The role of epimysium in suturing skeletal muscle lacerations

John F. Kragh, Steven J. Svoboda, Joseph C. Wenke, Daniel E. Brooks, Terry G. Bice, Thomas J. Walters

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

BACKGROUND: Direct muscle trauma is a common and disabling clinical problem. Surgical muscle repair is difficult to evaluate because reliable repair techniques have not been established scientifically. The purpose of this study was to assess the biomechanical properties of epimysium, the collagenous tissue sheath that surrounds muscles in the body. STUDY DESIGN: We surgically repaired transected porcine muscle bellies with and without epimysium. For both groups, 25 figure-eight stitches in lacerated quadriceps bellies from a euthanatized pig were loaded under tension on a biomechanical machine (model 8521S, Instron Company). Maximum loads and strains were measured and mechanisms of failure recorded. RESULTS: The mean load for repairs with epimysium (25.1 N) was significantly higher (p = 0.034) than that for repairs without epimysium (21.2 N). The mean strain for repairs with epimysium (10.4%) was significantly higher (p< 0.001) than that for repairs without epimysium (7.3%). The mechanisms of failure were also different. Among epimysium repairs, 15 stitches avulsed muscle transversely, and 10 stitches tore out longitudinally from the muscle. In the nonepimy-sium group, 1 suture avulsed muscle and 24 sutures tore out. Muscle was the weakest element in each test. CONCLUSIONS: These data showed that epimysium incorporation into suturing improves the capacity of repairs to bear force. These findings fill a knowledge gap and may improve outcomes of muscle suturing. By focusing the experiment on biomechanical properties of muscle stitching, this study showed the key role epimysium plays in muscle suturing.

Original languageEnglish (US)
Pages (from-to)38-44
Number of pages7
JournalJournal of the American College of Surgeons
Volume200
Issue number1
DOIs
StatePublished - Jan 2005
Externally publishedYes

ASJC Scopus subject areas

  • Surgery

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