Barbed suture: a review of the technology and clinical uses in obstetrics and gynecology

Abstract

Surgical knots are simply a necessary evil needed to anchor smooth suture to allow it to function in its role in tissue reapproximation. Surgical knots reduce the tensile strength of all sutures by thinning and stretching the material. The tying of surgical knots introduces the potential of human error and interuser variability. Knot-secured smooth suture must create an uneven distribution of tension across the wound with the higher tension burdens placed at the knots. Given the excessive relative wound tension on the knot and the reasonable concerns of surgeons for suture failure due to knot slippage, there is a natural tendency toward overcoming these concerns by over-tightening knots; however, tighter knots may be worse for wound healing and strength than looser knots. In minimally invasive laparoscopic surgeries, the ability to quickly and properly tie surgical knots presents a new challenge. In cases in which knot tying is difficult, the use of knotless barbed suture can securely reapproximate tissues with less time, cost, and aggravation. This article reviews the technology behind barbed sutures with a focus on understanding how they differ from traditional smooth sutures and how barbed sutures have performed in in vitro and animal model testing, as well as in human clinical trials.

Keywords: Barbed suture; Laparoscopic myomectomy; Smooth suture; Soft tissue reapproximation.

Figure 1

(A) Piece of latex tubing early in the knot formation. (B) Piece of latex tubing as the knot begins to tighten. Notice the thinning of the diameter of the tubing. (C) Piece of latex tubing after the knot is tightened. Notice the thinning of the diameter of the tubing and the pinching of the area immediately before the knot (arrows).

Figure 2

Tensile strength and energy-to-failure of tightly and loosely approximated fascial incisions. Reproduced with permission from Stone IK et al.

Figure 3

Original drawings for barbed suture. Reproduced from Alcamo JH.

Figure 4

(A) Quill™ Knotless Tissue-Closure Device (Angiotech Pharmaceuticals, Inc; Vancouver, BC, Canada). (B) V-Loc™ Wound Closure Device (Covidien; Mansfield, MA). (C) Quill Knotless Tissue-Closure Device.