Suture Pullout in Human Cadaveric Skin: Evaluation of HEMIGARD® Augmentation vs Suture Alone

Abstract

Category: Other; Ankle; Midfoot/Forefoot Introduction/Purpose: Closure of high-tension surgical wounds is a challenge frequently encountered during surgical procedures. The use of a novel adhesive augmentation device, HEMIGARD, has been proposed to decrease tension on wound closure and thereby increase the amount of force needed for suture pullout. In principle, this may help prevent wound dehiscence, skin edge necrosis and the sequelae thereof. We hypothesized that HEMIGARD augmentation of suture placement would require more force for suture pullout from human cadaveric lower extremity skin when compared to suture alone. Methods: In this study, HEMIGARD with suture was compared to suture alone on leg and foot measurements from four cadavers. One side of the incision was used to test the HEMIGARD according to the manufacturer's instructions. The other side of the same incision was used to test the same suture material, passed without HEMIGARD, to allow for direct comparison. A force gauge was used to measure the Newtons of force required for suture pullout. A total of 30 measurements were recorded per cadaver; 15 using HEMIGARD and 15 using suture alone. Results: No difference was observed between HEMIGARD and suture alone in the amount of force required for suture pullout. When excluding instances of HEMIGARD adhesive failure, which occurred in 67% of measurements, the HEMIGARD was found to be superior to suture alone in the cadaveric foot, but not in the leg. Conclusion: The amount of force required for suture pullout from human cadaveric lower extremity skin did not significantly differ when using HEMIGARD augmentation of suture placement versus using suture alone. However, when excluding instances of HEMIGARD adhesive failure, the HEMIGARD may be superior to suture alone in the cadaveric foot, but not in the cadaveric leg.