Smooth Suture Research Articles

Barbed suture in neck dissection: a randomized clinical study on efficacy, safety and aesthetic outcome.

The resection of lymph nodes/neck dissection is a typical part of the surgical treatment of head and neck malignancies. The aim of this study was to compare subcutaneous closure using single knotted, braided suture (VicrylTM, standard arm) with continuous self-locking, monofilament barbed suture (V-LocTM, experimental arm). Neck Lock was a randomized clinical trial at a single tertiary referral center. It was conducted from 2016 till 2022 with a follow-up period of 3months. Assessment of safety and aesthetic outcome was double-blinded. 68 patients were randomized after application of exclusion criteria. Subcutaneous wound closure was performed in an intrapatient randomized fashion for suture technique. The primary endpoint was the duration of subcutaneous sutures. Wound healing and scar formation were recorded at multiple postoperative intervals as secondary endpoints. The median age was 61years, 89.7% were male. 92.6% suffered from a squamous cell carcinoma. There was a significant difference in median subcutaneous suture time (p = 0.024) between the experimental (6:11 ± 2:30min) and standard (7:01 ± 2.42min) arms. There was no significant difference in safety when assessing adverse events (AEs). At least one AE occurred in 14.7% vs. 5.9%, for barbed and smooth sutures respectively (p = 0.16). For neck dissection of head and neck malignancies, subcutaneous wound closure with self-locking sutures offers significant time savings over the single knot technique with similar safety and aesthetic results. The trial was registered with WHO acknowledged primary registry "German Clinical Trials Register" under the ID DRKS00025831 ( https://drks.de/search/de/trial/DRKS00025831 ).

Reproductive outcome after laparoscopic ovarian cystectomy using barbed sutures versus conventional smooth sutures: Aretrospective cohort study.

To investigate the effects of barbed and conventional sutures on reproductive outcomes and ovarian reserve after laparoscopic treatment for benign non-endometrioma ovarian cysts. This retrospective study was conducted at an affiliated women's hospital between May 2017 and December 2019. Patients with benign non-endometriotic ovarian cysts undergoing laparoscopic cystectomy were included. Patients received barbed sutures (221 patients) or conventional smooth sutures (203 patients) intraoperatively. The two groups had comparable baseline characteristics. The surgical duration and ovarian suturing time were significantly shorter in the barbed suture group than in the conventional smooth suture group (P < 0.001 and P = 0.002, respectively). The rate of postoperative hemoglobin decline and serum anti-Müllerian hormone decline were similar between the two groups (P > 0.05). A total of 316 (74.53%) patients experienced at least one pregnancy postoperatively: 170 (76.92%) and 146 (71.92%) patients in the barbed suture and conventional smooth suture groups, respectively (χ2 = 1.395, P = 0.238). Multivariate Poisson regression demonstrated that barbed sutures had no significant effect on the overall postoperative pregnancy rate (adjusted incidence rate ratio, 1.10; 95% confidence interval, 0.93-1.36; P = 0.382). In patients with benign non-endometriotic ovarian cysts undergoing laparoscopic ovarian cystectomy, barbed sutures had a reproductive outcome similar to that of conventional smooth sutures while providing higher surgical efficiency without adverse effects on the postoperative ovarian reserve. Barbed sutures are probably a viable option to conventional smooth sutures.

MT40 Trends of Use of Knotless Tissue Control Devices and Smooth Sutures in Robotic Ventral Hernia Repair: A Retrospective Database Analysis

MT40 Trends of Use of Knotless Tissue Control Devices and Smooth Sutures in Robotic Ventral Hernia Repair: A Retrospective Database Analysis

Minimally invasive repair of congenital inguinal hernias in nine foals using an automated laparoscopic suturing device and barbed suture

