Bidirectional Barbed Sutures for Wound Closure: Evolution and Applications

Abstract

Traditionally, wound closure sutures have in common the need to tie knots with the inherent risk of extrusion, palpability, microinfarcts, breakage, and slippage. Bidirectional barbed sutures have barbs arrayed in a helical fashion in opposing directions on either side of an unbarbed midsegment. This suture is inserted at the midpoint of a wound and pulled through till resistance is encountered from the opposing barbs; each half of the suture is then advanced to the lateral ends of the wound. This design provides a method of evenly distributing tension along the incision line, a faster suture placement and closure time with no need to tie knots, and the possibility of improved cosmesis. Bidirectional barbed sutures, which are available in both absorbable and nonabsorbable forms, can be used for simple closures, multilayered closures, and closure of high-tension wounds in a variety of surgical settings.

Is There an Advantage to Knotless Barbed Suture in TKA Wound Closure? A Randomized Trial in Simultaneous Bilateral TKAs

“…In the current study, barbed closures were associated with a mean savings of 5 minutes, which is in the range of 3 to 12 minutes reported in other studies with use of this device (Table 1) [2][3][4][9][10][11]. Running knotless closures with barbed sutures consistently are reported to have shorter closure times than standard interrupted closure techniques [2][3][4][8][9][10].…”

“…Compared with standard sutures, the design of bidirectional barbed sutures allows for knotless fixation and provides for more even distribution of tension along the entire length of the incision [8]. Evidence from cadaver knee studies suggests that bidirectional barbed sutures may provide a more watertight closure [6] and evidence from biomechanical testing suggests that TKAs closed with bidirectional barbed sutures are more resistant to failure than those where interrupted standard sutures have been used [12].…”

“…First introduced in 2007, the knotless, bidirectional, barbed suture is used by surgeons from numerous specialties, including plastic and reconstructive surgery, urology, obstetrics, and laparoscopic gynecology [8]; however some skepticism regarding the risk or benefit profile of the suture technology in orthopaedic applications persists. This may be partly attributable to a statistically significantly higher frequency of postoperative wound complications reported in two large studies (n = 694 patients) in which closures were performed using the unidirectional barbed suture, V-Loc TM (Covidien, Mansfield, MA, USA) [1,7]; or the three reported occurrences of extensor mechanism repair failure with the bidirectional barbed suture [13].…”

Clinical Applications of Barbed Suture in Aesthetic Breast Surgery

“…Some have even suggested that the final scar result is subjectively improved from a clinical perspective as a result of a reduction of tissuerelated ischemia, less suture extrusion, and locking of the tissues more tightly through the barbing, although this is difficult to prove clinically when Monocryl-type sutures are used. [4][5][6][7][8][9] Three main barbed suture device companies are currently being used for soft tissue closure in breast, body contouring, and other soft tissue closure procedures in the United States. A bidirectional self-retaining suture (Quill SRS, now Surgical Specialties, Vancouver, British Columbia, Canada) uses a helically distributed back-cut spaced distance of 5.08 mm apart on a variety of monofilament sutures of both the absorbable (polyglycolic acid/polycaprolactone [Monoderm]) and polydioxanone (PDO) along with nonabsorbable (nylon and polypropylene) ( Figs.…”

Use of Barbed Sutures for Fixation of Spreader Grafts in Rhinoplasty: A Novel Technique

“…Scar widening and suture extrusion due to the presence of knots along the suture line is eliminated. This timesaving also reduces costs and eliminates the need for additional surgeons for assistance [3]. I have personally been using barbed suture, Quill™ and STRATAFIX™, suture since 2007 in both facial aesthetics and body contouring.…”