Optimal patterns for suturing wounds of complex shapes to foster healing

Stress is one of the many biological factors that plays an important role in wound healing. It is therefore essential to analyze stresses around the wound closure theoretically, especially when no invasive/noninvasive technique to measure stress directly is available. The objective of this paper is to determine the regions of high stresses and the optimal pattern of suturing wounds of complex shapes. It is hypothesized that the optimal pattern of suturing wounds is that pattern which will produce minimum principal stresses. The finite element method (FEM) employing the basic equations of elasticity theory for orthotropic materials is utilized to compute the principal stresses and displacements resulting from suturing fusiform, elliptical and triangular wounds in human abdominal skin. The optimal suturiug pattern for the triangular wound is determined. The average stress indices for varying suturing density are also determined which call provide useful clinical information for the surgeon. Since regions of high stresses in surgical closures produce adverse affects on healing and scar production, this work of predicting areas of high stresses is useful in indicating regions of slow healing in wounds. (C) 2000 Elsevier Science Ltd. All rights reserved.