SummaryBackgroundLaparoscopic herniorrhaphy using staples or smooth suture has been shown to be safe and effective for the surgical treatment of congenital inguinal hernia in colts and gives the possibility to spare the testicles. An automated laparoscopic suturing device combined with barbed suture reduces the technical challenges of laparoscopic suturing.ObjectivesThe objective of the study was to describe the application of the Endo Stitch™ automated suturing device in combination with V‐Loc™ unidirectional barbed suture for laparoscopic herniorrhaphy in foals with congenital inguinal hernia, share experiences and provide long‐term follow‐up regarding the outcome.Study designRetrospective case series.MethodsMedical records of all foals that had laparoscopic herniorrhaphy using the Endo Stitch™ combined with V‐Loc™ unidirectional barbed suture at two equine referral hospitals between May 2015 and July 2022 were reviewed. Long‐term follow‐up was conducted by telephone interviews with the owners using a standardised questionnaire.ResultsNine foals aged 0.5–13 weeks suffering from unilateral (seven cases) or bilateral (two cases) indirect inguinal hernia underwent unilateral (two cases) or bilateral (seven cases) laparoscopic herniorrhaphy using the described technique. In two animals, the testicles were spared, five animals were bilaterally castrated, and two were unilaterally castrated at the time of herniorrhaphy. No major intraoperative complications occurred. Postoperatively, foals were bright and alert and none of them had significant complications attributable to the surgery. Median long‐term follow‐up was 8 months. No re‐herniation was observed in any of the cases at any time postoperatively.Main limitationsRetrospective study design and follow‐up period of less than 6 months in three cases.ConclusionsLaparoscopic herniorrhaphy using the Endo Stitch™ laparoscopic suturing device and V‐Loc™ barbed suture is technically less demanding than previously described laparoscopic techniques and effective in preventing re‐herniation in foals suffering from congenital inguinal hernia. A fast and uncomplicated postoperative recovery can be expected.

Close orthopedic surgery skin incision with combination of barbed sutures and running subcuticular suturing technique for less dermal tension concentration: a finite element analysis

BackgroundMechanical forces have an important role in the initiation and progression of orthopedic surgical incisions complications. To avoid incision complications with the reduction of dermal tension, surgeons may choose a buried continuous suture technique other than the traditional interrupted vertical mattress suture. Absorbable barbed sutures are widely used in orthopedics due to their convenience and reducing wound tension. The aim of this research is to compare and explain the advantages of running subcuticular suturing technique with absorbable barbed sutures for orthopedic surgical incisions closure.MethodsFinite element models of layered skin and two different suture techniques, running subcuticular suture and intradermal buried vertical mattress suture, ware constructed. The mechanical property difference between standard sutures and barbed sutures was modelled using different contact friction coefficient. Pulling the skin wound was simulated, and the sutures’ pressure on the skin tissue was determined.ResultsCompared with traditional smooth sutures, the barbed sutures effectively increased the contact force for subepidermal layers, which led the less force variation between different layers. The results also suggested that subcuticular suture caused less stress concentration compared with intradermal buried vertical mattress suture.ConclusionsIn conclusion, our study indicated that running subcuticular suturing technique with absorbable barbed sutures for orthopedic surgical incisions closure results in more uniform stress distribution in the dermis. We recommend this combination as the preferred method of skin closure in orthopedic surgery unless contraindicated.

Incidence and ultrasonographic characteristics of cesarean scar niches after uterine closure by double-layer barbed suture: A prospective comparative study.

To compare the ultrasonographic features of uterine scars and clinical symptoms after cesarean delivery (CD) using barbed and conventional smooth sutures. This case-control study enrolled women who underwent primary CD at 37 weeks of pregnancy or later. The uterus was closed using either double-layer unidirectional barbed suture or conventional double-layer smooth suture. Ultrasound scans of the uterine scar and evaluations of menstrual patterns were performed at 6, 12, and 24 months after surgery. In all, 102 patients underwent uterine closure with barbed suture, while 135 patients underwent smooth suture. At 6months, patients in the barbed group had a lower incidence of uterine niches (20.2% vs 32.6%) that were also shallower in depth (P < 0.001). Lower incidence of niches was also observed in the barbed group at 12 and 24 months (P=0.043 and 0.048, respectively). At these two follow-up times, the smooth group had a higher number of patients reporting postmenstrual spotting (P < 0.05) and more postmenstrual spotting days per month (P < 0.050). The use of double-layer barbed suture during CD was associated with a lower incidence of scar niches and a more favorable menstrual pattern compared with the use of smooth suture.

