Introduction

The suture is a surgical procedure that allows the margins of a wound to be permanently approached, favouring its healing. In particular, the surgical suture consists in the application of one or more stitches that keep the edges of the wound in contact. A surgical suture may encounter a post-operative complication called dehiscence that is represented by spontaneous reopening of the previously sutured wound; the dehiscence may be partial, and therefore involve one or some suture stitches, or complete, and therefore involve all the suture. In addition to associated microbiological risks, a dehiscence can have serious aesthetic repercussions, as wounds that heal by second intention (i.e. after reopening) can easily undergo an hyperplastic scarring process.

One of the main causes of surgical suture dehiscence is an excessive tension between the edges of the wound that are held together by the suture; moreover, this tension tends to locally ischemize the blood vessels, reducing blood flow to the wound and thus delaying healing. For this reason the surgeon must assess the tension between the edges to be sutured  before applying the sutures, and, to date, this assessment is performed manually, therefore, in an inaccurately and completely subjective way. In fact, no technologies are yet available to standardize the tension between flaps to be sutured, in order to univocally correlate a specific tension value to a series of surgical options to be applied to the lesion.

Technical features

The purpose of this invention is to provide an easy-to-use, cost-effective surgical instrument capable of measuring the tension between the margins of a skin wound, or between two tendons, or nerves stumps, 

The instrument consists of a sterilizable and reusable surgical forceps, modified as follows. At the end of each arm, a special gripping hook has been inserted to grasp a corresponding flap of soft tissue; on the other end, the operating hook, there are the classic rings for the user’s fingers. Along the arms, several notches have been carved, whose function is to accommodate a circular elastic band of disposable silicone, made with precise and standardized thickness and composition, able to measure the return force with which the two flaps to be sutured tend to move away from each other.

The possibility of correlating an objective value of tension of the flaps to be sutured with the surgery outcomes will allow to establish new cut-offs to quickly and standardizedly choose the best surgical technique, as well as the best type of suture thread to be used to suture the lesion. In addition, it will provide a new type of instrument to study the elastic behavior of the skin.

Possible Applications

• Aesthetic and reconstructive surgery;
• orthopedic tendon reconstruction surgery;
• neurosurgery, for peripheral nerve injuries repairing;
• research.

Advantages

• Easy to use;
• Low cost;
• Sterilisable;
• Could become a standard operating tool;
• Allow to optimize and speed-up the choice of the surgical technique to be used for the suture in an objective way, based on real tension values.