# The Split-Level Folding, Step-Type Tension-Relieving Suture Technique Improves the Wound Tensile Strength

## TL;DR

A new suturing technique called STS improves wound tensile strength and healing compared to traditional methods in a rat model.

## Contribution

The novel Split-Level Folding, Step-Type Tension-Relieving Suture (STS) technique is introduced for improved wound healing.

## Key findings

- On day 7, the STS group showed significantly higher wound tensile strength compared to SIS and BVMS groups.
- Histological analysis revealed better healing and collagen deposition in the STS group on day 7.
- The STS advantage in tensile strength persisted until day 14 post-suturing.

## Abstract

Wound closure techniques are essential for skin and soft tissue repair following trauma or surgical procedures, with suturing being the most commonly employed method. Wound dehiscence is a serious postoperative complication, mostly caused by high tension and poor wound healing. The selection of an appropriate suturing method can improve the wound tensile strength and the healing process.

In this study, we proposed a novel double dermal flap suturing technique, Split-Level Folding, Step-Type Tension-Relieving Suture (STS), which increases the contact area between the two sides of the sutured wound. The elliptical dorsal rat wound model was applied to compare the difference among STS, Simple Interrupted Suture (SIS) and Buried Vertical Mattress Suture (BVMS). The wound tensile strength and healing process were evaluated via mechanical testing and histological analysis at different time points after suturing.

On day 7 post-suturing, the ultimate load of the wound in the STS group (5.225 ± 0.661) was significantly higher than that in the SIS group (1.750 ± 0.412) and the BVMS group (3.192 ± 0.327). This advantage persisted until day 14. In histological analysis, the STS group showed superior histological scores and collagen deposition compared to the other two groups on day 7.

The STS technique increased the dermal contact area between the two sides of the sutured wound, improved the histological healing pattern, and enhanced the wound tensile strength.

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The online version contains supplementary material available at 10.1007/s00266-025-05399-2.