Wound Dillemmas: Investigating the Effect of Barbed Knotless Suture Versus Smooth Suture for Subcuticular Tissue Closure During Knee Surgery in Youth Athletes

Background:Surgical procedures of the knee are commonly performed on youth athletes for a myriad of conditions. Restoration of motion is paramount following surgery and wound healing issues may arise. Studies have investigated wound closure technique and its’ effect on wound healing in arthroplasty, but there is a paucity of information in youth sports medicine.Purpose:To investigate wound healing following knee surgery as affected by smooth running monofilament versus barbed running knotless suture for subcuticular closure.Methods:A retrospective investigation was conducted of a single surgeon’s knee procedures between January 2013 to December 2020. Suture type for closure of the operative wound as well as any wound healing dilemmas (i.e., wound dehiscence and formal operative debridement) encountered during the post-operative period were recorded. The surgical procedure, perioperative antibiotics, wound lavage, dressing type and patient demographics were also recorded. Group 1 underwent subcuticular wound closure performed with a running smooth non-barbed monofilament suture and was compared to Group 2 where closure was performed with barbed monofilament suture. Exclusion criteria was a history of ipsilateral knee surgery and congenital syndromes. Statistical analysis was performed.Results:486 patients were identified of which 21 were excluded leaving 202 patients in Group 1 and 263 in Group 2. Average age was 15.8 years (range 10 to 25 years). 277 were female. Wound dehiscence occurred in 17 patients in Group 1 (8.42%) and 25 in Group 2 (9.51%) (p=0.684). Formal debridement was performed in 8 patients in Group 1 (3.96%) and 4 (1.52%) in Group 2 (p=0.100). There was a significantly higher tourniquet time (p<0.001), number of meniscus repairs (p<0.001) and trochleoplasties (P=0.011) in Group 2. There was no difference between groups regarding comorbidities, body mass index, and age. A power analysis yielded to reach 80% power (p<0.05) 12,405 patients per group would be needed for investigating the rate of dehiscence and 868 patients per group for formal debridement.Conclusion:Subcuticular suture type did not significantly affect the rate of wound healing dilemmas encountered following knee surgery in this young cohort. Formal debridement was required at a diminished rate in the barbed suture group but not significant enough to recommend routine use. Larger cohort studies are needed to further investigate this trend.Table 1.Patient characteristics

New Perspective for Soft Tissue Closure in Medication-Related Osteonecrosis of the Jaw (MRONJ) Using Barbed Sutures.

The aim of this study was to compare the effectiveness of barbed versus smooth sutures for soft tissue closure of exposed jawbone sites in medication-related osteonecrosis of the jaw (MRONJ) patients. Exposed necrotic jawbone sites surgically managed by intraoral soft tissue closure were evaluated. Either barbed sutures (Stratafix™ or V-Loc™) together with Prolene® or Vicryl® sutures were used. We estimated the effect of barbed sutures (BS) with Prolene® compared to smooth sutures (Vicryl®) on the hazard rate of intraoral soft tissue dehiscence using a multivariate Cox regression model within a target trial framework, adjusting for relevant confounders. In total, 306 operations were performed in 188 sites. In the primary analysis 182 sites without prior surgery were included. Of these, 113 sites developed a dehiscence during follow-up. 84 sites were operated using BS and Prolene®. A total of 222 sites were operated with Vicryl® (control group). In the BS group, the median time to event (i.e., dehiscence) was 148 days (interquartile range (IQR), 42–449 days) compared to 15 days (IQR, 12–52 days) in the control group. The hazard rate of developing intraoral dehiscence was 0.03 times (95%-confidence interval (CI): 0.01; 0.14, p < 0.001) lower for BS patients compared to the control group. Within the limits of a retrospective study, BS showed a high success rate and are therefore recommended for soft tissue closure of exposed jawbone sites in MRONJ patients. Additional studies are warranted to further evaluate this novel application of BS.

Biomechanical properties of canine staphylectomies closed with barbed or smooth suture.

To compare the duration of closure and biomechanical properties of staphylectomies closed with absorbable bidirectional barbed suture or smooth monofilament suture in a simple continuous or interrupted pattern STUDY DESIGN: Ex vivo study SAMPLE POPULATION: Soft palates (n = 60) harvested from mesaticephalic canine cadavers METHODS: One centimeter of tissue was excised from the caudal border of each soft palate, and the oral and nasopharyngeal mucosal surfaces were apposed with 2-0 bidirectional Quill Monoderm knotless closure device barbed suture (Q), 3-0 Monocryl in a simple continuous (MC) pattern, or 3-0 Monocryl in a simple interrupted (MI) pattern (n = 20 per group). Duration of closure was compared between groups. Tissues were tested under tension to failure, and mode of failure data were collected by video capture. Closure time was longer for MI closures than for Q and MC closures, with means of 259.9, 215.4, and 196.7 seconds, respectively (P < .0001). No difference was detected in yield force, force to first tissue rupture, maximum force, and energy required for yield and maximum force between groups. Energy to yield was 190.0, 167.8, and 188.95 N-mm for MI, Q, and MC closures, respectively. Biomechanical properties of staphylectomies closed with barbed or smooth sutures did not differ in this cadaveric model. Barbed suture can be considered as an alternative for closure of canine staphylectomies. These results provide evidence to justify additional research to evaluate clinical outcomes in dogs undergoing staphylectomy.

