Biomechanical Comparison of Different Suturing Techniques in Rabbit Medial Gastrocnemius Muscle Laceration Repair

Abstract

Skeletal muscle laceration is a common injury. Repair of disrupted delicate tissue is still a clinical challenge for surgeons. A few different muscle repair techniques have been reported. However, the best muscle repair technique has not been identified. The aim of the present study is to compare the biomechanical features of different repair techniques in muscles to identify the most effective one. New Zealand white rabbits (2.5-3 kg) were euthanized and medial gastrocnemius muscles were isolated. The muscles were completely transected with scalpels and then repaired by 3 different techniques, namely, (1) 2-strand mattress, (2) 4-strand Kessler (with epitendinous suture), and (3) Mason-Allen. To measure suture performance, the repaired specimens were mounted onto a mechanical testing machine Instron 5543. The muscles were loaded to failure at a constant speed of 60 mm/min. Data collected from Merlin v5.31 software were used to compute the biomechanical properties of each specimen. There was no significant difference in the mean maximum load of Kessler group (15.5 N) and Mason-Allen group (13.2 N), whereas the mean maximum load of the control (Mattress) group (4.4 N) was significantly smaller than the other 2 groups. Moreover, Kessler stitches were the stiffest among the 3. It is noteworthy that the mechanisms of failure were different: Kessler stitches were all pulled out longitudinally, whereas Mason-Allen stitches transmitted load across the laceration and ruptures occur at areas adjacent to the stitches, indicating that muscle is the weakest element in the biomechanical testing. Both Kessler and Mason-Allen stitches have shown better biomechanical features compared with the control group. Further study has to be done to compare the effect of these 2 techniques on muscle regeneration and scar formation in an in vivo model.