Computational Modeling of Wound Suture: A Review

Suturing is an acquired skill which is based on a surgeon's experience. To date, no two sutures are the same with respect to the type of knot, tension, or suture material. With advancement in medical technologies, robotic suturing is becoming more and more important to operate on complex and difficult to reach internal surgical sites. While it is very difficult to translate a surgeon's suturing expertise to an automated environment, computational models could be employed to estimate baseline suture force requirements for a given wound shape, size, and suture material, which could be subsequently processed by a robot. In the literature, there have been few attempts to characterize wound closure and suture mechanics using simple two- and three-dimensional computational models. Single and multiple skin layers (epidermis, dermis, and hypodermis) and tissues with different wound geometries and sizes have been simulated under simple wound flap displacements to estimate suture force requirements. Also, recently, sutures were modeled to simulate a realistic wound closure via suture pulling, and skin prestress effect due to the natural tension of skin was incorporated in a few models to understand its effects on wound closure mechanics. An extensive review of this literature on computational modeling of wound suture would provide valuable insights into the areas in which further research work is required. Discussion of various computational challenges in modeling sutures in a numerical environment will help in better understanding the roadblocks and the required advancements in suture modeling.