Laparotomy closure using an elastic suture: a promising approach

J Biomed Mater Res B Appl Biomater. 2015 Feb;103(2):417-23. doi: 10.1002/jbm.b.33222. Epub 2014 Jun 5.


Background: Midline laparotomy wound failure like burst abdomen remains one of the major complications after abdominal surgery. The use of sutures with a closer resemblance to abdominal wall physiology, like elastic threads, could decrease the risk of these complications occurring. Thus, we evaluated the possibility of using a new elastic thread composed of thermoplastic polyurethane (TPU) as a suture for the closure of midline laparotomies compared to conventionally used polypropylene (PP) in a rabbit model.

Methods: The elastic TPU thread was processed and tensile tests were performed. Twenty female chinchilla rabbits underwent midline laparotomy. They were randomized to a TPU and a PP group depending on the suture used for fascia closure. After 7 or 21 days, the abdominal walls were assessed macroscopically for wound healing complications and were explanted for histopathological investigation.

Results: Tensile tests showed a mean elastic elongation of 55.5% and a sufficient material strength of the TPU thread. In animal experiments, there was no difference between the groups at 7 days; however, the TPU suture showed significantly less CD68 positive cells (p < 0.001) and a higher collagen I/III ratio (p = 0.011) than PP did after 21 days. The amount of apoptotic cells was significantly elevated in the TPU group (p = 0.007) after 21 days. No differences were found concerning granuloma size and number of Ki67-positive cells.

Conclusions: The newly developed TPU thread shows promising tensile characteristics. Midline laparotomy closure is feasible and safe in a rabbit model. Immunohistochemistry indicates similar biocompatibility and wound healing after implantation compared to PP after 21 days. To confirm these findings and to proof long-term capability further studies need to be conducted.

Keywords: abdominal wound failure; burst abdomen; elastic thermoplastic polyurethane suture; immunohistochemistry; midline laparotomy closure; polypropylene; rabbit model; tensile tests.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdominal Wall / surgery*
  • Abdominal Wound Closure Techniques*
  • Animals
  • Elasticity
  • Female
  • Laparotomy*
  • Materials Testing
  • Polypropylenes / chemistry*
  • Rabbits
  • Suture Techniques*
  • Sutures*


  • Polypropylenes