The Lasso Suture: Ex Vivo Testing of an Alternative to the High-Tension Deep Dermal Stitch

Abstract

Summary: Wound dehiscence, with an estimated occurrence rate greater than 4% in plastic surgery, is generally underreported, and can be an indicator of increased mortality and remission rates. The authors developed the lasso suture as a stronger alternative to the current standard patterns. The lasso suture takes less time to perform than the standard high-tension wound repair method. The authors dissected caprine skin specimens to create full-thickness wounds for suture repair using simple interrupted, vertical mattress, horizontal mattress, and deep dermal with running intradermal (DDR) sutures ( n = 10) and lasso sutures ( n = 9). They then conducted uniaxial failure testing to quantify the suture rupture stresses and strains. They also measured the suture operating time with medical students and residents (PGY or MS programs) performing wound repair (10-cm wide, 2-cm deep, 2-0 polydioxanone sutures) on soft-fixed human cadaver skin. The lasso stitch had a greater first-suture rupture stress compared with all other patterns ( P < 0.001): 2.46 ± 0.27 MPa for lasso versus 0.69 ± 0.14 MPa for simple interrupted, 0.68 ± 0.13 MPa for vertical mattress, 0.50 ± 0.10 MPa for horizontal mattress, and 1.17 ± 0.28 MPa for DDR sutures. Performing the lasso suture was 28% faster than performing standard DDR (264 ± 21 versus 349 ± 25 seconds; P = 0.027). In summary, the authors showed that the lasso has superior mechanical properties compared with the studied traditional sutures, and that the new technique can be performed more quickly than the current standard (DDR stitch) for high-tension wounds. Future animal and in-clinic studies will be helpful to confirm the authors' findings in this proof-of-concept study.

Clinical relevance statement: The authors propose the lasso suture, a new suturing method with improved tensile performance compared with traditional techniques and a faster operative time than the deep dermal stitch typically used for high-tension wounds in reconstructive surgery to prevent wound dehiscence.