In vitro evaluation and in vivo use of a novel surgical stent to minimize suture pressure necrosis

Abstract

Objective: To evaluate the efficacy of stents to distribute pressure when incorporated into tension-relieving sutures. Study design: An in vitro study and case report. Animal: One common bottlenose dolphin (Tursiops truncates).Methods: Three novel silicone stents, a traditional stent, and a control were tested in vitro by using a suture simulator. Stent surface area was measured by using a pressure mapping sensor. Pressure was derived from the measured surface area and the downward force of the suture simulator. Novel silicone stents were also used in the closure of an incision in a bottlenose dolphin. Results: No difference was found in surface area or pressure among the three silicone stents (adjusted P > .05). Silicone stents yielded an average, 2.69 cm 2 more surface area and 842.37 kPa less pressure compared with the control as well as 1.67 cm 2 more surface area and 110.67 kPa less pressure compared with the traditional stent. The traditional stent yielded 1.02 cm 2 more surface area and 731.7 kPa less pressure compared with the control. Incision site and silicone stent assessment performed postoperatively revealed no obvious pressure necrosis.Conclusion: Stents improved distribution of suture pressure, and novel silicone stents were more effective compared with traditional stents. Novel silicone stents appear to have preliminary clinical success in vivo. Clinical significance:Our study provides evidence that stents effectively help distribute suture pressure, and their incorporation might minimize the risk of suture pressure necrosis. Novel silicone stents should be integrated into tension-relieving suture patterns when closing wounds and incisions, particularly in aquatic animals.

A novel tension relief technique to aid the primary closure of traumatic equine wounds under excessive tension

“…A recent study by Dannemiller et al, 8 demonstrated the importance of a wide surface area in contact with the skin to prevent pressure‐related damage in the dolphin. In addition, in human surgery, tension‐relieving devices with a large contact area are used to decrease this risk 8–10 …”

“…In addition, in human surgery, tension-relieving devices with a large contact area are used to decrease this risk. [8][9][10] Skin is a heterogeneous viscoelastic tissue that is capable of further extension beyond its initial elasticity with the application of a stretching over time. These inherent properties, called mechanical creep and complemented by stress relaxation, can be harnessed to aid wound closure.…”