Comparison of fertility outcomes after laparoscopic myomectomy for barbed versus nonbarbed sutures

To assess the impact on women's reproductive outcomes of barbed sutures to repair uterine breaches during laparoscopic myomectomy compared with traditional smooth sutures. Retrospective, monocentric cohort study, with information on subsequent pregnancies prospectively acquired for some women. Tertiary-level academic referral center. Women older than 18 years who had undergone a laparoscopic myomectomy and had sought pregnancy afterward, divided into two groups based on type of suture used to repair the uterine wall: group A (nonbarbed) and group B (barbed). Laparoscopic removal of FIGO types 3, 4, 5, and 6 uterine leiomyomas by use of either only barbed sutures or only traditional smooth sutures to reconstruct the uterine defect. Pregnancy achievement rates, delivery modes, main pregnancy complications, perioperative complications for both kinds of suture, and the trend of the use of barbed sutures over time at our center. Of 164 patients included, 83 were in group A and 81 in group B. Ninety-one patients (55.5%) experienced at least one postoperative pregnancy, with no differences between the groups (group A 60.5%; group B 50.6%). Of the 103 recorded postoperative pregnancies, 70 (68%) resulted in live births, 29 (28.1%) in first-trimester miscarriages, and 4 (3.9%) were ongoing. Barbed sutures have a similar impact on reproductive outcomes as smooth conventional threads, both in terms of pregnancy and obstetric complication rates, after laparoscopic myomectomy.

Bidirectional knotless barbed versus conventional smooth suture for closure of surgical wounds in inguinal castration in horses

BackgroundCastration of the stallion is one of the most frequently performed surgical procedures in the horse. Recently barbed suture materials for surgical wound closure were introduced to the market with manufacturers claiming that these sutures enhance speed and security as they eliminate the need to tie knots. Recently, it has been suggested that this type of suture may increase postoperative complications. This study aimed at investigating and comparing a bidirectional absorbable knotless barbed suture (KBS) to a conventional smooth suture (SS) for wound closure of inguinal castrations in the horse. This was done by evaluating short-term and post-discharge complications and by comparing the time spent on suturing the surgical wounds after bilateral inguinal castration, which was performed on 45 horses undergoing castration at The Large Animal Teaching Hospital at University of Copenhagen from September 2017 to May 2019.ResultsShort-term complications were few; at 24 h minor swelling occurred in 29 and 33% of horses sutured with KBS and SS respectively and cutaneous dehiscence during recovery occurred in two horses of each group. Post-discharge follow-up revealed that three horses needed veterinary attention for treatment of complications (scrotal swelling (n = 1, KBS); wound exudation (n = 1, SS) and wound dehiscence after return to pasture (n = 1, SS)). Wound closure was achieved 6 min faster with KBS than with SS (P < 0.0001).ConclusionsUse of the KBS suture did not result in increased occurrence of postoperative complications. Wound closure was faster with KBS than with SS in equine bilateral inguinal castration. Our results show that KBS can safely be used in the horse following bilateral inguinal castrations without adverse effects and with a reduction in suturing time.

Reproductive Outcomes following Use of Barbed Suture during Laparoscopic Myomectomy

