Advancing Suture Technology: A Stitch in Time

Abstract

Little attention has been paid to methods of enhancing wound closure following elective procedures, raising several fundamental questions: 1) Can we improve upon current techniques? 2) In an era of cost containment where time is money, can we make wound closure more rapid? 3) Is it beneficial to have a water tight seal when closing an arthrotomy or fascia? 4) Will enhanced closure improve outcome? A new type of suture material featuring bidirectional barbs is now available from at least 2 manufacturers. This new suture consists of polydioxanone (PDO) material with tiny barbs cut into the length of the filament in a helical array set in opposite directions from an unbarbed midsegment, with a needle attached to each end. Tissues can be approximated without surgical knots, providing a more uniform distribution of tension, reducing closure time and wound tissue reactions. At our practice, closure with bidirectional, barbed absorbable Quill suture (Angiotech, Vancouver, British Columbia) has been the standard of care for all primary arthroplasty procedures since 2007. We present results from a preliminary review of 7191 primary hip and knee arthroplasties performed from July 2007 to February 2011.