title: Laparotomy closure using an elastic suture: a promising approach.
abstract: BACKGROUND
  Midline laparotomy wound failure like burst abdomen remains one of the major complications after abdominal surgery. The use of sutures with a closer resemblance to abdominal wall physiology, like elastic threads, could decrease the risk of these complications occurring. Thus, we evaluated the possibility of using a new elastic thread composed of thermoplastic polyurethane (TPU) as a suture for the closure of midline laparotomies compared to conventionally used polypropylene (PP) in a rabbit model.
  
  
  METHODS
  The elastic TPU thread was processed and tensile tests were performed. Twenty female chinchilla rabbits underwent midline laparotomy. They were randomized to a TPU and a PP group depending on the suture used for fascia closure. After 7 or 21 days, the abdominal walls were assessed macroscopically for wound healing complications and were explanted for histopathological investigation.
  
  
  RESULTS
  Tensile tests showed a mean elastic elongation of 55.5% and a sufficient material strength of the TPU thread. In animal experiments, there was no difference between the groups at 7 days; however, the TPU suture showed significantly less CD68 positive cells (p < 0.001) and a higher collagen I/III ratio (p = 0.011) than PP did after 21 days. The amount of apoptotic cells was significantly elevated in the TPU group (p = 0.007) after 21 days. No differences were found concerning granuloma size and number of Ki67-positive cells.
  
  
  CONCLUSIONS
  The newly developed TPU thread shows promising tensile characteristics. Midline laparotomy closure is feasible and safe in a rabbit model. Immunohistochemistry indicates similar biocompatibility and wound healing after implantation compared to PP after 21 days. To confirm these findings and to proof long-term capability further studies need to be conducted.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital of the RWTH Aachen, Aachen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Lambertz
authors.forename: R R M
authors.initials: RR
authors.lastname: Vogels
authors.forename: D
authors.initials: D
authors.lastname: Busch
authors.forename: P
authors.initials: P
authors.lastname: Schuster
authors.forename: S
authors.initials: S
authors.lastname: Jockenhövel
authors.forename: U P
authors.initials: UP
authors.lastname: Neumann
authors.forename: U
authors.initials: U
authors.lastname: Klinge
authors.forename: C D
authors.initials: CD
authors.lastname: Klink
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D058107:Abdominal Wound Closure Techniques; D000818:Animals; D004548:Elasticity; D005260:Female; D007813:Laparotomy; D008422:Materials Testing; D011126:Polypropylenes / Q000737:chemistry*; D011817:Rabbits; D013536:Suture Techniques; D013537:Sutures
chemical_list: D011126:Polypropylenes
keywords: abdominal wound failure; burst abdomen; elastic thermoplastic polyurethane suture; immunohistochemistry; midline laparotomy closure; polypropylene; rabbit model; tensile tests