Editorial Type:
Article Category: Research Article
 | 
Online Publication Date: 01 Jun 2017

In Vitro Tensile Strength Study on Suturing Technique and Material

DDS,
DDS, MS,
DDS, MS,
DDS, MS, PhD,
DDS, MS, PhD, and
DDS, MS, PhD
Page Range: 169 – 174
DOI: 10.1563/aaid-joi-D-16-00164
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Suture technique and materials are important in preventing complications such as wound dehiscences. The purpose of this study was to determine the tensile strength of different suturing techniques, comparing several materials with different diameters. One hundred sixty sutures were performed using silk, e-PTFE, and 2 types of polyamide (monofilament and Supramid). Ten simple, 10 horizontal mattress, and 10 combinations of the two stitches were performed with 4-0 gauge of each material. Additionally, 10 simple sutures were performed with the 5-0 gauge of each material. The maximum tensile force resisted by each suture was recorded. When 5 mm of traction was applied, the polyamide monofilament resisted significantly better without untying or breaking compared with Supramid or silk, while the e-PTFE was superior to all the others. However, the force when e-PTFE 4-0 sutures untied or broke was lower than for either type of polyamide. The combined technique withstood a significantly higher tensile force before unknotting or breaking than did the simple and mattress stitches. The 5-0 gauges of silk and both types of polyamide showed lower tensile strengths than the 4-0 materials. Among the 5-0 sutures, Supramid showed a higher tensile strength than silk. The combined suture technique possessed greater tensile strength than did a simple or a horizontal mattress suture, and e-PTFE 4-0 withstood more traction without untying or breaking than did all the other materials, although at a lower tensile force. With the exception of e-PTFE, 4-0 sutures had greater tensile strength than did 5-0 sutures.

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  <sc>Figure 1</sc>
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Figure 1

(a) Simple suture. (b) Mattress suture. (c) Combined suture.


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  <sc>Figure 2</sc>
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Figure 2

Microtensile tester device.


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  <sc>Figures 3–5</sc>
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Figures 3–5

Figure 3. Tensile strength (N) box-plot for 4-0 materials. Statistically significant differences were found between expanded polytetrafluoroethylene (e-PTFE) and monofilament polyamide and between e-PTFE and Supramid (*statistically significant; °outlier result). Figure 4. Tensile strength (N) box-plot for 5-0 materials. Statistically significant differences were found between silk and Supramid (*statistically significant; °outlier result). Figure 5. Tensile strength (N) box-plot for 4-0 sutures. Statistically significant differences were found between the combined suture and both the simple and mattress sutures (*statistically significant; °outlier result).


Contributor Notes

Corresponding author, e-mail: rui@ruibf.com
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