Computational Modeling of Wound Suture: A Review

Abstract

Suturing is an acquired skill which is based on a surgeon's experience. To date, no two sutures are the same with respect to the type of knot, tension, or suture material. With advancement in medical technologies, robotic suturing is becoming more and more important to operate on complex and difficult to reach internal surgical sites. While it is very difficult to translate a surgeon's suturing expertise to an automated environment, computational models could be employed to estimate baseline suture force requirements for a given wound shape, size, and suture material, which could be subsequently processed by a robot. In the literature, there have been few attempts to characterize wound closure and suture mechanics using simple two- and three-dimensional computational models. Single and multiple skin layers (epidermis, dermis, and hypodermis) and tissues with different wound geometries and sizes have been simulated under simple wound flap displacements to estimate suture force requirements. Also, recently, sutures were modeled to simulate a realistic wound closure via suture pulling, and skin prestress effect due to the natural tension of skin was incorporated in a few models to understand its effects on wound closure mechanics. An extensive review of this literature on computational modeling of wound suture would provide valuable insights into the areas in which further research work is required. Discussion of various computational challenges in modeling sutures in a numerical environment will help in better understanding the roadblocks and the required advancements in suture modeling.

The Biomechanical Properties of Suture Materials and Their Relationship to Bacterial Adherence

“…Natural sutures, such as silk, are more likely to cause infection due to their properties. However, it is utilized more by surgeons because of the superior handling and knot characteristics [13]. The main disadvantage is that it has a fairly high possibility in producing an acute inflammatory response, which could hinder the healing process [14].…”

“…Polyglycolic acid was the first synthetic absorbable suture that had a higher tensile strength [15]. Silk has unique handling but carries high tissue reactivity [13].…”

Biomechanical Modeling of Wounded Skin

“…After baseline measurements, tensile tests ( Figure 4) were conducted on test specimens with wounds and strain changes with time were quantified using VIC 2D. Overstraining, defined as the occurrence of a high strain zone (i.e., strain ≥25% of average strain [4]), was identified during the tests. Possibility of rupture was indicated for incidences of high strain zones surrounded by low strain zones (i.e., strain ≤25% of average strain [4]).…”

“…In literature, the mechanics of wound closure has been studied using computational modeling [4]. One of the earliest numerical wound closure models was developed by Danielson and Natarajan et al [5], which involved the estimation of maximum and minimum stress zones using the tension field theory.…”

Automated open wound suturing: detection and planning algorithm

“…Algorithms that use a stereo image for detection, initialization, and tracking of a suture thread through fitting a nonuniform rational B-spline (NURBS) curve allowed real time tracking a suture thread undergoing translations and deformation 16 . Chanda et al 17 presented a review for computational modeling of wound suture and closure mechanics with geometrical modeling, material characterizations, finite element meshing.…”