Wound closure and suturing patterns: a vector analysis of suture tension.

When the vectors of force required to close the ideal surgical wound are analysed, it is apparent that suture tension varies with the pattern of suture. For a given closing force, perpendicular interrupted sutures have the least tension. Symmetrical continuous sutures require greater suture tension, and this increases the more the suture is aligned with the direction of the wound. Asymmetrical (perpendicular/diagonal) continuous suturing requires more tension than interrupted sutures but this never exceeds 200%. Symmetrical suturing has slightly less tension than asymmetrical suturing when the spacing is about equal to the width of the suture. However, as the spacing ratio increases to greater than 2, the tension in the symmetrical suture rises very sharply. At a length:width ratio of 4, the symmetrical suture tension is about 70% greater than the same asymmetrical suturing.