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Haenen FWN. Letter re: Knotless Closure of the Cardiac Arterial Canulation Site Using Barbed Suture. Surg Innov 2024:15533506241285233. [PMID: 39317381 DOI: 10.1177/15533506241285233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Affiliation(s)
- Filip W N Haenen
- Department of Cardiac Surgery, Antwerp University Hospital, Edegem, Belgium
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Xiang N, Lin Y, Su X, Hu Z, Zhou J, Wu Y, Du L, Huang J. Assessing the application of barbed sutures in comparison to conventional sutures for surgical applications: a global systematic review and meta-analysis of preclinical animal studies. Int J Surg 2024; 110:3060-3071. [PMID: 38445518 DOI: 10.1097/js9.0000000000001230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/14/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Following an initiative published by Lancet in 2002 and an IDEAL-D framework, the value of preclinical animal studies has garnered increasing attention in recent research. Numerous preclinical animal experiments tried to generate evidence to guide the development of barbed sutures. However, discernible drawbacks and incongruities in outcomes have emerged between clinical and preclinical animal studies. Therefore, this meta-analysis aimed to review the preclinical animal experiments comparing barbed sutures with conventional sutures. The authors hope to facilitate clinical translation of barbed sutures by evaluating effectiveness, safety, and physical properties/reliability. MATERIALS AND METHODS A systematic search of PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov was conducted to identify controlled preclinical animal experiments comparing barbed sutures with conventional sutures. The risk of bias was assessed using SYRCLE. GRADE approach was used to evaluate evidence quality. Revman was applied to analyze all the data. Subgroup, sensitivity, and meta-regression analyses were also performed. RESULTS A total of 62 articles were eligible with low to moderate quality, including 2158 samples from 10 different animal species across 27 surgical procedures. Barbed suture exhibited a significant reduction in suture time, limited change in Cross-Sectional Area (CSA), and decreased instances of tissue disruption (all P <0.05). Subgroup analyses, considering both clinical and research significance, indicated that barbed sutures might cause more specific adverse events and demonstrate suboptimal performance of physical properties/reliability. Meta-regression suggested that heterogeneity resulted from variations in studies and animal models. CONCLUSION Although barbed suture demonstrated superiority in numerous surgeries for time efficiency, its safety and physical properties/reliability might be influenced by diverse preclinical models, sutures' brand, surgeries, and anatomical sites. Further evaluation, based on standardized and well-designed animal experiments, is essential for medical device development and applications in human beings.
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Affiliation(s)
- Nanyan Xiang
- Department of Urology, Innovation Institute for Integration of Medicine and Engineering, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Chengdu, Sichuan, People's Republic of China
| | - Yifei Lin
- Department of Urology, Innovation Institute for Integration of Medicine and Engineering, West China Hospital, Chengdu, Sichuan, People's Republic of China
- Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Xiaoyi Su
- Department of Urology, Innovation Institute for Integration of Medicine and Engineering, Chinese Evidence-Based Medicine Center,West China Hospital, Chengdu, Sichuan, People's Republic of China
| | - Zifan Hu
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jinyu Zhou
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yi Wu
- Peking Union Medical College, Beijing, People's Republic of China
| | - Liang Du
- Department of Urology, Innovation Institute for Integration of Medicine and Engineering, West China Hospital, Chengdu, Sichuan, People's Republic of China
| | - Jin Huang
- Department of Urology, Innovation Institute for Integration of Medicine and Engineering, West China Hospital, Chengdu, Sichuan, People's Republic of China
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Haenen FW, Van Oostende C, Allegaert M, Round KJ, Rosen JL, Guy ST, Rodrigus I. Prosthesis-prosthesis anastomosis using barbed sutures compared to conventional sutures under high, long-term pressure; in vitro extracorporeal circulation setup. Perfusion 2024; 39:571-577. [PMID: 36691745 DOI: 10.1177/02676591231153539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND While barbed sutures have been extensively utilized in other disciplines, they have not been widely adopted in cardiac surgery. The lack of safety and feasibility data has limited its use within the field. To aide in the further understanding of how cardiac surgeons can use barbed sutures, we sought to develop a high-pressure in vitro simulation model. We compared knotless barbed sutures in a highly pressurized anastomosis to conventional sutures. METHODS Ten specimens in total were utilized in prosthesis anastomosis, using 34 mm Gelweave Plexus (Terumo Aortic, Sunrise, FL 33325, USA) and 34 mm Hemabridge (Intergard Woven Hemabridge, Getinge, Göteborg, Sweden). Five models of size 3-0 barbed suture anastomoses using non-absorbable, barbed, self-retaining, monofilament polypropylene sutures (Filbloc® 3-0, Assut Europe, Rome, Italy) were compared against five conventional anastomoses using size 4-0 polypropylene monofilament (Ethicon, USA). The systems were connected using a novel-designed extracorporeal circulation system. Pressure was rapidly increased in the specimen to a mean pressure of 300-350 mmHg, running then for a minimum of 48 hours to assess anastomosis strength and endurance. RESULTS No anastomotic dehiscence or rupture was recorded. Complex, angular anastomosis required extra stitch leakage sutures in both conventional and barbed suture specimens. CONCLUSION Using knotless barbed sutures with an additional self-locking maneuver for prosthesis-prosthesis anastomosis in cardiac surgery is feasible in an in vitro model under long term, high-mean pressure when compared to conventional sutures. In vivo trials should be performed to further validate the in vitro findings.
