OC-089 STANDARDIZED SUTURING OF MEDIAN INCISIONS AND DEFECTS CAN REDUCE SUTURE SLACKENING AND BURST RATES

Abstract

Abstract Aim Has standardization of criteria of a small-stitch-small-bite suture (SSSB) a significant influence on its durability? Material and Methods Porcine abdominal walls and bovine flanks were used as model tissues. We cut a median 15 cm long incision into the tissues. Then we punched an additional round (5–10 cm wide) or rhomboid (5×15 cm) defect in the middle of the incision. Monomax® and Maxon® USP 1 and 2–0 sutures were used in a running technique with a suture to incison lengths above 4:1. The mesh-tissue compounds were investigated on our self-built hydraulic bench test simulating coughs. Cyclic pressure impacts were repeatedly delivered peaking around 210 mmHg. In each of twenty experimental series, ten preparations were loaded 425 times. Results Standardized SSSB sutures using 2–0 Monomax® with a suture-incision-ratio of 4.5 : 1 can give a durable closure of a large defect in thin, elastic tissues. Under other conditions, suture lines can reopen. Standardization of the suturing technique significantly increased the durability (p = 0.00008). Defect shape is important since the larger rhomboid defects were easier to close compared to the smaller, 5 cm wide, round defects (SSSB: p = 0.00018; LSLB: p = 0.00906). Discussion After standardization, insignificant influences on the durability were exerted by the suture material and diameter, the bite and stitch size (small versus large), the surgeon, the tissue elasticity and tension and the defect size. Conclusions A standardized suturing technique was developed. The standardization improved the durability of a suture repair significantly.