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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

-.11 #{149}I.1.1.

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±11

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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

I

jf

QMQt##{176}A’ 8

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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