Buried Tension Sutures: Force‐Tension Comparisons of Pulley, Double Butterfly, Mattress, and Simple Interrupted Suture Patterns

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Abstract
Objectives—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.Study Design—In vitro study.Sample Population—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.Clinical Relevance—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.

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