Evaluating the Use of a Barbed Suture for Skin Closure during Autologous Breast Reconstruction

Abstract

This study compared the use of barbed suture to a traditional skin closure method for incision closure in free flap breast reconstruction. A retrospective study compared the two closure methods in consecutive series of patients undergoing autologous breast reconstruction between January 2007 and January 2009. Outcomes included total duration of operation and wound complications. We also performed a cost analysis. Use of the barbed suture significantly decreased operative time for unilateral cases by an average of 45 minutes (405 versus 360 minutes, P = 0.02). For bilateral cases, the mean operative time was decreased by an average of 10 minutes (510 versus 500 minutes, P = 0.44). There were more episodes of delayed wound healing in the bilateral barbed suture group (33/46 [72%] versus 15/31 [48%], P = 0.04). No statistical difference was noted between the two groups with regard to dehiscence, infection, or suture extrusion. Use of the barbed suture was, however, more cost-effective. The use of a barbed suture in the closure of abdominal and breast incisions in free flap breast reconstruction may expedite wound closure and reduce the cost of the procedure but may increase wound complications.

A Comparison of Barbed Sutures and Standard Sutures with regard to Wound Cosmesis in Panniculectomy and Reduction Mammoplasty Patients

“…This is important to note as pressure-induced ischemia and necrosis are major contributors to wound dehiscence [6]; however, due to the small sample size of this study and the low overall complication rate, it is not possible to determine whether wound dehiscence was prevented by the use of barbed sutures. Conversely, several retrospective reviews have reported complication rates that were significantly higher among wounds closed with barbed sutures [13, 14]. This conflict in clinical opinion indicates that additional research with a larger patient base is necessary to discern whether complications from incisions closed with barbed sutures differ significantly from standard sutures.…”

“…In our study, the use of barbed sutures decreased the time to closure over that of standard sutures by 32.8% (24.4 minutes versus 36.3 minutes, p = 0.003). In a 2011 study, Jandali and colleagues reported that use of barbed sutures decreased the duration of unilateral breast reconstruction by 50 minutes, although there was no significant difference in the duration of bilateral breast reconstruction [13]. According to their cost analysis, despite the increased cost of barbed sutures over standard sutures, a 50-minute decrease in operative time would save a total of $7600 in operating room and anesthesia charges.…”

Clinical Applications of Barbed Suture in Aesthetic Breast Surgery

“…[18][19][20] Early literature with respect to breast surgery has focused on the effectiveness of barbed suture material in the closure of donor sites in breast reconstruction. [21][22][23] Thekkinkattil and colleagues 21 in 2013 evaluated the use of unidirectional barbed suture for quilting of the donor site in a latissimus dorsi myocutaneous flap breast reconstruction compared with nonbarbed material in 50 patients. The implementation of barbed sutures was found to have a similar complication profile with regards to seroma formation and wound concerns as conventional suture materials.…”

New suture materials for midline laparotomy closure: an experimental study

“…Another type of suture that has recently appeared on the market [8], the barbed suture, is not really new. It was patented back in 1964 [9] and has been reintroduced for several surgical applications such as plastic surgery [10] and digestive surgery [11,12]. Barbed sutures have also been experimentally tested for the closure of fascias [13] and tendons [14].…”