The Influence of Tension on the Success of Aponeurotic Suture of the Anterior Abdominal Wall in Experiment

Yuriy M. Sheptunov, Pavel V. Vnukov, Evgeniy F. Cherednikov, Andrey A. Filin, Evgeniy S. Ovsyannikov

 
International Journal of Biomedicine. 2018;8(3):247-249.   
DOI: 10.21103/Article8(3)_ShC2
Originally published September 15, 2018  

Abstract: 

Background: The problem of predicting the failure of aponeurotic sutures today is of current interest in abdominal surgery, especially in herniology.
Methods and Results: The experimental study was carried out on 20 rabbits of the white giant breed (both sexes). Aponeurotic defects of various sizes were made to the animals’ middle zone of the anterior abdominal wall in the area of the anterior rectus sheath. The defects were sutured with a different tension of the aponeurosis depending on the size of the defect. This tension was determined by traction over ligatures conducted through the borders of the reduced aponeurosis by a digital dynamometer where the edges contact. To increase the rigidity of the layers, titanium frames were installed in the retromuscular space. Thus, tension from 0.012 MPa to 1.2 MPa was created. The results were evaluated on the 30th day of the postoperative period  Macroscopic assessment under a loupe and histological examination were used. It was found that aponeurotic sutures failed at a higher tension index (TI) (0.66±0.16 MPa vs. 0.26±0.16 MPa, P<0.001). At the same time, histological changes were characterized by signs of inflammation with a pronounced alterative component. We did not find that the direction of the incision had any effect on the tension value in cases of suture failure.
Conclusion: No failure of the suture in the early postoperative period was observed in cases of aponeurosis edge tension less than 0.4MPa. Exceeding this value in 68.7% of cases led to the failure of aponeurotic sutures.

Keywords: 
tension • aponeurosis • abdominal wall • suture failure
References: 

1. Fink C, Baumann P, Wente MN, Knebel P, Bruckner T, Ulrich A, et al. Incisional hernia rate 3 years after midline laparotomy. Br J Surg. 2014;101(2):51-4. doi:10.1002/bjs.9364. PubMed
2. Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ. Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg. 2012;204(5):709-16. doi: 10.1016/j.amjsurg.2012.02.008. PubMed
3. Alam NN, Narang SK, Pathak S, Daniels IR, Smart NJ. Methods of abdominal wall expansion for repair of incisional herniae: a systematic review. Hernia. 2016;20(2):191-9. doi: 10.1007/s10029-016-1463-0. PubMed
4. Sheptunov YM, Vnukov PV.  Method of prevention of intra-abdominal hypertension in the median ventral hernioplasty. Voronezh State Medical University named after N.N. Burdenko. 2017: 2 629 803 (25). [In Russian].
5. Muresan M, Muresan S, Bara T, Brinzaniuc K, Sala D, Suciu B, Radu N. The intraabdominal pressure A real indicator of the tension free principle during anterior wall repair procedure after incisional hernias. Ann Ital Chir. 2015;86:421-6. PubMed
6. Schachtrupp A, Wetter O, Höer J. An implantable sensor device measuring suture tension dynamics: results of developmental and experimental work. Hernia. 2016;20(4):601-6. doi: 10.1007/s10029-015-1433-y. PubMed
7. Vnukov PV, Sheptunov Y.M. Some Strain Characteristics of the White Lne of the Abdomen in the Median Laparotomic Wound (Experimental Study). Vestnik of Experimental and Clinical Surgery. 2016;9(1):76-80. doi: 10.18499/2070-478X-2016-9-1-76-80. [Article in Russian]. Google Scolar

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Received May 22, 2018.
Accepted June 5, 2018.
©2018 International Medical Research and Development Corporation.