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TENSILE STRENGTH AND ELASTICITY TESTS ON HUMAN FASCIA LATA CHAS. MURRAY GRATZ J Bone Joint Surg Am. 1931;13:334-340.
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334
C.
TENSILE
STRENGTH
M.
AND
GRATZ
ELASTICITY
FASCIA BY
CHAS.
MURRAY
TESTS
GRATZ,
M.D.,
NEW
The possibility of more extensive use has led to a study of the tensile strength
fields
commonly
data
used,-namely,
fascia
which have been In 1924 a pioneer
Mesuner’.
They
selected study
made
ON
lata.
YORK,
N.Y.
of living sutures in surgical and elasticity of the one most
This
paper
presents
certain
from the observations made. in this field was presented by
rough
tests
HUMAN
LATA*
of the
tensile
strength
Gallie
test and
of fascia
Le
taken
from the backs of rabbits. The fascial strips were used to repair the edges of the gap left by their removal. These were recovered at intervals varying from a few days to two years and again tested. “No stretching or contracture occurs and the strength of the suture is approximately the same
time of operation.” The above research, besides confirming of fascia as suture material, also showed that its strength remained unimpaired over long periods. A search of the literature did not reveal any other tests of this nature.
the
as at the
viability
In 1930 the author undertook to measure with the tensile strength and elasticity of human fascia the results briefly, the material showed surprisingly comparing favorably with soft steel wire of the same showed utilize
an unexpected the test results
correct
size
of suture
degree clinically
of elasticity. An as an approximate
to be used
in operative
engineering
lata.
To
great
tensile
weight
effort guide
accuracy
summarize strength
; in addition
it
was also made in determining
to the
procedures.
The test material was obtained from the thighs of patients at the time undergoing operations in which this material was a small piece of the fascia lata being reserved for test purposes.
to be used, The test
piece
sent
was
testing
piece
and
hours.
material The standard terials,
We and
immediately
laboratory.
in saline-moistened
elapsed
time
gauze
between
the
and
removal
the actual testing of the material varied from It is of interest to note that even after eighteen was essentially alive at the time of testing. tests were conducted by the New York tension machine used for the general
under
the
supervision
of a consulting
Dejartment
and Hospital.
of Orthopaedic
Surgery,
Testing testing
engineer,
hoped in this way to have the advantage equipment to aid us in the solution of these
#{149}Fmmthe School
packed The
New
two hours
who
of
to the the
test
to eighteen delay
Laboratory of engineering Mr.
were
the on the ma-
F. J. Nankivell.
of engineering
experience
problems. York
Post-Graduate
Medical
TENSILE
The
actual
testing
sufficiently
before
AND
STRENGTH
TESTS
ELASTICITY
presented
accurate
ON
difficulties
results
were
HUMAN
which
of a soft and slippery It was necessary
testing
cloth
machine
cised
to
with
emery
lata with small pins the amount of stretch apply
steady
tension
to
to
The
inherent
nature to line
and the
prevent slipping, points which
obtain
or elongation. in order
Due
to avoid
and
difficulthat grips
only a of the
to pierce
also
could be used for care had to be exer-
fluctuations
resulted in excessive inaccuracies. The following reproduction of one of the test from an athletic individual is self-explanatory.
335
LATA
to be overcome
had
obtainable.
ties were that the fascia was small test piece was obtainable.
the fascia measuring
FASCIA
which
would
have
TENSILE
Weight
TESTS
ON
SUTURE
FROM
sheets
LEG
on fascia
OF
1.305
Average
thickness
Length
4.7
Average
area
Width
0.60
in grams
No.
TEST
1
Load
Elonga1ion
lbs.
reading 1.30 1.31
8
1.32
Dis. bet. heads
in.
TEST
in.
0 5
in.
Load lbs.
reading
0 4
1.30 1.33
8
no load
Load in.
0.Ol4in. sq. in. 1.73 in.
0.0084
TEST
E1OngaiOn
taken
MAN
2
No.
lata
No.3 Elongation
158.
in.
reading
0 7
1.325 1.34
1.34
12
12
1.34
12
1.34
16
1.36
16 20
1.34 1.34
16 20
1.35 1.36
20 25
1.365 1.37
24
1.365
24
1.365
30
1.37
30 36
1.37 1.38
3636 40
1.38 1.385
40
1.39
48
1.40
44
1.40
52
1.40
48
1.405
56
1.405
62 66
1.405 Broke
Remove
Remove
load
1.35
load
20 16
1.36 1.35
40 36
1.39 1.383
12
1.34
30
1.380
Tensile
8
1.33
23
1.37
strength
5
1.32
16
1.36
persq.in.,
0
1.30
10
1.355
5 0
Remarks:
Pins
inserted
break
was
of fibers. Operation Test
at
into obtained
performed 10.00
AM.,
suture
3:00
7,860
1.35 1.325 for gage
between
October
lbs.
grips.
r.., 7.
marks. Failure
October
6.
Emery
cloth
used
was
of the
nature
Kept
wet
with
in grips.
Good
of a slippage
saline
solution.
TENSILE
STRENGTH
After instrument data
making readings
on material
AND
the we from
ELASTICITY
TESTS
ON
necessary engineering were able to prepare
several
individuals,
HUMAN
FASCIA
allowances a composite
and
from
for
these
inaccuracies of the results
to plot
the
panying graphs of tensile strength and elasticity (Chart I). The curves in these graphs show the reaction of fascia lata degrees of tension ; the graph on the right shows the corresponding As tension (0 to A). Upon length. is
is applied The
repeated
the
elongation
material
releasing When
then
the tension subjected that the
except
sufficient
an
tension
tensile
stiffens
(A
the
material
strength
of
very
course.
thick
corpuscles
which
are
these
separated
A probable adjustments
the
findings study.
which
are
cells) a small
explanation
tissue
leaving
With
fibers by
the
of
areolar
down,
fibers
(tendon
an tendon
cells.
