ORCID Profile
0000-0001-6122-4516
Current Organisations
Silver Falls Dermatology
,
SUTUREGARD Medical, Inc.
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Publisher: Mary Ann Liebert Inc
Date: 06-2018
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.JMBBM.2019.05.015
Abstract: Conduct a first in vivo study on the large deformation stress relaxation behavior of the human scalp. This study was conducted during Mohs micrographic surgery of the scalp of 14 patients aged 59-90 with wounds initially ranging from 9 to 41 mm wide. The initial wound diameter was measured under zero applied force. Then, the force required to close each wound using a single size 1 nylon suture and a SUTUREGARD suture retention device was measured, after which the suture was then locked in the retention device at fixed displacement. At time points of 300 s, 600 s, and 1800 s, the suture retention device was released, and the wound opening was again recorded at zero force, and the force required to close the wound was recorded. The average wound closure force relaxed by 44% and 65% after 300 s and 1800 s, respectively. Average wound width decreased 30% and 42%, after 300 s and 1800 s, respectively, due to creep deformation. Furthermore, all wounds relaxed to be below 15 N of closure force after 600 s, which is considered the maximum clinically acceptable force. A relaxation time of ∼270 s and a threshold force for creep of ∼5 N was found. Results of this study provide the first quantitative clinical guidance for efficient scalp closure of large wounds by creep deformation and stress relaxation. Furthermore, the methodology developed here can be used as a basis for future in vivo studies of the stress relaxation and creep deformation of human scalp, which in turn can provide data for the development and validation of constitutive models for scalp deformation.
Publisher: Wiley
Date: 09-2021
DOI: 10.1002/HSR2.364
Abstract: The purpose of this investigation was to test the hypothesis that a novel adhesive retention suture device (ARSD) can increase perfusion at elliptical wound closures by distributing stress away from the suture site. Stress in the skin around a suture both with and without support from an ARSD was evaluated using a finite element model. A single‐center, randomized split‐scar comparison trial using laser speckle contrast analysis was used to quantify the perfusion at elliptical wound closures in human patients both with and without an ARSD. The finite element model revealed that the ARSD promoted load transfer to the skin over a larger area, thus reducing the local stress and deformation in the skin around the suture site. Results from the split‐scar study showed a mean improvement of 25% perfusion units with the ARSD, and the improvement was statistically significant ( p = 0.002). The reduction in local stress and enhanced perfusion around the suture site reveals the potential benefit of using an ARSD to enable more efficient healing by avoiding complications associated with both low perfusion and skin tearing, such as dehiscence, infection, and cheese wiring.
Publisher: Wiley
Date: 18-07-2014
DOI: 10.1002/JBM.B.33171
Abstract: Comprehensive studies comparing tensile properties of sutures are over 25 years old and do not include recent advances in suture materials. Accordingly, the objective of this article is to investigate the tensile properties of commonly used sutures in cutaneous surgery. Thirteen 3-0 sized modern sutures (four nonabsorbable and nine absorbable) were tensile tested in both straight and knotted configurations according to the procedures outlined by the United States Pharmacopeia. Glycomer 631 was found to have the highest failure load (56.1 N) of unknotted absorbable sutures, while polyglyconate (34.2 N) and glycomer 631 (34.3 N) had the highest failure loads of knotted absorbable sutures. Nylon (30.9 N) and polypropylene (18.9 N) had the greatest failure loads of straight and knotted nonabsorbable sutures, respectively. Polydioxane was found to have the most elongation prior to breakage (144%) of absorbable sutures. Silk (8701 MPa) and rapid polyglactin 910 (9320 MPa) had the highest initial modulus of nonabsorbable and absorbable sutures, respectively. The new data presented in the study provide important information for guiding the selection of suture materials for specific surgeries.
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.JMBBM.2016.06.033
Abstract: To test the hypothesis that the mechanical strength of wounds closed with a combination of buried dermal absorbable sutures and superficial nonabsorbable nylon sutures will be higher than wounds closed with only superficial nonabsorbable nylon sutures. Four Yucatan pigs were anesthetized and each received four 4.5cm full thickness incisions on their dorsal surfaces, placed 8cm apart. Half of all incisions were randomly allocated and repaired with 3-0 polyglactin 910 (Vicryl(™)) buried dermal absorbable sutures and superficial 3-0 nylon sutures, using a simple interrupted pattern. The other half received only 3-0 nylon sutures. Two pigs were humanely euthanized at day 10, with specimen harvest for mechanical testing the other two pigs had superficial nylon sutures removed at day 10, as per current clinical practice, and were humanely euthanized at day 42, with specimen harvest for mechanical testing. Tensile loads were applied perpendicularly to the wounds with a displacement rate of 40mm per minute. Wounds at day 42 were >9 times stronger than wounds at day 10 (p<0.0001). There was no difference in average wound strength at either day 10 or day 42 between wounds with and without buried dermal absorbable sutures. Buried dermal absorbable sutures failed to provide additional wound support at either 10 or 42 days. This result may have immediate implications for clinicians who perform cutaneous surgery and keep superficial sutures in for at least 10 days. Future research will be directed to shorter time studies, other buried dermal absorbable suture materials, and alternatives to buried dermal absorbable sutures.
Publisher: Wiley
Date: 17-01-2016
DOI: 10.1002/JBM.B.33600
Abstract: Surgeons can choose from a wide selection of commercially available suture brands, which come at a range of prices. There is currently limited evidence in the literature to guide this selection process. This investigation examined the breaking force, stress, and elongation of a variety of commercially available nylon sutures compared to their relative prices. Seven 5-0, nonabsorbable, nylon suture brands were tensile tested in straight, knotted and knot-security configurations according to the procedures outlined by the United States Pharmacopeia for the tensile testing of sutures. Covidien, the cheapest brand tested, had the highest failure load of straight and knot-security tests. Dafilon was found to have the highest breaking force and percent elongation of knot-pull tests. J&J Ethicon and Supramid had the highest percent elongation to failure for straight-pull and knot-security tests, respectively. This study was limited to specific in vitro tensile properties of nylon suture. Other factors affecting suture quality and price, such as needle properties, were not investigated. The data presented in the study provide information for guiding the selection and purchase of sutures according to tensile properties. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 815-819, 2017.
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.CLINBIOMECH.2019.12.018
Abstract: To close elliptical excisions, surgeons commonly use the rule of halves which involves initially closing of the middle portion of the wound, followed by closure of the remaining halves. Understanding the forces required for suturing such wounds can aid excisional surgery planning to decrease complications and improve wound healing. Following full thickness excision for removal of skin cancers, back wounds with 3:1 ratio of length-to-width were closed using the rule of halves. The force required to bring the wound edges into contact at the middle portion of the wound was measured, followed by the two bisected halves. The average force to close the center of the wounds averaged 3.7 N and was six times larger than that of the bisected halves. The forces to close the bisected halves were consistently small, and essentially negligible (<0.5 N) for ~50% of the cases. When planning excisional surgery to avoid complications such as tearing the dermis (cheese wiring), the use of special wound closure techniques (high tension and/or pully sutures, skin support or suture retention devices, etc.) should focus on the center suture only when using the rule of halves, as the remaining sutures require very low forces.
No related grants have been discovered for William Lear.