title: Buried tension sutures: force-tension comparisons of pulley, double butterfly, mattress, and simple interrupted suture patterns.
abstract: OBJECTIVE
  To compare suture patterns (simple interrupted, modified pulley, horizontal mattress, double butterfly) by use of a novel in vitro model that quantifies force required for closure against tension.
  
  
  METHODS
  In vitro study.
  
  
  METHODS
  Suture constructs.
  
  
  METHODS
  An in vitro suturing frame was constructed with extension springs to provide a standard resistance against movement of 2 panels of loops toward each other. Four different suture patterns were applied to the frame in randomized trials. The frame was affixed to a tensiometer that measured the force required for each suture pattern to close a fixed distance (3.81 cm) at a constant rate (5.08 cm/min) against the tension (0.6 kg/cm) of the extension springs. The closure distance and tension were selected subjectively to mimic tension encountered clinically during wound reconstruction oncologic surgical procedures.
  
  
  RESULTS
  The modified pulley suture required the least force to close, followed by the double butterfly, simple interrupted, and horizontal mattress patterns.
  
  
  CONCLUSIONS
  The modified pulley suture and double butterfly suture patterns require less force to close a given distance under tension than either simple interrupted or horizontal mattress suture patterns.
  
  
  CONCLUSIONS
  Application of tension relieving suture techniques for fascia, subcutaneous, and buried-knot subdermal suturing should be considered to facilitate direct closure of wounds under tension. Modified pulley and double butterfly suture patterns offer some mechanical advantage by requiring less force to achieve closure compared with other suture patterns that might be used in reconstructive surgery.
authors.affiliation: Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL 36849-5540, USA. austibr@auburn.edu
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Austin
authors.forename: Ralph A
authors.initials: RA
authors.lastname: Henderson
mesh_terms: D000818:Animals; D062109:Dermatologic Surgical Procedures; D008954:Models, Biological; D013514:Surgical Procedures, Operative / Q000379:methods / Q000662:veterinary*; D013536:Suture Techniques / Q000295:instrumentation / Q000662:veterinary*; D013537:Sutures; D013718:Tensile Strength; D014945:Wound Healing / Q000502:physiology