ASSESSING THE ROLE OF PRESUTURING ON WOUND CLOSURE

The efficacy of presuturing was tested by quantitating the tissue gain s for standardized wounds in a white swine piglet (9 to 11-kg) model. Also measured were the changes in wound closure tension for the wounds . Measurements were carried out at 1, 4, 17, 24, 48, and 72 hours in a total of 20 piglets. Presuturing was carried out on one of the flanks and the opposite flank served as the control. Presuturing achieved a modest tissue gain, amounting to 67 mm at 4 hours and a maximum of 1.4 cm at 48 and 72 hours, for a 4-cm defect. The encouraging tissue gain was unfortunately not paralleled by a decrease in the tension require d to approximate the wound edges. At 4 hours, the tension to close the wound was 1.2 N (only 120 g) less than the control wound. This initia l small reduction in wound-closing tension was diminished thereafter, and at 72 hours the wounds were stiffer and harder to close than the c ontrol. This appeared to be due to tissue edema and was confirmed by a n increase in measurable tissue water with increasing time. In this mo del, presuturing produces a minimal tissue advancement and even less r eduction in wound-closing tension. It is concluded, from this work and from previously published work, that undermining will prove generally to be a more useful technique in closing broad defects.