Grants Funded

Abstract
Increased wound tension during closure is believed to be a major contributing factor to hernia recurrences and other wound healing complications. Limited data exists to validate this long-standing surgical dogma. By objectively measuring wound tension using a non-invasive device at the time of surgical closure, we intend to determine the true impact of tension on wound healing and clinical outcomes. Our specific aims include: 1. Developing and validating a laboratory model to test a simple spring tensiometer device for measuring tension during wound closure, 2. Utilizing cadaveric torsos to further validate and test device reliability, and 3. Correlating intraoperative measurements of fascial tension by the same device with patient outcomes followed prospectively for the development of wound complications. We hypothesize that we can develop a reliable, yet simple model for measuring tension, and that increased amounts of wound tension during closure in the operating room will correlate with increased rates of wound healing problems such as infection, dehiscence (wound separation), hernia recurrence and need for further surgical procedures.

Our study design will be based upon validating and using a simple, non-invasive device (“tensiometer”) for measuring force (e.g. tension) required to close surgical wounds such as an abdominal wall hernia. It consists of a medical grade stainless steel spring with a known intrinsic recoil force constant (k). By attaching the spring to the wound edges or fascia via an atraumatic surgical clamp and stretching the spring until the tissue approximates the expected distance required for closure (e.g. halfway across the wound), the length of the spring on stretch (X) can be measured and used to calculate force (F) based on Hooke's Law (F=kX). This device will first be tested in the lab using a synthetic skin to establish reproducibility of the technique. Next, fresh cadavers will be used with standardized fascial defects to emulate hernias in a more controlled setting. Finally, the device will be used intraoperatively to measure fascial closing tension during the course of ventral hernia repairs performed by the plastic surgery service at a major university hospital. Patients will be followed prospectively during routine postoperative visits to assess wound healing and the development of complications. We will then examine the data to see if there is a threshold tension associated with increased rates of complications.

Biography
Dr. Adam Levy is a Plastic and Reconstructive Surgery Resident within the New York-Presbyterian Hospital program of Cornell and Columbia Universities. He has a long-standing scientific interest, having first received a pilot research grant as an undergraduate at the University of Colorado to study how the vascular endothelium is affected by exercise and aging. During medical school, he maintained multiple research interests, including taking an additional year to study the use of patient derived stem cells for transplantation and regeneration of neurons in an animal model of Parkinson’s disease. After graduating with honors from Boston University Medical School, he then completed three years of General Surgery Residency at NYP/Cornell prior to spending time in a surgical immunology laboratory at Memorial Sloan Kettering Cancer Center. From there, he joined the Plastic and Reconstructive Surgery Residency where he has focused on clinical research -- presenting at multiple national meetings on novel biomaterial use in hernia repair. This clinical interest in hernia repair stems from frequent exposure during both general surgery and plastic surgery residencies and a dissatisfaction with the lack of high quality evidence guiding repair. Additionally, he is a member of the Phi Beta Kappa and Alpha Omega Alpha Honor societies and is an avid marathon runner in his spare time.