Abstract
There is a lack of information regarding the forces required for suturing human wounds. The knowledge of suturing forces serves as complementary information for setting up the limiting geometry when using tissue adhesives and it might also be used in robot-assisted surgery. The main purpose of this paper was to evaluate the forces required for suturing selected skin wounds. An elliptical wound was chosen for our study. In this study a numerical analysis and in vivo experiments were performed. Regarding the numerical models, the maximum forces occurred in the middle of the elliptical wound in all cases. In the case of highest pre-stress used in these analyses the maximal force varied from 0.5 N for the smallest wound (30 × 5 mm) to 1.5 N for the largest wound (30 × 15 mm). The maximum peak force for the wound with a size of 46 × 13 mm was 3.2 N. The minimum peak force for the wound with a size of 36 × 5 mm was 1.1 N.
Similar content being viewed by others
References
Alexander H, Cook TH (1977) Accounting for natural tension in the mechanical testing of human skin. J Invest Dermatol 69:310–314
Bann S, Khan M, Hernandez J (2003) Robotics in surgery. J Am Coll Surg 96:784–795
Bischoff J, Arruda E, Grosh K (2000) Finite element modelling of human skin using an isotropic, non-linear elastic constitutive model. J Biomech 33:645–652
Cacou C, Anderson JM, Muir I (1994) Measurements of closing force of surgical wounds and relation to the appearance of resultant scars. Med Biol Eng Comp 32:638–642
Cacou C, Muir I (1995) Effects of plane mechanical forces in wound healing in humans. J R Coll Surg Edinb 40:125–131
Camarillo D, Krummel T, Salisbury K (2004) Robotic technology in surgery: past, present and future. Am J Surg 188:2S–15S
Capek L, Lochman Z, Jacquet E, Dzan L (2010) Biaxial extensometer for mesuring of the human skin anisotropy in vivo. In: 5th IEEE international conference, Cairo, Egypt, 83–85
Cavicchi A, Gambarotta L, Massabo R (2009) Computational modelling of reconstructive surgery: the effects of the natural tension on skin wrinkling. Finite Elem Anal Des 45:519–529
Chandra V, Nehra D, Parent R, Woo R, Reyes R, Hernandez-Boussard T, Dutta S (2010) A comparison of laparoscopic and robotic assisted suturing performance by experts and novices. Surgery 47:830–839
Chaudry H, Bukiet B, Siegel M, Findley T, Ritter AB, Guzelsu N (1998) Optimal patterns for suturing wounds. J Biomech 31:653–662
Danielson DA, Natarajan S (1975) Tension field theory and the stress in stretched skin. J Biomech 8:135–142
Diridollou S, Black D, Lagarde M, Gall Y, Berson M, Vabre V, Patat F, Vaillant L (2000) Sex and site dependent variations in the thickness and mechanical properties of human skin in vivo. Int J Cosmet Sci 22:421–435
Flynn C (2010) Finite element models of wound closure. J Tissue Viability 19:137–149
Frick T, Marucci D, Cartmill J, Martin C, Walsh W (2001) Resistance forces acting on suture needles. J Biomech 34:1335–1340
Handschel JGK, Depprich RA, Dirksen D, Runte C, Zimmermann A, Kübler NR (2006) A prospective comparison of octyl-2-cyanoacrylate and suture in standardized facial wounds. Oral Maxillofac Surg 35:318–323
Holzapfel G, Ogden R (2003) Biomechanics of soft tissue in cardiovascular systems. Springer, Udine
Jacquet E, Josse G, Khatyr F, Garcin C (2008) A new experimental method for measuring skin’s natural tension. Skin Res Technol 14:1–7
Kirby SD, Wang B, To CWS, Lampe HB (1998) Non-linear, three- dimensional finite-element model of skin biomechanics. J Otolaryngol 27:153–160
Larrabee WF Jr, Galt JA (1986) A finite element model of skin Deformation. III. The finite element model. The Laryngoscope 96:413–419
Lim J, Hong J, Chen W, Weerasooriya T (2011) Mechanical response of pig skin under dynamic tensile loading. J Imp Eng 38:130–135
Lott-Crumpler D, Chaudry HR (2001) Optimal patterns for suturing wounds of complex shapes to foster healing. J Biomech 34:51–58
Macpherson N, Lee S (2010) Effect of different suture techniques on tension dispersion in cutaneous wounds: a pilot study. Australas J Dermatol 51(4):263–267
Marescaux J, Rubino F (2003) The ZEUS robotic system: experimental and clinical applications. Surg Clin N Am 83:1305–1315
Melis P, Noorlander M, Bos K (2001) Tension decrease during skin stretching in undermined versus not undermined skin: an experimental study in piglets. Plast Reconstr Surg 107:1201–1205
Nguyen C, Vu-Khanh T (2009) Mechanics and mechanisms of puncture by medical needles. Proc Eng 1:139–142
O′Callaghan P, Jones M, James D, Leadbeatter S, Holt C, Nokes L (1999) Dynamics of stab wounds: force required for penetration of various cadaveric human tissues. Forensic Sci Int 104:173–178
Ogawa R, Akaishi S, Huang C, Dohi T, Aoki M, Omori Y, Koike S, Kobe K, Akimoto M, Hyakusoku H (2011) Clinical applications of basic research that shows reducing skin tension could prevent and treat abnormal scarring: the importance of fascial/subcutaneous tensile reduction sutures and flap surgery for keloid and hypertrophic scar reconstruction. J Nippon Med Sch 78(2):68–76
Reiley C, Akinbiyi T, Burschka D, Chang D, Okamura A, Yuh D (2008) Effects of visual force feedback on robot-assisted surgical task performance. J Thorac Cardiovasc Surg 135:196–201
Retel V, Vescovo P, Jacquet E, Trivaudey F, Varchon D, Burtheret A (2001) Non-linear model of skin mechanical behaviour analysis with finite element method. Skin Res Technol 7:152–158
Shapiro AJ, Dinsmore RC, North JH Jr (2001) Tensile strength of wound closure with cyanoacrylate glue. Am Surgeon 67:1113–1115
Singer A, Quinn J, Hollander J, Clark RE (2002) Closure of lacerations and incisions with octylcyanoacrylate. A multicenter randomized controlled trial. Surgery 131:270–276
Singer A, Quinn J, Hollander J (2008) The cyanoacrylate topical skin adhesives. Am J Emerg Med 26:490–496
Szabo Z, Avery J, Sandor A, Litwin D (2000) Suturing and knotting techniques for thoracoscopic cardiac surgery. Surg Clin N Am 80:1555–1574
Yoshida H, Tsutsumi S, Mizunuma M, Yanai A (2000) Three-dimensional finite element analysis of skin suture. Part 1: spindle model and S-shaped modified model. Med Eng Phys 22:481–485
Yoshida H, Tsutsumi S, Mizunuma M, Yanai A (2001) A surgical simulation system of skin sutures using a three-dimensional finite element method. Clin Biomech 6:621–626
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Capek, L., Jacquet, E., Dzan, L. et al. The analysis of forces needed for the suturing of elliptical skin wounds. Med Biol Eng Comput 50, 193–198 (2012). https://doi.org/10.1007/s11517-011-0857-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11517-011-0857-5