Reply To: Permanent or absorbable sutures for Shouldice repair?
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I don’t think that being back to 100% tissue strength is necessary to get back to normal living. I am not arguing for or against anything just showing some different perspectives.
You can find quite a bit in the mesh repair literature about “burst strength”, where the surgeon/scientist is considering the mesh as prosthetic tissue. A patch over the hernia defect. In theory, the defect area is “tension-free”. But the edges of the mesh do feel tension. Otherwise there would be no need to worry about burst strength. You can also find literature about “small bites” for closing wounds, to avoid suture pullout. That was a hot topic a couple of years ago. There is even a new type of suture material called T-Line that is being promoted for its width, apparently for the benefit of avoiding suture pullout. There is discussion about using a running suture (a single filament passed through the edges of the wound to close it), as opposed to a series of separate sutures. But, like many of the many things to consider in hernia repair the final decision is left up to whatever the surgeon feels comfortable doing.
As far as healing after a suture repair, here is a good review of the healing process. It covers a wide area of healing responses, but it is well-written and understandable. It has an interesting comment about the size of the gap between the two surfaces that are expected to knit together. It made me wonder about how the two surfaces of the layers in a Shouldice procedure knit together. What is the impetus for the body to realize that the pristine surfaces are damaged? Only the edges have been cut. What parts actually form new collagen?
Anyway, it’s easy to get lost in the fine elements of what actually happens during healing of a pure tissue repair. But those fine elements might help explain why surgeons using what seems to be the same technique get different results.
The article doesn’t use the word years, but it does use months.
Overview of Wound Healing in Different Tissue Types
John D. Stroncek and W. Monty Reichert.”
“1.4.1. Non-CNS Tissue
The first stage of tissue repair is stabilization of the discontinuity created by the injury. Traditionally, there are two broad classifications of healing. Tissue that has little to no gap separating the wound boundaries will undergo “primary healing” from the apposed edges of the tissue. Tissue that is unstable with a large gap or discontinuity injury will undergo “secondary healing,” where excess ECM is produced to secure and fill the lesion. The ECM of secondary healing, which subsequently becomes vascularized, is referred to as granulation tissue—a term arising from its appearance. In general, the amount of granulation tissue formed is proportional to the eventual level of scarring.”