeh S., Dill J., Toward modeling of a suturing task, Graphics Interface, 2003, 1, 273–279
  • [32] Brown J., Montgomery K., Latombe J.-C., Stephanides M., A microsurgery simulation system, MICCAI01, Utrecht, 2001, 17
  • [33] Phillips J., Ladd A., Kavraki L., Simulated knot tying, Proceedings of IEEE International Conference on Robotics and Automation (11–15 May 2002, Washington, USA), USA, 2002, 841–846
  • [34] Jasinoski S.C., Reddy B.D., Louw K.K., Chinsamy A., Mechanics of cranial sutures using the finite element method, Journal of Biomechanics, 2010, 43, 3104–3111[WoS][Crossref]
  • [35] Limbert C., Bryan R., Cotton R., Young P., Hall-Stoodley L., Kathju S., Stoodley P., On the mechanics of bacterial biofilms on non-dissolvable surgical sutures: a laser scanning confocal microscopybased finite element study, Acta Biomaterialia, 2013, 9, 6641–6652[WoS][Crossref]
  • [36] Capek L., Jacquet E., Dzan L., Simunek A., The analysis of forces needed for the suturing of elliptical skin wounds, Medical & Biological Engineering & Computing, 2012, 50(2), 193–198[Crossref][WoS]
  • [37] Shilko S.V., Chernous D.A., Panin S.V., Model and analysis of contact interaction of one-dimensional polymeric implants with biotissues, Russian Journal of Biomechanics, 2011, 15(1), 65–73
  • [38] Pgez G.J.M., San Martin C.A., Sestafe A.G., Herrero E.G., Navidad R., Cordon A., Castillo-Olivares J.L., Elastic behaviour of sutured calf pericardium: influence of the suture threads, Biomaterials, 1996, 17, 1677–1683[Crossref]
  • [39] Nishimura K.A., Mori R., Miyamoto W., Uchio Y., New technique for small and secure knots using slippery polyethylene sutures, Clinical Biomechanics, 2009, 24, 403–406[Crossref][WoS]
  • [40] Balgobin S., Hamid C.A., Brown S.A., Wai C.Y., Mechanical performance of surgical knots in a vaginal surgery model, Journal of Surgical Education, 2013, 70(3), 340–344[WoS][Crossref]
  • [41] van’t Riet M., de Vos van Steenwijk P.J., Kleinrensink G.J., Steyerberg E.W., Bonjer H.J., Tensile strength of mesh fixation methods in laparoscopic incisional hernia repair, Surg Endosc., 2002, 16(12), 1713–1716[Crossref]
  • [42] Ishikawa K., Sadahiro S., Tanaka Y., Suzuki T., Kamijo A., Tazume S., Optimal sutures for use in the abdomen: an evaluation based on the formation of adhesions and abscesses, Surgery Today, 2013, 43(4), 412–417[WoS][Crossref]
  • [43] Bekiari A., Dimopoulos D., Mantelou A., Tatsis V., Fatouros M., Baltogiannis G., Glantzounis G., Surgical site infections in general surgery operations in North West Greece: A prospective pilot study, Hellenic Journal of Surgery, 2013, 85(4), 229–234[Crossref]
  • [44] Azizi E., Halenda G.M., Roberts T.J., Mechanical properties of the gastrocnemius aponeurosis in wild turkeys, Integrative and Comparative Biology, 2009, 49(1), 51–58[WoS][Crossref]
  • [45] Holzapfel G.A., Gasser T.C., Ogden R.W., A new constitutive framework for arterial wall mechanics and comparative study of material models, Journal of Elasticity, 2000, 61, 1–48[Crossref]
  • [46] Marquardt D.W., An algorithm for least-squares estimation of non-linear parameters, SIAM Journal on Applied Mathematics, 1963, 11, 431–441[Crossref]
  • [47] Holzapfel G.A., Gasser C.T., Sommer G., Regitnig P., Determination of the layer-specific mechanical properties of human coronary arteries with nonatherosclerotic intimal thicking, and related constitutive modeling, American Journal of Physiology-Heart and Circulatory Physiology, 2005, 289, H2048–H2058
  • [48] Morrow D.A., Donahue T.H., Odegard G.M., Haufman K.R., A method for assessing the fit of a constitutive material model to experimental stress-strain data, Computer Methods in Biomechanics and Biomedical Engineering, 2010, 12, 247–256[Crossref][WoS]
  • [49] Tuktamyshev V.S., Kuchumov A.G., Nyashin Yu.I., Samarcev V.A., Kasatova E.Yu. Intraabdominal pressure of human, Russian Journal of Biomechanics, 2013, 17(1), 22–30
Document Type
Publication order reference
YADDA identifier
JavaScript is turned off in your web browser. Turn it on to take full advantage of this site, then refresh the page.