Comparing Various Suture Techniques for Lacerated Muscle Repairs

ABSTRACT

Purpose: While closed muscle injuries are usually treated conservatively, the optimal treatment technique for open muscle lacerations is still unknown¹. Only three studies have compared the biomechanical strength of muscle repairs however they had conflicting results^2,3,4.  Very few studies have looked at the time required for each suture technique.  The purpose of this study was to examine the biomechanical properties of common muscle repair techniques to determine the superior repair in terms of strength and time required to achieve approximation.

Methods: Forty-two fusiform porcine muscle specimens were dissected to comparable sizes and used for testing the suture repair techniques.  We investigated three traditionally known repairs: Figure Eight, Mason-Allen, and Perimeter.  Each muscle was completely transected and then repaired using one of the three techniques. Fourteen muscle-tendon specimens were prepared for each group.  We recorded the time for each repair and the force at repair failure utilizing a materials load bearing testing system.  We recorded biomechanical properties including breaking strength and stiffness as well as the time required for each approximation.

Results: There were no statistical differences found between the three techniques in regards to breaking strength. Both the Figure Eight (p = 0.039) and Perimeter techniques (p = 0.001) were significantly stiffer than the Mason-Allen technique.  The figure eight technique was the quickest repair in terms of time.

Conclusions: Given the equivalent breaking strength, increased stiffness, and relatively quickest time to perform we found the Figure-Eight technique should strongly be considered for muscle laceration repair.

 

References

1. Menetrey J, Kasemkijwattana C, Day CS, et al. Growth factors improve muscle healing in vivo. J Bone Joint Surg Br. 2000;82(1):131-137.
2. Chance JR, Kragh JF, Jr., Agrawal CM, Basamania CJ. Pullout forces of sutures in muscle lacerations. Orthopedics. 2005;28(10):1187-1190.
3. Kragh JF, Jr., Svoboda SJ, Wenke JC, Ward JA, Walters TJ. Suturing of lacerations of skeletal muscle. J Bone Joint Surg Br. 2005;87(9):1303-1305.
4. He M, Sebastin SJ, Gan AW, Lim AY, Chong AK. Biomechanical comparison of different suturing techniques in rabbit medial gastrocnemius muscle laceration repair. Ann Plast Surg. 2013;73(3):333-335.