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Affiliation(s)
- Filip Wn Haenen
- Department of Cardiac Surgery, Antwerp University Hospital, Edegem, Belgium
| | | | - Mathias Allegaert
- Department of Anesthesia, Antwerp University Hospital, Edegem, Belgium
| | - Kellen J Round
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jake L Rosen
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sloane T Guy
- Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Inez Rodrigus
- Department of Cardiac Surgery, Antwerp University Hospital, Edegem, Belgium
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Mun J, Hyun SJ, Lee JK, An S, Kim KJ. Surgical and Clinical Outcomes Associated With the Use of Barbed Sutures and Self-Adhering Mesh System and Polymeric Glue for Wound Closure in Multilevel or Revision Spinal Surgery: A Matched Cohort Comparative Study With Conventional Wound Closure Procedure. Neurospine 2023; 20:981-988. [PMID: 37798992 PMCID: PMC10562243 DOI: 10.14245/ns.2346534.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE Multilevel or revisional posterior spinal surgery is prone to infection and delayed wound healing, related with the wound closure time and suture strength. Knotless barbed suture is an innovative self-locking, multianchor suture. This study aims to evaluate the safety and efficacy of the knotless barbed suture and self-adhering mesh with polymeric glue in multilevel or revisional posterior spinal surgery. METHODS This is a single-center retrospective matched cohort study. Patients were divided into 2 groups based on the wound closure method: barbed suture group with novel wound closure, and conventional suture group with conventional wound closure, 1:1 matched by the level of surgery and sex, resulting in 120 subjects each. Total operation time and wound closure time were measured intraoperatively, and perioperative clinical outcome parameters including postoperative wound complication were investigated for the first 3 months postoperatively. The distribution of continuous variables was assessed for normality by Shapiro-Wilk test, then parametric or nonparametric tests were applied accordingly (paired t-test or Wilcoxon signed-rank test). RESULTS Wound closure time was significantly shorter with the novel barbed suture than with conventional suture in all subgroups divided by the level of spinal surgery: 3-5, 6-9, ≥ 10 levels (p < 0.001). The 2 groups showed no significant differences in surgical complications (p = 1.000). Specially, total operation time and wound-closing time were significantly shorter in revisional subgroup. CONCLUSION Absorbable knotless barbed suture and self-adhering mesh with polymeric glue can shorten spinal wound closure time with noninferiority in complications for multilevel or revisional spinal surgery.
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Affiliation(s)
- Junho Mun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jae-Koo Lee
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sungjae An
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Initial Experience with the PONTiS Tendon Repair System in Traumatic Upper Extremity Injuries. Plast Reconstr Surg 2022; 150:375e-380e. [PMID: 35671448 DOI: 10.1097/prs.0000000000009351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tendon injuries of the upper extremity remain a common surgical condition requiring prompt intervention. We review our initial experience with the PONTiS flexor tendon repair system (PFRS) - a knotless, multifilament stainless steel crimp system. METHODS Consecutive patients undergoing repair by our plastic and orthopedic surgeons with the PFRS were reviewed from 2015-2017. Multivariate risk and Kaplan-Meier survival analyses were performed to assess risk factors associated with complications. RESULTS Eighty-one patients with mean follow up of 75 days (range 0 - 33 months) were identified. The most common demographics of our patients were right-handed (82.9%), male (71.4%), laborer (35.7%), sustaining laceration injuries (77.1%) at zone 2 (27.2%). There was an average of 3.7 tendon injuries per patient. Associated injuries included fractures (21.4%), arterial injuries (24.3%), and nerve injuries (61.4%). Thirteen (16.0%) patients developed complications: adhesions/contracture (4), rupture (2), flap ischemia (2), arterial thrombosis (1), wound dehiscence (1), tendon lag (1), and erosion of the PFRS through soft-tissue grafts (2). Multivariate analysis identified poor soft-tissue coverage (OR 9.990; p=0.043) and zone 2 involvement (OR 7.936; p=0.016) as risk factors, while epitendinous repairs (OR 0.096; p=0.010) were protective against complications. CONCLUSIONS The PFRS system is rapid and simple to deploy and advantageous especially in multiple traumatic tendon injuries. Compared to traditional suture repair, it has a comparable overall complication profile but superior rupture and tenolysis rates. We advise use with caution in cases with poor soft tissue coverage to minimize risks of extrusion and strongly recommend the use of epitendinous sutures concurrently to limit complications.
