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Reinforcement of Subcuticular Continuous Suture Closure with Surgical Adhesive Strips and Gum Mastic: Is There Any Additional Strength Provided?

Reha Yavuzer, MD, Christopher Kelly, MD, Noreen Durrani, MD, Vijay Mittal, Ian Jackson, MD, and Stephen ReMine.

  <>Introduction: The absorbable continuous subcuticular suture is frequently used to close surgical incisions. Surgical adhesive strips, with or without application of adhesive agents to increase the adherence, are also placed over the wound for various reasons but mainly to decrease the likelihood of unwanted wound separation. In this study the burst strength of suture versus suture and strip with or without gum mastic was studied to find out any beneficial effect of their usage in an immediate wound separation model. <>Materials and Methods: The back of two fresh frozen male adult cadavers were used. On each cadaver 25 3cm full thickness incisions were created. Then these 50 incisions were closed in five groups: Group 1: 4/0 absorbable subcuticular continuous suture; Group 2: In addition to same suturing horizontally placed surgical adhesive strips; Group 3: Same as Group 2 except gum mastic was applied prior to strip application; Group 4: Surgical adhesive strips alone and Group 5: Surgical adhesive strips with prior application of gum mastic. The burst strength of each wound was measured by using tensilometer and the force necessary to separate the wounds were recorded. <>Results: The mean separation force required for each group was: Group 1: 14,17 kg; Group 2: 14,37; Group 3: 15.39, Group 4: 1,52 and Group 5: 3,85. Group 4 and 5 showed significantly less burst strength than sutured used groups (Group 1, 2, 3). There were no statistically significant difference between groups 1,2 and 3 (Kruskal Wallis test p=0.508). When compared with Group 4, Group 5 required markedly more force to separate the wound (Mann Whitney test p=0.001). In Group 2 and 3 before the wound separation occurred the strips were peeled off the skin and the strip separation forces of those two groups were statistically significant in favor of gum mastic treated subjects (Mann Whitney test p=0.008)





Group 1

Suture alone

14.171.92 kg

Group 2

Suture + Strip

14.371.96 kg

Group 3

Suture + Gum mastic + Strip

15.392.69 kg

Group 4

Strip alone

1.520.33 kg

Group 5

Gum mastic + Strip

3.840.58 kg


Conclusion: When wound closure was achieved with sutures no additional strength was provided by reinforcement with either additional strip alone or mastic gum application and strip placement. Mastic gum significantly increased the adherence of strips and this seems to be especially important when strips are the only means of wound closure. Application of surgical strips over a sutured incision has various purposes such as avoiding any other means of dressing, decreasing the tension on wound and blocking transient bacterial contamination. However, strip reinforcement does not provide any additional strength in this wound separation model.

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