A REALISTIC 3D COMPUTATIONAL MODEL OF THE CLOSURE OF SKIN WOUND WITH INTERRUPTED SUTURES

Abstract

Wounds or cuts are the most common form of skin injuries. While a shallow wound may heal over time, deep wounds often require clinical interventions such as suturing to ensure the wound closure and timely healing. To date, suturing practices are based on a surgeon's experience and there is no benchmark to what is right or wrong. In the literature, there have been few attempts to characterize wound closure and suture mechanics using simple 2D computational models. In our current work, for the first time, a realistic three-dimensional (3D) computational model of the skin with the two layers, namely the epidermis and dermis, have been developed. A 3D diamond shaped wound with a varying cross-section has been modeled, and interrupted sutures have been placed numerically in multiple steps to close the wound. Nonlinear hyperelastic material properties have been adopted for the skin and a skin pre-stress was applied bi-axially. The force requirements for each suture were estimated numerically using a novel suture pulling technique. The suture forces were found to lie in the range of 0–5 N with a maximum value at the center. Also, the center suture was observed to require an approximately four times pull force compared to the first end suture. All these findings provide important guidelines for suturing. Additionally, the suture force can be approximated as a polynomial function of the displacement. Given a wound geometry, wound depth, skin material properties, skin pre-stress, suture wire material and cross-sectional area, using our computational model, such a relationship can be used to estimate and characterize the suture force requirements accurately. To our knowledge, such a 3D computational model of skin wound closure with interrupted sutures have not been developed till date, and would be indispensable for planning robotic surgeries and improving clinical suturing practices in the future.