The
to he tension
final
elasticity.
pronounced relaxes
again.
nearly to its original before, the same cycle and less elastic. When and
a calculation
a straight
a small
The amount
of the
tension in the
to varying
quite
finally
accom-
of
in relation to the structure This tissue consists of
runs
scattered .
or
slightly
number
tendon gives the direction
into The
bundles parallel
these tissues great in which they are
observed
rests
in successive
fascia lata to the tension than the fibers, are the first
resisted
by
the
applied,
the
fibers
rupture
of the
stronger
material
a
“
wavy
of connective-
fibers are gathered of areolar tissue.
phenomena
material composing cells, being weaker
the
increase
and
returns than stiffer
is destroyed
of heavy fiber fascia and in one direction,-that is, in subjected to strain.”2
arrangement.
strength normally
The
parallel
Between
tissue
at first.
in of
is obtained.
It is of interest. to study the above of fascia lata as shown by microscopic mass
place, to B)
the test piece to tension greater material is slightly
is applied
maximum
takes
337
LATA
fibrous
begin
applied. to break material.
to separate
occurs
with
the
from pulling
apart
of the fibers one from the other. Macroscopically the fibers themdid not appear to break. In the three materials the cohesive forces within the areolar tissue are comparatively weak. The adhesive forces between tendon cells and fibers are greater and the cohesion in the fibers
selves
themselves shows the greatest strength. The fibers are aLso the elastic elements. The with to some extent by the areolar tissue, especially by
excessive
stretching.
capacity to return of maximum safe elasticity
of
curve.
prepared
graphs
lat.a
elasticity between the elasticity of the latter lata, hence its maximum strength
and
spite
of
this,
however,
the
to original dimensions) of the material, stress, is above ninety-one per cent., The
fascia
In
elasticity is interfered after it is broken down
thickness
shown below indicates maximum strength.
in Chart
and
II
demonstrate
depict
the
the
elasticity
(the
under the limits as shown by the
result
of
variations
in
a similar
test
strength
and
living and dead tissues. It will be noted that the does not compare favorably with the living fascia safe stress would be much less. The comparative of
human
that.
there
fascia
lata
from
is a comparatively
three small
individuals variation
as in
338
C.
M.
GRATZ
Averagethiekness Adult
female
seventy-four Athletic
years
years
tensile
8treflQth
6222
age
-
.014
7860
.030
6375
of age
female of age
Paralytic
years
fifteen
(bothiegeinvolved ten
for
years)
an analysis
From
of
male
thirty-five
Maximum
.017
of the
above
data,
the
following
observations
may
be made:
Maximum
load
living
for
lala sutures.
fascia
The
strength of fascia in the specimens thirty-second of an inch.
lata is proportional to its area of cross section. studied varied from one-sixty-fourth to oneTaking an average thickness, the breaking tension of a strip of this material three-eighths of an inch wide is about fifty-five pounds. Working under the maximum safe stress, as described in the graph, the optimum load applied to such a strip should not exceed Thickness
fifteen
pounds.
When
it is thought that the load requirement may be in excess of the above figure, a larger or multiple suture should be used. When a suture is tied in a loop, it is approximately equivalent to a single suture of double strength provided that the technique of tying is correct. Multiple sutures readily
are
preferable
to
wider
ones
as
a proper
lymph
supply
more
reaches the central portion. The following table is an approximate guide for the widths of sutures for clinical use, based on average thickness of .02 inches (one-fiftieth of an inch):
Width
tension in poisnds
in
Safe
inches
Width
31 3
8.07 10.75
7%
5%
13.5
3/
Comparative
The ultimate
strength
specific gravity tensile strength
Soft steel has 45,000 pounds
soft steel,
offascia
weight
3%
for weight.
16.1
18.8 21.5
lata.
of fascia lata is approximately
a specific gravity per square inch.
Safe tension in pounds
in
inches
of 7.83 Thus
is about 7,000
1.31 pounds
and the average per square inch.
and an ultimate strength of about fascia lata is nearly as strong as
TENSILE
STRENGTH
Elasticity
AND
offascia
The
high
correct.
any
sutures
are
TESTS
elastic
property
properly
of this
their
of
tissue
osseous
HUMAN
placed.
The
elasticity
and
presence
also
after
i-
may
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since
339
viability.
.i:T:
j
LATA
operation,
of excessive
their
___
6000
FASCIA
is important
structures
,.
8000
ON
iota.
displacement
with
interfere
ELASTICITY
II
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340
c.
M.
GRATZ
COMMENT
The above observations presuppose that a way that the stress is placed longitudinally since ative that be
fascia
lata
procedures these tests
has
very
little
strength
of value
in the
clinical
use
fascial
tissues
are
contemplated.
other
in the
must be so devised as to bear and observations may supplement of living
suture
the sutures are used in such in the direction of the fibers, transverse this
direction.
Oper-
in mind. It is hoped previous researches and
material.
Similar
tests
of
REFERENCES 1.
GALLIE,
sues
W.
in the
E., Repair
AND
LEMESURIER,
of Anatomical
2. Surgery.
Canadian
Med.
Asan.
A. B. : The Transplantation Defects. British J. Surg., The Use of Living 1.. XI. 504. 1921.
XII,
of the 289,
Sutures
Fibrous Tis1924-1925. in
Operative