The barbed sutures

Abstract

OBJECTIVE: This study aims to analyze the use of barbed sutures in minimally invasive procedures, considering safety, efficiency and reduction of surgical time. METHODS: The analysis included 43 articles selected from the PubMed electronic databases, using the descriptors "Barbed sutures", "Suture Suspension", and "Absorbable Knotless Barbed Suture". RESULTS: Among the selected articles, it was observed that the reduction in operative time provided by barbed sutures potentially cancels out the slight increase in cost and can also improve overall results due to shorter anesthesia time. The use of barbed sutures decreased the closure time in relation to standard sutures by 32.8%. The unidirectional barbed suture allows a higher concentration and more homogeneous distribution of soft tissues, avoids the subtle sliding of the edges of the sutured tissue, providing a safer and more stable environment for tissue healing, resulting in scars less prone to inflammation and, consequently, thinner and more imperceptible in an aesthetic analysis. The barbed suture is also seen as a useful tool in the plication of the rectus abdominis, being used in the fascia of the abdominal wall after the removal of the transverse rectus abdominis myocutaneous flap (TRAM) for breast reconstructions, for example, or associated with abdominoplasty. Although not a formal outcome of the study, the suture extrusion rate was 10% in the barbed suture group compared to 20% in the conventional suture group. In the study, the mean complication rate was 9.7% and the mean surgical time was 108 minutes for mammoplasty and 156 minutes for abdominoplasty. CONCLUSION: The present review demonstrated similar safety between the barbed suture technique and the conventional suture. Among the advantages of barbed sutures, it allows greater concentration and more homogeneous distribution of soft tissues, providing greater support with less tension on the thread, and better aesthetic results with less possibility of inflammation. Therefore, the data indicate an improvement in the complication rate, surgical time and safety for the patient in reduction mammoplasties and panniculectomies. It was concluded that barbed thread has greater applicability in plication of the rectus abdominis, superficial closure of the skin and accommodation of the deep layers in body contouring procedures. In the region of the arms, it is not applicable, as it can trigger problems in the healing of the surgical wound, due to a similar prolonged response of a foreign body by the sharper barbs and its slower absorption.