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Laimer J, Hechenberger M, Lercher JM, Born E, Schomaker M, Puntscher S, Siebert U, Bruckmoser E. New Perspective for Soft Tissue Closure in Medication-Related Osteonecrosis of the Jaw (MRONJ) Using Barbed Sutures. J Clin Med 2021; 10:jcm10081677. [PMID: 33919696 PMCID: PMC8069803 DOI: 10.3390/jcm10081677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/03/2021] [Accepted: 04/11/2021] [Indexed: 12/19/2022] Open
Abstract
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.
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Affiliation(s)
- Johannes Laimer
- University Hospital for Craniomaxillofacial and Oral Surgery, Medical University Innsbruck, A-6020 Innsbruck, Austria; (J.L.); (M.H.); (J.M.L.); (E.B.)
| | - Martin Hechenberger
- University Hospital for Craniomaxillofacial and Oral Surgery, Medical University Innsbruck, A-6020 Innsbruck, Austria; (J.L.); (M.H.); (J.M.L.); (E.B.)
| | - Johanna Maria Lercher
- University Hospital for Craniomaxillofacial and Oral Surgery, Medical University Innsbruck, A-6020 Innsbruck, Austria; (J.L.); (M.H.); (J.M.L.); (E.B.)
| | - Eva Born
- University Hospital for Craniomaxillofacial and Oral Surgery, Medical University Innsbruck, A-6020 Innsbruck, Austria; (J.L.); (M.H.); (J.M.L.); (E.B.)
| | - Michael Schomaker
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, A-6060 Hall in Tirol, Austria; (M.S.); (S.P.); (U.S.)
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, 7550 Cape Town, South Africa
| | - Sibylle Puntscher
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, A-6060 Hall in Tirol, Austria; (M.S.); (S.P.); (U.S.)
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, A-6060 Hall in Tirol, Austria; (M.S.); (S.P.); (U.S.)
- Center for Health Decision Science, Departments of Epidemiology and Health Policy & Management, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Emanuel Bruckmoser
- Private Practice for Oral and Maxillofacial Surgery, A-5020 Salzburg, Austria
- Correspondence: ; Tel.: +43-677-63846310
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Vishwanathan K, Patel R, Talwalkar S. Which Headless Compression Screw Produces the Highest Interfragmentary Compression Force in Scaphoid Fracture? Indian J Orthop 2020; 54:548-564. [PMID: 32850017 PMCID: PMC7429644 DOI: 10.1007/s43465-020-00107-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 04/04/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Interfragmentary compression at the fracture site facilitates healing. Headless compression screws used to treat scaphoid fractures can be grouped as shank screws, conical tapered screws and double component screws. There has been no meta-analysis of biomechanical studies to compare interfragmentary compression produced by the above screws. METHODS A computerised search of Pubmed, Embase and OVID database was undertaken to identify the studies. We estimated the weighted mean difference of interfragmentary compression (in Newton) with 95% confidence intervals. Random effects model was selected for meta-analysis. RESULTS The pooled estimate of nine studies demonstrated that conical tapered screw produced significantly higher interfragmentary compression force compared to the shank screw (WMD 19.96, 95% CI 11.2-28.8, p < 0.0001, I 2 = 99%). The pooled estimate of four studies demonstrated that dual component screw produced significantly higher interfragmentary compression force compared to the shank screw (WMD 16.93, 95% CI 12.3-21.6, p < 0.0001, I 2 = 97.7%). The pooled estimate of four studies showed that there was no significant difference in the interfragmentary compression force generated by either conical tapered screw or dual component screw (WMD 3.93, 95% CI - 8.3 to 16.2, p = 0.53, I 2 = 99.7%). There was evidence of minimal publication bias. CONCLUSION Conical tapered screws and dual component screws produced statistically significant higher interfragmentary compression force at the scaphoid fracture site compared to shank screws. There was no difference in the compression force generated by either conical tapered screw or dual component screw.