To review pregnancy outcomes after laparoscopic myomectomy with the use of barbed suture. Retrospective cohort study and follow-up survey. Single, large academic medical center. Patients who underwent laparoscopic myomectomy with the use of barbed suture for myometrial closure between 2008 and 2016. Laparoscopic myomectomy and a follow-up survey regarding pregnancy outcome. A total of 486 patients met inclusion criteria and underwent a laparoscopic myomectomy between 2008 and 2016. Of the 428 with viable contact information, 240 agreed to participate (56%). Of those who responded to the survey, 101 (42%) attempted to get pregnant, and there were 4 unplanned pregnancies. There were 110 pregnancies among 76 survey respondents. In total, of the women attempting a postoperative pregnancy, 71% had at least 1 pregnancy. Comparing the women who did and did not conceive postoperatively, the group who got pregnant was on average younger, 33.8 ± 4.5 years vs 37.5 ± 6.5 years (p = .001); had fewer myomas removed, median = 2 (range 1-9) vs median = 2 (range 1-16) myomas (p = .038); and had a longer follow-up period, 30 months ( vs 30 (11-93 months) ± 20 (p <.001). The mean time to first postoperative pregnancy was 18.0 months (range 2-72 months). Of the 110 reported postoperative pregnancies, there were 60 live births (55%), 90% by means of cesarean section. The mean gestational age at birth was 37.8 weeks. In the cohort, there were 8 preterm births, 3 cases of abnormal placentation, 2 cases of fetal growth restriction, 3 cases of hypertensive disorders of pregnancy, and 2 cases of myoma degeneration requiring hospitalization for pain control. There were no uterine ruptures reported. According to our findings, pregnancy outcomes after laparoscopic myomectomy with barbed suture are comparable with available literature on pregnancy outcomes with conventional smooth suture.

975: Glove perforation after handling of knotless barbed and smooth sutures during cesarean section

975: Glove perforation after handling of knotless barbed and smooth sutures during cesarean section

Barbed sutures versus conventional sutures for uterine closure at cesarean section; a randomized controlled trial

Introduction: The aim of this randomized control trial was to compare the operative data and the early postoperative outcomes of cesarean sections in which the uterine incision was closed with a barbed suture (STRATAFIX™ Spiral PDO Knotless Tissue Control Device, SXPD2B405, Ethicon Inc.) with those of cesarean sections in which the uterine incision was closed with a conventional smooth suture (VICRYL™; Ethicon Inc.).Materials and methods: One hundred pregnant patients were randomized in a 1:1 ratio to the Stratafix group or the Vicryl group. The uterine incision was closed by two layers of sutures in both groups. In the Vicryl group, the first layer was continuous and the second layer was interrupted. In the Stratafix group, both layers were continuous.Results: The uterine closure time was significantly lower in the Stratafix group (224 ± 46 versus 343 ± 75 s, p < .001). Operative time was comparable between both groups. Twelve patients in the Vicryl group and two patients in the Stratafix group required additional sutures to achieve hemostasis (p value = .009). The mean blood loss during closure of uterine incision and mean hospital stay were lower in the Stratafix group but these differences failed to reach statistical significance.Conclusion: The use of barbed suture for uterine incision closure at cesarean section is associated with shorter uterine closure time and similar early perioperative complications compared with conventional smooth suture. The difference between both groups in the technique of suturing the second layer of the uterine incision may be the cause of the reduction in the uterine closure time and the need for additional sutures to achieve hemostasis during suturing the uterine incision with a barbed suture. Further, well designed randomized controlled trials should be conducted to investigate the association between the type of suture (barbed or conventional smooth) and remote complications of cesarean section (infertility, pelvic pain, abnormal placentation and rupture uterus).

Development and characterization of antibacterial braided polyamide suture coated with chitosan-citric acid biopolymer.

Braided polyamide sutures are frequently used in dermatologic surgery for wound closure. However, braided sutures promote bacteria proliferation. In order to prevent wound complications due to this effect, antibacterial sutures should be used. The main objective of this study is the development of new non-absorbable antibacterial polyamide braided suture. This paper suggests new coating process that leads to obtain suture uniformly covered by antibacterial film enclosing chitosan, which is known for its antibacterial benefit. Mechanical properties and surface morphology of developed sutures were investigated by using mechanical tests. Sutures surfaces were also examined by scanning electron microscope, to perceive spreading of coating product on suture surface. In order to identify potential reactions between chemical compounds present in coating solution and suture material, sutures were analyzed by ATR-IF spectroscopy. It has been demonstrated that many eventual bonds between compounds present in coating solutions and polyamide macromolecular chain may occur. The existence of these bonds implies the fixation of biopolymer coating on suture surface. It has been demonstrated that uniform surface may be obtained by progressively applying coating solution containing little amount of chitosan on suture surface. We have also found that developed coating process has not affected mechanical properties of suture, which still meet United States Pharmacopeia requirement. Finally, antibacterial effects against four colonies, very widespread in hospitals, were studied. Prominent antibacterial effects of braided polyamide suture against two gram-positive ( S Aureus, S epidermidis) and two gram-negative ( E coli and P aeruginosa) colonies are presented. Optimal result of best properties is obtained by applying three layers of biopolymer coating comprising 1% chitosan and 10% citric acid. The new developed suture coating process appears as a promising method for obtaining important antibacterial effect with smooth suture surface.

