A comparison of the mechanical strength of three different suture techniques for intercostal thoracotomy closure - ex vivo study

The transcostal closure technique of intercostal thoracotomy closure appears to be associated with less pain in the first 24 hours and could be an alternative to the standard circumcostal technique. The goal of this study was to compare the ex vivo biomechanical properties of three suture techniques for intercostal thoracotomy closure. Samples of porcine ribs were used for the research. A 10 cm incision was made in the intercostal space in each sample. The techniques compared were: simple circumcostal interrupted suturing, continuous circumcostal suturing, and interrupted transcostal suturing. During the testing in the machine, suture rupture or rib cracking occurred. If rib cracking occurred first, the testing was continued until the suture broke as well. In the first group, rib fracture occurrence was 60% and suture rupture was 40%. In the second group, rib fracture occurrence was 55%, while 45% of the samples failed by suture rupture. In the third group, rib fracture occurrence was 70%, while suture rupture was 30%. These data did not differ significantly between groups (P>0.05). Continuous circumcostal suturing took the least amount of time, and the most time-consuming technique was interrupted transcostal suturing. Simple circumcostal suturing used most material, and the least amount of material was used with continuous circumcostal suturing. The conclusion of this paper is that the continuous pattern suture has the same mechanical strength as the other two suture patterns, but it consumes the least time and material. Therefore, from a mechanical standpoint, we advise the use of continuous circumcostal suture for intercostal thoracotomy closure.
Doima se da je interkostalna tehnika zatvaranja torakotomije povezana s manje bola unutar prva 24 sata te bi mogla bi biti alternativa standardnoj cirkumkostalnoj tehnici. Cilj ovog istraživanja bio je usporediti ex vivo biomehanička svojstva triju tehnika za zatvaranje interkostalne torakotomije. Za istraživanje su korišteni uzorci svinjskih rebara. Na svakom je uzorku učinjena incizija duga 10 cm. Uspoređivano je jednostavno cirkumkostalno pojedinačno šivanje, produžno cirkumkostalno šivanje i pojedinačno transkostalno šivanje. Tijekom testiranja na trgalici popuštali su šavovi ili je došlo do loma rebara. Ako je došlo do loma rebara, testiranje je nastavljeno do popuštanja šavova. U prvoj skupini lom rebara dogodio se na 60 % uzoraka, dok je u 40 % uzoraka popustio šivaći materijal. U drugoj skupini u 55 % uzoraka popustila su rebra, dok je u 45 % uzoraka popustio šivaći materijal. U trećoj skupini u 70 % uzoraka popustila su rebra, dok je u 30 % slučajeva popustio šivaći materijal. Ovi se podaci ne razlikuju znakovito među testiranim skupinama (P > 0,05). Produžnim cirkumkostalnim šivanjem utrošak vremena bio je najmanji, dok je pojedinačnim transkostalnim šivanjem utrošak vremena bio najveći. Jednostavnim cirkumkostalnim šivanjem utrošilo se najviše šivaćeg materijala, dok je najmanje materijala utrošeno produžnim cirkumkostalnim šivanjem. Zaključak ovog rada je da produžno šivanje pruža jednaku mehaničku snagu kao i ostale testirane metode, ali je utrošak vremena i materijala manji. Stoga, s mehaničkog stajališta, za zatvaranje interkostalne torakotomije preporučujemo jednostavni cirkumkostalni šav.