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Affiliation(s)
- Karthik Vishwanathan
- Department of Orthopaedics, Parul Institute of Medical Sciences and Research, P.O Limda, Waghodia, Vadodara, 391760 India
| | - Ravi Patel
- Pramukhswami Medical College, Charutar Arogya Mandal, Gokal Nagar, Karamsad, 388325 India
| | - Sumedh Talwalkar
- Department of Orthopaedics, Wrightington, Wigan and Leigh NHS Trust, Wrightington, WN6 9EP UK
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Frame K, Ben‐Amotz O, Simpler R, Zuckerman J, Ben‐Amotz R. The use of bidirectional barbed suture in the treatment of a complete common calcanean tendon rupture in a dog: Long-term clinical and ultrasonographic evaluation. Clin Case Rep 2019; 7:1565-1572. [PMID: 31428393 PMCID: PMC6692997 DOI: 10.1002/ccr3.2287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 11/22/2022] Open
Abstract
The canine common calcanean tendon can be repaired successfully using a modified Kessler knotless barbed technique. A long-term ultrasound follow-up showed improved and increased normal tendon fibrillar echotexture and homogeneity.
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Affiliation(s)
- Kevin Frame
- Veterinary Specialty and Emergency CenterBluepearl Veterinary PartnersPhiladelphiaPennsylvania
| | - Oded Ben‐Amotz
- Rambam 80, Hand and Microsurgery UnitHealthcare CampusHaifaIsrael
| | - Renee Simpler
- Veterinary Specialty and Emergency CenterBluepearl Veterinary PartnersPhiladelphiaPennsylvania
| | - Josh Zuckerman
- Veterinary Specialty and Emergency CenterBluepearl Veterinary PartnersPhiladelphiaPennsylvania
- Cape Cod Veterinary SpecialistsBuzzards BayMassachusetts
| | - Ron Ben‐Amotz
- Veterinary Specialty and Emergency CenterBluepearl Veterinary PartnersPhiladelphiaPennsylvania
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Kim J, Eom HJ, Shin H, Jeong SY, Kim MS, Yoon HS, In CH, Kim BG, Bae DS, Lee JW. In Vivo Comparison of MONOFIX, A Novel Barbed Suture with a Triangular Stopper, with Pre-existing Products in a Porcine Model. J Minim Invasive Gynecol 2019; 27:473-481. [PMID: 30959198 DOI: 10.1016/j.jmig.2019.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/11/2019] [Accepted: 04/01/2019] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE MONOFIX, a new absorbable barbed suture device, has a triangular stopper at the end to hold the suture to the tissue without hooking the looped end or knotting. The aim of this study was to compare the biomechanical strength and histologic features of MONOFIX with other barbed suture devices using a porcine model. DESIGN Well-designed, controlled trial without randomization. SETTING Animal laboratory in university hospital. SUBJECTS Sixteen, 60-kg, mature female domestic pigs (skin closure group) and 5, 60-kg, mature female domestic pigs (fascial closure group). INTERVENTIONS In the skin closure group, 3-0 MONOFIX versus 2 widely used 3-0 absorbable barbed sutures (3-0 V-Loc 180 or Stratafix). In the fascial closure group, 2-0 MONOFIX versus 1 widely used 2-0 absorbable barbed sutures (2-0 Stratafix). MEASUREMENTS AND MAIN RESULTS In the skin closure group, the biomechanical wound strength of skin sutured with size 3-0 MONOFIX, V-Loc 180, or Stratafix was evaluated by postoperative day assessment (days 0, 3, 7, 14, and 28). In the fascial closure group, pigs underwent 2 paramedian incisions and were sutured with 2-0 MONOFIX or with 2-0 Stratafix to evaluate histologic reaction. At 6 weeks the tissues around the suture line were excised and microscopically evaluated. The biomechanical strength of the MONOFIX had similar tissue tensile strength compared with the control, regardless of postoperative day. In the fascial closure model, there was no significant difference in the average tissue reaction score between MONOFIX and Stratafix (1.2 ± .3 vs 1.3 ± .3, p = .478). CONCLUSION This study demonstrated that MONOFIX has equivalent tensile strength and histologic reaction when compared with commonly used barbed suture devices. Accordingly, this preclinical study suggests that the use of MONOFIX is a safe alternative to other barbed suture devices.
