Distance of insertion points in a mattress suture from the wound margin for ideal primary closure in alveolar mucosa: an in vitro experimental study

Abstract

Purpose This study was conducted to determine how the distance of the near insertion points in a vertical mattress suture from the wound margin influences the pattern of primary closure in an in vitro experimental model. Methods Pairs of 180 porcine gingival and alveolar mucosa samples were harvested from 90 pig jaws and fixed to a specially designed model. A vertical mattress suture was performed with the near insertion point at 3 different distances from the wound margin (1-, 3-, and 5-mm) on both the gingival and mucosal samples (6 groups; n=30 for each group). The margin discrepancy and the presence of epithelium between the wound margins were measured on histologic slides. Results The margin discrepancy decreased significantly as the near insertion point became closer to the wound margin both in mucosal tissue (0.241±0.169 mm, 0.945±0.497 mm, and 1.306±0.773 mm for the 1-, 3-, and 5-mm groups, respectively) and in gingival tissue (0.373±0.304 mm, 0.698±0.431 mm, and 0.713±0.691 mm, respectively). The frequency of complications of wound margin adaptation reduced as the distance of the near insertion point from the wound margin decreased both in the mucosal and gingival tissues. Conclusions Placing the near insertion point close to the wound margin enhances the precision of wound margin approximation/adaptation using a vertical mattress suture.

The distance of insertion points from wound margins in interrupted and vertical mattress sutures influences the tensile load capacity: An in vitro experimental study

“…We found no tearing when the insertion points were located 3–5 mm from the wound margins, which supports previous recommendations of placing the insertion points at 3–4 mm from the wound margins for interrupted sutures (Silverstein & Kurtzman, 2005) and at 4 mm from the wound margins for horizontal mattress sutures (Urban et al., 2016). Moreover, the present findings align with the notion that positioning near insertion points (<3 mm) decreases the probability of epithelium‐related complications (Lee et al., 2021).…”

“…These findings agree with previous reports that the distance of the insertion point may increase the tensile capacity (Silverstein & Kurtzman, 2005). However, it should be noted that using insertion points in mattress sutures that are farther from the wound margin may also compromise tight flap adaptation, which could delay wound healing (Lee et al., 2021; Miller et al., 2015). Therefore, from a clinical standpoint, it seems prudent to recommend a combination of suturing techniques; a mattress to counteract the tensile forces of the wound and interrupted sutures with a close insertion point to achieve a tight flap adaptation.…”

“…This was accomplished using a surgical scalpel and periosteal elevator. The tissue samples were stored as described previously (Lee et al., 2021), and kept moist using wet soaking saline gauze and placed in a refrigerator until the experiments were carried out in order to prevent tissue shrinkage and dryness. One pair of oral mucosa samples was fixed to a silicone putty plate by metal pins at a position apposing each flap margin.…”

“…A clinical study found that the wound dehiscence rate was ≥40% at sites where primary closure was achieved using a high closing force (>0.1 N), but only 10% at sites where a lower force was used (0.01–0.1 N) (Burkhardt et al., 2008). Moreover, the distance from the wound margin during suturing also appears to play a role in the success of primary closure (Lee et al., 2021). A previous in vitro study by our group found that having the insertion points too far from the wound margins can compromise their correct adaptation (Lee et al., 2021).…”

“…Moreover, the distance from the wound margin during suturing also appears to play a role in the success of primary closure (Lee et al., 2021). A previous in vitro study by our group found that having the insertion points too far from the wound margins can compromise their correct adaptation (Lee et al., 2021). Sutures should be inserted as near as possible to the wound margin to achieve adequate tissue adaptation, but this may increase the risk of tearing the flap.…”