Single layer cystotomy closure of excised porcine bladders with barbed versus smooth suture material.

To determine which of 2 suture materials would be superior in terms of closure time and leakage pressure in open single-layer cystotomy closure. Experimental study. Twenty-four freshly harvested porcine urinary bladders. A cystotomy was performed and the incision closed with a single layer simple continuous suture pattern with barbed (n = 12) or smooth (n = 12) suture. Time required for closure was measured. Each bladder was connected to a system for monitoring intraluminal pressure while inflated with saline until leakage occurred. Intraluminal pressure at time of initial leakage and leakage site were recorded. Two-sample t tests were used to compare maximum leakage pressure and closure time between the 2 groups. P < .05 was considered significant. All bladders were sutured successfully with no difference in mean closure time (barbed suture 296 ± 46 seconds; smooth suture 293 ± 26 seconds) (P = .821). There was no difference in mean leakage pressure of porcine urinary bladder incisions closed in a single layer with barbed suture (28.8 ± 10.4 mm Hg) compared with smooth suture (30.6 ± 8.8 mm Hg) (P = .642). Barbed suture provides comparable cystotomy repair to smooth suture, and no benefit to its use was identified in an open procedure. Barbed suture closure should be evaluated for adequate tensile strength in the presence of urine, satisfactory in vivo healing of cystotomies, and lack of long-term urolith formation in dogs and cats.

Barbed Versus Conventional Suture: A Randomized Trial for Suturing the Endometrioma Bed After Laparoscopic Excision of Ovarian Endometrioma

ObjectivesTo determine whether the unidirectional knotless barbed suture can be used to control bleeding from the endometrioma bed after laparoscopic excision of ovarian endometrioma, and to detect whether the use of the unidirectional barbed suture is associated with shorter suturing time of the endometrioma bed compared with the continuous conventional smooth suture with intracorporeal knot tying. DesignRandomized clinical trial (Canadian Task Force classification I). SettingTertiary hospital. PatientsForty patients with unilateral ovarian endometrioma (mean diameter, 3–10 cm) were randomized in a 1:1 ratio to the barbed suture group or the conventional suture group. InterventionsThe endometrioma bed was sutured either with unidirectional barbed suture (V-Loc 180; Covidien, Mansfield, MA) or conventional suture (Vicryl; Ethicon, Somerville, NJ). Two layers of continuous sutures were used to control bleeding from the endometrioma bed and to reapproximate the ovarian edges. Measurements and Main ResultsThe degree of suturing difficulty was evaluated by the surgeons using a visual analog scale (VAS) ranging from 1 (least difficult suturing) to 10 (most difficult suturing). Operating time and suturing time were significantly shorter in the barbed suture group (43.3 ± 10.54 vs 52.8 ± 9.69 minutes; p = .005 and 8.85 ± 2.52 vs 15.7 ± 4.12 minutes; p < .001, respectively). Suturing with barbed suture was less difficult than suturing with conventional suture (3.68 ± 1.37 vs 4.77 ± 1.56; p = .025). Intraoperative blood loss was similar in the 2 groups. No perioperative complications were reported in either group. A nonsignificant decrease in serum anti-mullerian hormone (AMH) levels was observed after the operation in the barbed suture group and the conventional suture group (3.04 ± 1.5 vs 2.52 ± 1.31 ng/mL; p = .252 and 2.76 ± 1.48 vs 2.13 ± 1.14 ng/mL; p = .139, respectively). The rate of decline in serum AMH levels after the operation was 18.32% in the barbed suture group and 22.84% in the conventional suture group. ConclusionThe unidirectional knotless barbed suture (V-Loc) facilitates suturing of the endometrioma bed after laparoscopic excision of ovarian endometrioma. Compared with conventional smooth suture (Vicryl), the unidirectional barbed suture reduces the time needed to suture the endometrioma bed and the total operating time.

