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A small-stitch\u2013small-bite suture might close the incision durably. We analyzed specific details of this closure technique and assessed their influence on the closure stability.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>The effects of cyclic loads, simulating coughs were investigated on a bench test. We prepared porcine bellies in the median line and bovine flanks parallel to the muscle fibers with 15\u00a0cm long incisions. Then we punched round or rhomboid defects with a diameter of 5\u201310\u00a0cm into the center of the incision. Monomax\u00ae 2\u20130 and Maxon\u00ae 1 and 2\u20130 were used as suture materials. We tested the durability of the closure with pressure impacts of 210\u00a0mmHg repeated 425 times. Throughout the experiments, we modified the suturing technique, the surgeon, the tissue tension, the defect size and shape and the suture diameter.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Standardizing the suture technique improved the durability of the closure significantly. Any other variations showed minor influences after standardization. All incisions with round defects up to 7.5\u00a0cm width withstood 425 impacts using standardized suturing. Unstandardized sutures failed in all cases. When closing an incision with a 10\u00a0cm wide defect, the tissues ruptured frequently next to the suture line. We defined criteria to standardize this suturing technique. For the first time, we developed a suture factor related to the durability of a sutured tissue closure. We integrated the suture factor into the concept of biomechanically durable repairs.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Suturing the abdominal wall with a standardized suturing technique improves its durability significantly.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s10029-022-02659-x","type":"journal-article","created":{"date-parts":[[2022,8,23]],"date-time":"2022-08-23T08:03:15Z","timestamp":1661241795000},"page":"1611-1623","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Standardized suturing can prevent slackening or bursting suture lines in midline abdominal incisions and defects"],"prefix":"10.1007","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9062-7728","authenticated-orcid":false,"given":"C.","family":"Lesch","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Uhr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Vollmer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Raschidi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Nessel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Kallinowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,8,23]]},"reference":[{"key":"2659_CR1","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2021.602181","volume":"8","author":"F Kallinowski","year":"2021","unstructured":"Kallinowski F, Gutjahr D, Harder F, Sabagh M et al (2021) The Grip concept of incisional hernia repair-dynamic bench test, CT abdomen with valsalva and 1-year clinical results. 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Trials 16:52. https:\/\/doi.org\/10.1186\/s13063-015-0572-x","journal-title":"Trials"}],"container-title":["Hernia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10029-022-02659-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10029-022-02659-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10029-022-02659-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,24]],"date-time":"2022-11-24T15:25:45Z","timestamp":1669303545000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10029-022-02659-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,23]]},"references-count":43,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["2659"],"URL":"https:\/\/doi.org\/10.1007\/s10029-022-02659-x","relation":{},"ISSN":["1265-4906","1248-9204"],"issn-type":[{"value":"1265-4906","type":"print"},{"value":"1248-9204","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,23]]},"assertion":[{"value":"26 May 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 July 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 August 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"FK received material support from Dahlhausen\u00ae related to this work, honoraria from Medtronic\u00ae not related to this work and funding from the Heidelberger Stiftung Chirurgie as mentioned above. All other authors declare that they have no conflict of interest. A statement for each author of the manuscript is attached.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"The research was conducted after building a bench test for low cyclic loading of tissues. Human material was not used. Accordingly, no informed consent from patients was required. The ethical approval to use of animal tissues was given by local authorities according to European law with the permission DE 08 221 1018 21. Hereby, I, Carolin Lesch, consciously assure that for the manuscript \u201cStandardized suturing can prevent slackening or bursting suture lines in midline abdominal closure\u201d the following is fulfilled: (1) This material is the authors' own original work, which has not been previously published elsewhere. (2) The paper is not currently being considered for publication elsewhere. (3) The paper reflects the authors' own research and analysis in a truthful and complete manner. (4) The paper properly credits the meaningful contributions of co-authors and co-researchers. (5) The results are appropriately placed in the context of prior and existing research. (6) All sources used are properly disclosed. Literature references are correctly cited. Literally copying of text was not performed. (7) All authors have been personally and actively involved in substantial work leading to the paper and will take public responsibility for its content.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}