Effect of different suture techniques on tension dispersion in cutaneous wounds: A pilot study

Abstract

Wound tension plays an integral role in both wound healing and cosmesis. The use of W-plasty has been shown to evenly distribute tension, but is difficult to use in cutaneous surgery. This pilot study aimed to review suture techniques that may give the same wound-tension distribution as W-plasty. Porcine skin mounted on a standard board was used. A standard grid was superimposed onto the tissue, and an incision was made which was digitally photographed. The defect was then sutured using three suture techniques: simple interrupted sutures, mattress sutures and mattress sutures with knots on alternate sides. Subcutaneous sutures were also used in conjunction with each of these suturing techniques. The grid points were compared and the variation from baseline recorded. These variations were then graphed. The simple interrupted and mattress sutures showed bias of tension opposite to the side of the knot. The alternate mattress suture demonstrated a more even distribution of tension. The mattress suture with alternating knots had a tension pattern that distributed the forces equally across the wound. This is similar to the pattern of W-plasty, suggesting the technique may be used for improved wound healing and cosmesis in areas of tension.