A randomized ‘N-of-1’ single blinded clinical trial of barbed dermal sutures vs. smooth sutures in elective plastic surgery shows differences in scar appearance two-years post-operatively

Barbed sutures have unidirectional circumferential shallow barbs, which distribute tension throughout the wound and close wound securely without the need to tie knots. We compare two different methods of wound closure in elective plastic surgical cases: barbed 3/0V-Loc™180 suture and smooth 3/0Maxon™ sutures, both polyglyconate monofilament synthetic absorbable sutures. We assessed the aesthetic long-term results with a minimum two year follow up. This is a prospective, randomized controlled study with internal control. A single surgeon performed all cases. Patients who underwent elective operations that involved long wound closure were enrolled in the study. Each patient acted as their own internal control with half their wound being sutured with 3/0V-Loc™180 barbed suture and the other half with smooth 3/0Maxon™ deep dermal sutures and then a subcuticular skin closure. In both groups, the superficial fascial system was closed with 1 Vicryl interrupted sutures on both sides. Long-term cosmesis was evaluated using the modified Hollander cosmesis score by review of standardized postoperative photographs by 9 blinded plastic surgeons and specialist registrars. The study reports on 33 female patients. The time taken for wound closure was significantly reduced using the barbed suture (p<0.001). There was no difference in the complication ratio in either group. Two-year aesthetic outcome was significantly superior when using the barbed suture (p=0.0075). Barbed sutures closure of long wounds is faster and produces a better long-term aesthetic outcome than smooth sutures.

A Multicenter Randomized Controlled Trial Comparing Absorbable Barbed Sutures Versus Conventional Absorbable Sutures for Dermal Closure in Open Surgical Procedures

Barbed sutures were developed to reduce operative time and improve security of wound closure. The authors compare absorbable barbed sutures (V-Loc, Covidien, Mansfield, Massachusetts) with conventional (smooth) absorbable sutures for soft tissue approximation. A prospective multicenter randomized study comparing barbed sutures with smooth sutures was undertaken between August 13, 2009, and January 31, 2010, in 241 patients undergoing abdominoplasty, mastopexy, and reduction mammaplasty. Each patient received barbed sutures on 1 side of the body, with deep dermal sutures eliminated or reduced. Smooth sutures with deep dermal and subcuticular closure were used on the other side as a control. The primary endpoint was dermal closure time. Safety was assessed through adverse event reporting through a 12-week follow-up. A total of 229 patients were ultimately treated (115 with slow-absorbing polymer and 114 with rapid-absorbing polymer). Mean dermal closure time was significantly quicker with the barbed suture compared with the smooth suture (12.0 vs 19.2 minutes; P<.001), primarily due to the need for fewer deep dermal sutures. The rapid-absorbing barbed suture showed a complication profile equivalent to the smooth suture, while the slow-absorbing barbed suture had a higher incidence of minor suture extrusion. Barbed sutures enabled faster dermal closure quicker than smooth sutures, with a comparable complication profile. 1.

Repair of the Midline Fascial Defect in Abdominoplasty With Long-Acting Barbed and Smooth Absorbable Sutures

Traditionally, repair of the midline fascial defect has been performed with interrupted or running permanent sutures during abdominoplasty. Barbed suture devices, however, eliminate the need for knot tying and potentially are equally effective at maintaining the repair while allowing for faster deployment and elimination of a potential nidus for infection. The authors report their experience with long-acting absorbable barbed and smooth sutures. A retrospective chart review was conducted on 34 consecutive patients who underwent abdominoplasty, alone or in conjunction with other procedures, between August 2006 and December 2009. Seventeen patients had repair of the midline abdominal wall rectus diastasis performed with a smooth running absorbable polydioxanone suture, and 17 underwent repair with a barbed suture. All 34 patients were women; their mean age was 43.6 years, and their mean body mass index was 23.0 kg/m(2). Sixty-eight percent of the patients elected to undergo concurrent procedures. Patients were followed for a mean of 34 months (27 months barbed; 42 months smooth). No cases of recurrent diastasis were observed. Complications included minor seroma (two cases in the barbed suture group, one in the smooth group) and infected hematoma (one in the barbed suture group). Based on the data from this series of patients, long-acting absorbable barbed or smooth sutures appear to be equally effective in maintaining rectus diastasis repair. Barbed sutures therefore hold promise as a useful alternative to permanent sutures for the plication of the rectus fascia during abdominoplasty.