Mechanics of Wound Closure: Emerging Tape-Based Wound Closure Technology vs. Traditional Methods.

Kemal Levi,Pelin Kefel,Kei Ichiryu,Ori Belson,Bauback Safa,Eric Storne,Juergen Keller,Jon Grice

doi:10.7759/cureus.827

Abstract

To date, there is still a lack of understanding of how wound closure methods perform comparatively under daily bodily movement during the course of healing and how they affect the mechanics of healing. The present study is a first step in understanding and objectively quantifying the gap. The study provides both a new method of metrology for noninvasive evaluation of skin mechanics at the onset of wound healing and an emerging tape-based wound closure technology. The latter shows better performance with respect to commonly used staples and sutures, holding the wound intact and providing uniform mechanical support across the incision.

Highlights

Karl Langer’s work [1] allowed surgeons to recognize that the stress state of skin has significant impact on wound closure and healing post surgery
Our analyses suggest that the tape-based technology distributes mechanical strains along the incision uniformly, preventing dehiscence, when the wound is subject to physiologically relevant loading
The incision front did not move in the same direction and did not separate uniformly during loading. This indicates the presence of significant shear strains at transition points, and that creates a high propensity for post-surgical scarring [9]

Summary

Introduction

Karl Langer’s work [1] allowed surgeons to recognize that the stress state of skin has significant impact on wound closure and healing post surgery. Langer’s lines represent the directions of the skin’s maximum tension and are used as the preferred directions in which surgical incisions are made so that the tension across the wound is minimal post surgery [2]. We use biomechanical testing and digital image correlation (DIC), a noninvasive technique, to measure displacement and strains during loading of both non-biological and biological materials [6,7,8], to substantiate specific differences in how wound closure methods hold the skin tissue intact and impact the tensile strain distribution along the incision. Our analyses suggest that the tape-based technology distributes mechanical strains along the incision uniformly, preventing dehiscence, when the wound is subject to physiologically relevant loading. While staples have the highest holding strength, they fail to prevent dehiscence when skin is stretched and impart high shear at the incision front, increasing the likelihood of post-surgical scarring

Methods

Results

Discussion

Conclusion