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Affiliation(s)
- Jihye Kim
- Departments of Obstetrics and Gynecology (Drs. J. Kim, Jeong, M. S. Kim, B.-G. Kim, Bae, and Lee)
| | - Hye Jin Eom
- Samyang Biopharmaceuticals Corporation, Sungnam-si, Korea, and Medical Device Plant (Ms. Eom), Samyang Biopharmaceuticals, Daejeon, Korea
| | - Hyeongchan Shin
- Pathology and Translational Genomics (Dr. Shin), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Young Jeong
- Departments of Obstetrics and Gynecology (Drs. J. Kim, Jeong, M. S. Kim, B.-G. Kim, Bae, and Lee)
| | - Myeong Seon Kim
- Departments of Obstetrics and Gynecology (Drs. J. Kim, Jeong, M. S. Kim, B.-G. Kim, Bae, and Lee)
| | | | | | - Byoung-Gie Kim
- Departments of Obstetrics and Gynecology (Drs. J. Kim, Jeong, M. S. Kim, B.-G. Kim, Bae, and Lee)
| | - Duk-Soo Bae
- Departments of Obstetrics and Gynecology (Drs. J. Kim, Jeong, M. S. Kim, B.-G. Kim, Bae, and Lee)
| | - Jeong-Won Lee
- Departments of Obstetrics and Gynecology (Drs. J. Kim, Jeong, M. S. Kim, B.-G. Kim, Bae, and Lee).
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Barbed sutures versus conventional tenorrhaphy in flexor tendon repair: An ex vivo biomechanical analysis. Arch Plast Surg 2019; 46:228-234. [PMID: 30913576 PMCID: PMC6536874 DOI: 10.5999/aps.2018.00962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 02/16/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The management of flexor tendon injuries has evolved in recent years through industrial improvements in suture materials, refinements of repair methods, and early rehabilitation protocols. However, there is no consensus on the ideal suture material and technique. This study was conducted to compare the tensile strength, repair time, and characteristics of 4-strand cruciate, modified Kessler, and 4-strand horizontal intrafiber barbed sutures for flexor tenorrhaphy with a 12-mm suture purchase length in an animal model. METHODS The right third deep flexors of 60 adult Leghorn chicken feet were isolated and repaired with a 12-mm suture purchase length. The tendons were randomly assigned to three groups of equal number (n=20 each). Groups 1 and 2 received 4-strand cruciate and modified Kessler repair with conventional suture materials, respectively. A 4-strand horizontal intrafiber barbed suture technique was used in group 3. The repaired tendons were biomechanically tested for tensile strength, 2-mm gap resistance, and mode of failure. Repair times were also recorded. RESULTS The maximum tensile strength until failure was 44.6±4.3 N in group 1, 35.7±5.2 N in group 2, and 56.7±17.3 N in group 3. The barbed sutures were superior to the other sutures in terms of the load needed for 2-mm gap formation (P<0.05). Furthermore, the barbed sutures showed the shortest repair time (P<0.05). CONCLUSIONS This study found that 4-strand horizontal intrafiber barbed suture repair with a 12-mm purchase length in a chicken flexor tendon injury model showed promising biomechanical properties and took less time to perform than other options.
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Abstract
BACKGROUND Barbed sutures have become increasingly popular in the field of aesthetic plastic surgery, particularly in body contouring and breast operations, in which the use of barbed sutures may offer both time and cost savings. Scar aesthetics is an important outcome for both surgeons and patients in these procedures; however, there is a paucity of studies assessing the aesthetic outcome of barbed sutures with regard to scarring. METHODS A systematic review of the PubMed, EMBASE, and Cochrane databases was performed from the date of their inception through July of 2017 using the search terms "barbed suture" combined with "scar" or "wound." Studies were included if they were prospective, evaluator-blind, randomized, controlled trials; closed the dermal layer of incisions using barbed sutures; and included an evaluator-blind aesthetic assessment of scarring. RESULTS Six prospective, randomized, controlled trials met inclusion criteria. The cosmetic result of scars in 926 patients was evaluated after an average of 8.1 months. Five of the six controlled trials found the aesthetic results of wounds closed with barbed sutures to be equivalent to those closed with traditional sutures, and one study showed significantly superior aesthetic results with barbed sutures. Use of barbed sutures resulted in shorter operating times in four of the five studies that timed incision closure. Similar complication rates were observed in all evaluated studies. CONCLUSION Based on this systematic review, the majority of studies concluded that there were no differences in scarring aesthetics when dermal layers were closed using barbed sutures compared with traditional suturing techniques.
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