Do Connell sutures provide greater tensile strength than simple interrupted sutures?

Connell Sutures vs Simple Sutures: Tensile Strength Comparison

The available evidence does not directly address Connell sutures specifically, but based on suture biomechanics principles, continuous suture techniques (which Connell sutures represent) do not inherently provide greater tensile strength than simple interrupted sutures—rather, they distribute tension differently along the wound edge. 1

Understanding Suture Strength Fundamentals

The tensile strength of a wound closure depends primarily on:

• Suture material properties (caliber, tensile strength, absorbability) rather than the specific pattern used 1
• Suture-to-wound length ratio of at least 4:1, which is more critical than whether the technique is continuous or interrupted 2
• Tissue incorporation and healing, not just the mechanical properties of the suture itself 1

Higher tensile strength suture is not always superior because increased caliber can cause tissue strangulation and increased inflammatory reactivity, potentially compromising healing 1

Tension Distribution Differences

While direct evidence on Connell sutures is absent, research on related continuous techniques shows:

• Continuous sutures create different tension patterns than interrupted sutures, but this relates to tension distribution rather than absolute strength 3
• Mattress sutures (which involve similar tissue incorporation as Connell sutures) can bias tension opposite to the knot side unless alternating patterns are used 3
• No significant difference in wound strength was found between continuous and interrupted techniques in keratoplasty studies, though interrupted sutures showed greater healing by tensiometry 4

Clinical Outcomes That Matter

Continuous subcuticular sutures dramatically reduce superficial wound dehiscence by 92% (RR 0.08; 95% CI 0.02-0.35) compared to interrupted sutures, but this benefit stems from prolonged wound support with absorbable material rather than inherent strength superiority 2

Key clinical findings:

• No difference in infection rates between continuous and interrupted techniques (RR 0.73; 95% CI 0.40-1.33) 2
• No difference in incisional hernia formation for fascial closure between techniques 2
• Continuous techniques offer time efficiency (0.276 cm/min vs 0.175 cm/min) and material economy without increased complications 5

Practical Recommendation

Choose suture technique based on wound characteristics and desired tension distribution, not presumed strength differences:

• Use slowly absorbable monofilament sutures (4-0 poliglecaprone or polyglactin) that retain 50-75% tensile strength after 1 week 2
• Maintain 4:1 suture-to-wound length ratio regardless of pattern chosen 2
• For high-tension wounds, consider mattress techniques with alternating knots for even tension distribution 3
• Select continuous subcuticular technique for skin closure to minimize dehiscence risk 2

Critical Pitfall

Do not assume that any specific suture pattern inherently provides greater strength—the material properties, proper technique execution, and adequate suture-to-wound ratio are far more important determinants of wound integrity than whether you use Connell, simple interrupted, or other patterns 2, 1