Monday, April 28, 2008

Barbed Sutures

 Updated 3/2017-- photos and all links removed as many are no longer active and it was easier than checking each one.

I am seeing more advertisements and a few articles in journals regarding barbed sutures. I find the concept interesting. The supposed benefits include:
  • less time to close the incision as there is no tying
  • multiple layers (subcutaneous and dermis) can be closed together with one continuous suture
  • less suture "spitting" as no knots to be dissolved
  • less or no strangulation of tissue as there are no knots tied
  • no need for an assistant to "follow" the suture
The Barbed sutures are sutures with small projections that radiate outward from the center of the suture. For example, the suture may be made by cutting the surface of 2-0 polypropylene to create small projecting barbs, all angled in one direction and helicoidally arrayed around the length of the suture core. The core of the barbed suture is then equivalent to a 4-0 polypropylene suture. Barbed sutures come in both permanent ( polypropylene and nylon) and dissolvable (polydioxanone) forms.
While Barbed sutures offer the promise of minimally invasive facial suspension (ie Threadlift, Featherlift , etc), I am more interested in how they might be used in vertical scar mastopexy or abdominoplasty or other body contouring procedures. Also, the use in tendon repair (no strangulation of the tendon) is worth watching.
Here are some basic instructions found on the Quill SRS Website:
QuillTM SRS contains bidirectionally oriented barbs to anchor tissues and does not require knots to approximate opposing edges of a wound. Tying of knots with QuillTM SRS will damage the barbs and potentially reduce their effectiveness. For the bidirectional forces to be created and for the device to function properly, both sides of the QuillTM SRS must be engaged in the tissue. Additionally, when completing placement, an additional J-stitch or bite of tissue lateral to the end of the incision is required to lock the device in place.
Avoid contacting the QuillTM SRS with other materials (e.g. surgical gauze, drapes, etc.) in the surgical field to prevent ensnaring on the barbs. If the barbs catch, carefully pull the material in the opposite direction of the needle to disengage it from the barbs.
When using QuillTM SRS subcutaneously, the device should be placed as deeply as possible in order to minimize erythema and induration normally associated with absorption.
Care should be taken to avoid damage when handling. Avoid crushing or crimping the suture material with surgical instruments, such as needle holders and forceps. Do not pull the QuillTM SRS out of the package by the needles as this can cause the barbs to catch on one another. Do not attempt to remove memory in the polymer by running fingers down the suture material as this can damage the barbs.

I would think that some down sides to using barbed sutures might be:
  • need to "never" redo a stitch placement as you can't "back" the suture out
  • ability to "feel" the barb if placed to superficial
  • can patient's "feel" the barb if to near the muscle layer?
I'd like to know more about these sutures. Has anyone used them?
APTOS Thread Website
Quill SRS Website
Evaluation of a Novel Technique for Wound Closure Using a Barbed Suture; Plastic & Reconstructive Surgery. 117(6):1769-1780, May 2006; Murtha, Amy P. M.D.; Kaplan, Andrew L. M.D.; Paglia, Michael J. M.D., Ph.D.; Mills, Benjie B. M.D.; Feldstein, Michael L. Ph.D.; Ruff, Gregory L. M.D.
Evaluation of a Novel Technique for Wound Closure Using a Barbed Suture: Reply; Plastic & Reconstructive Surgery. 120(1):350, July 2007; Ruff, Gregory L. M.D.
Barbed Sutures: A Review of the Literature; Plastic & Reconstructive Surgery. 121(3):102e-108e, March 2008; Villa, Mark T. M.D.; White, Lucile E. M.D.; Alam, Murad M.D.; Yoo, Simon S. M.D.; Walton, Robert L. M.D.
Caveats for the use of suspension sutures; Aesthetic Plast. Surg. 28: 170, 2004; Hudson, D. A., and Fernandes, D. B.
Treating the Aging Neck; PSP Innovation in Aesthetic Medicine, November 2007; Malcolm D. Paul, MD, FACS
An Experimental Multiple Barbed Suture for the Long Flexor Tendons of the Palm and Fingers: Preliminary Report; BrJBJS 49-B (3): 440; A. R. McKenzie
Breaking Strength of Barbed Polypropylene Sutures; Arch Dermatol. 2007;143(7):869-872;


AZReam said...

I no nothing of sutures, so cannot help, but I do know that if ever I have surgery, I want that American Flag as a wound closure please - very cool :)

Dreaming again said...

That looks like an embroidery stitch to me ;)

what about scarring? (asks the person who gets big ugly keloids)

rlbates said...

Dreaming, the reports are comparable. So if you tend to form keloids, you probably still would.

Bruce said...

I tried one recently for a thyroidectomy incision. It handled nicely and it pulled the skin edges together more securely than a monofiliment suture (I usually use PDS). So, maybe, it is a good thing.

rlbates said...

Thanks, Bruce. I'll have to see if I can get some to try.

Neumed said...

Interesting post as usual. Thanks.

Øystein said...

Interesting. Never seen sutures like this in use.

Be sure to submit it for the "Tools of the trade" surgexp edition!

Jeffrey Parks MD FACS said...

I like the idea for closing skin wounds....not so much for fascia.