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Peer-reviewedCC BY 4.0European Journal of Trauma and Emergency Surgery

Chest tube fixation strength depends on suture caliber and fixation technique rather than tube diameter: a biomechanical cadaver study

  • Johann Justus Fricke1
  • Tobias Schöbel1
  • Ric Meißner1,2
  • Stefan Schleifenbaum1,2,3
  • Christian Kleber1
  • Isabella Metelmann4
  • Sebastian Krämer4
4 affiliations
  1. 1Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
  2. 2ZESBO – Center for Research on Musculoskeletal Systems, Semmelweisstraße 14, 04103 Leipzig, Germany
  3. 3Fraunhofer Institute for Machine Tools and Forming Technology, Nöthnitzer Straße 44, 01187 Dresden, Germany
  4. 4Department of Visceral, Transplantation, Thoracic and Vascular Surgery, Leipzig University, Liebigstraße 20, 04013 Leipzig, Germany
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Abstract

Background: Chest tube dislodgement remains a relevant complication in emergency, trauma, and intensive care medicine. In a previous biomechanical study, the Modified Johannesburg technique using Mersilene USP 1 demonstrated superior fixation strength compared with other chest tube fixation techniques. The present study aimed to determine whether suture size, suture material, and chest tube diameter influence fixation strength.

Methods: A prospective interventional biomechanical cadaveric study was performed using fresh porcine thoracic wall specimens. A total of 320 load-to-failure tests were conducted under standardized laboratory conditions. Two fixation techniques, Modified Johannesburg and Purse String, were compared using two chest tube diameters (20/28 Ch) and four non-absorbable braided suture configurations: Mersilene USP 1, Mersilene USP 2 − 0, Silk USP 1, and Silk USP 2 − 0. Each experimental group consisted of 20 specimens. Specimens were tested in a uniaxial testing machine until construct failure. Force [N] and elongation [mm] at failure were measured. The experiments were videotaped, and the failure mechanism was analyzed.

Results: The Modified Johannesburg technique demonstrated significantly higher pull-out forces compared to the Purse String technique (125.0 vs. 66.4 N; p < 0.001), as did larger suture sizes (USP 1 vs. 2 − 0; p < 0.001) and Mersilene compared to Silk (114.6 vs. 76.9 N; p < 0.001). Chest tube size had only a very small and inconsistent effect on pull-out strength. The predominant failure mode was suture rupture (94.7%).

Conclusions: Chest tube fixation strength is significantly influenced by fixation technique, suture size, and suture material. The effect of chest tube diameter on fixation strength appeared negligible. The Modified Johannesburg technique, size 1 sutures, and Mersilene material provided superior biomechanical stability. Since failure occurred predominantly by suture rupture, the suture appears to represent the weakest link of the fixation construct.

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Cite

BibTeXRIS
BibTeX
@article{fricke2026chest,
  title = {{Chest tube fixation strength depends on suture caliber and fixation technique rather than tube diameter: a biomechanical cadaver study}},
  author = {Johann Justus Fricke and Tobias Schöbel and Ric Meißner and Stefan Schleifenbaum and Christian Kleber and Isabella Metelmann and Sebastian Krämer},
  journal = {European Journal of Trauma and Emergency Surgery},
  year = {2026},
  month = oct,
  doi = {10.1007/s00068-026-03369-0},
  url = {https://doi.org/10.1007/s00068-026-03369-0},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Chest tube fixation strength depends on suture caliber and fixation technique rather than tube diameter: a biomechanical cadaver study
AU  - Johann Justus Fricke
AU  - Tobias Schöbel
AU  - Ric Meißner
AU  - Stefan Schleifenbaum
AU  - Christian Kleber
AU  - Isabella Metelmann
AU  - Sebastian Krämer
PY  - 2026
DA  - 2026/10/26
JO  - European Journal of Trauma and Emergency Surgery
DO  - 10.1007/s00068-026-03369-0
UR  - https://doi.org/10.1007/s00068-026-03369-0
AB  - Background: Chest tube dislodgement remains a relevant complication in emergency, trauma, and intensive care medicine. In a previous biomechanical study, the Modified Johannesburg technique using Mersilene USP 1 demonstrated superior fixation strength compared with other chest tube fixation techniques. The present study aimed to determine whether suture size, suture material, and chest tube diameter influence fixation strength.  Methods: A prospective interventional biomechanical cadaveric study was performed using fresh porcine thoracic wall specimens. A total of 320 load-to-failure tests were conducted under standardized laboratory conditions. Two fixation techniques, Modified Johannesburg and Purse String, were compared using two chest tube diameters (20/28 Ch) and four non-absorbable braided suture configurations: Mersilene USP 1, Mersilene USP 2 − 0, Silk USP 1, and Silk USP 2 − 0. Each experimental group consisted of 20 specimens. Specimens were tested in a uniaxial testing machine until construct failure. Force [N] and elongation [mm] at failure were measured. The experiments were videotaped, and the failure mechanism was analyzed.  Results: The Modified Johannesburg technique demonstrated significantly higher pull-out forces compared to the Purse String technique (125.0 vs. 66.4 N; p < 0.001), as did larger suture sizes (USP 1 vs. 2 − 0; p < 0.001) and Mersilene compared to Silk (114.6 vs. 76.9 N; p < 0.001). Chest tube size had only a very small and inconsistent effect on pull-out strength. The predominant failure mode was suture rupture (94.7%).  Conclusions: Chest tube fixation strength is significantly influenced by fixation technique, suture size, and suture material. The effect of chest tube diameter on fixation strength appeared negligible. The Modified Johannesburg technique, size 1 sutures, and Mersilene material provided superior biomechanical stability. Since failure occurred predominantly by suture rupture, the suture appears to represent the weakest link of the fixation construct.
SN  - 1863-9933
SN  - 1863-9941
ER  -