Suture material for flexor tendon repair: 3-0 V-Loc versus 3-0 Stratafix in a biomechanical comparison ex vivo

A systematic review of the biomechanical properties of suture materials used in orthopaedics

Background

Soft tissue injuries are frequently repaired using various suture material. The ideal suture should have the biomechanical properties of low displacement, high maximum load to failure, and high stiffness to avoid deformation. Since tendon healing occurs over a period of months, it is important for the surgeon to select the proper suture with certain biomechanical properties. Therefore, the purpose of this study is to qualitative summarize the published literature on biomechanical properties of different suture materials used in orthopaedic procedures.

Methods

Following PRISMA guidelines, PubMed and Cochrane databases were queried for original articles containing "biomechanic(s)" and "suture" keywords. Following screening for inclusion and exclusion, final articles were reviewed for relevant data and collected for qualitative analysis. Data collected from each study included the tissue type repaired, suture material, and biomechanical properties, such as elongation, maximum load to failure, stiffness, and method of failure.

Results

17 articles met final inclusion criteria. Two studies found No.2 Fiberwire™ to have the lowest elongation and 4 studies found No. 2 Ultrabraid™ to have the greatest. 12 studies reported Maximum load to failure was highest in No. 2 Fiberwire™, No. 2 Ultrabraid™, and FiberTape™ while No. 2 Ethibond ™ had the lowest in 5 studies. 3 of the 5 studies that evaluated No. 2 Fiberwire™ found it to have the highest stiffness. No. 2 Ethibond™, No. 2 Orthocord™, and No. 2 PDS™ were reported as the least stiff sutures in 2 studies each.

Conclusion

Fiberwire™, FiberTape™, and Ultrabraid™ demonstrated the highest load to failure while Ethibond™ consistently was the weakest. Fiberwire™ was found to have the lowest elongation while Ultrabraid™ had the highest. Fiberwire™ was also noted to be the stiffest while PDS, Ethibond™, and Orthocord™ were found to be the least stiff. Final treatment decisions on which suture to utilize to optimize repair integrity and healing are complex, and rarely solely dependent upon the biomechanical properties of the materials used.

Level of evidence

Systematic Review, Level IV.

Efficacy and safety of V-Loc™ barbed sutures versus conventional suture techniques in gynecological surgery: a systematic review and meta-analysis

PURPOSE

One of the most challenging tasks in laparoscopic gynecological surgeries is suturing. Knotless barbed sutures are intended to enable faster suturing and hemostasis. We carried out a meta-analysis to compare the efficacy and safety of V-Loc™ barbed sutures (VBS) with conventional sutures (CS) in gynecological surgeries.

METHODS

We systematically searched PubMed and EMBASE for studies published between 2010 and September 2021 comparing VBS to CS for OB/GYN procedures. All comparative studies were included. Primary analysis and subgroup analyses for the different surgery and suturing types were performed. Primary outcomes were operation time and suture time; secondary outcomes included post-operative complications, surgical site infections, estimated blood loss, length of stay, granulation tissue formation, and surgical difficulty. Results were calculated as weighted mean difference (WMD) or risk ratio (RR) and 95% confidence intervals (CI) with a random effects model, and a sensitivity analysis for study quality, study size, and outlier results was performed. PROSPERO registration: CRD42022363187.

RESULTS

In total, 25 studies involving 4452 women undergoing hysterectomy, myomectomy, or excision of endometrioma. VBS were associated with a reduction in operation time (WMD - 17.08 min; 95% CI - 21.57, - 12.59), suture time (WMD - 5.39 min; 95% CI - 7.06, - 3.71), surgical site infection (RR 0.26; 95% CI 0.09, 0.78), estimated blood loss (WMD - 44.91 ml; 95% CI - 66.01, - 23.81), granulation tissue formation (RR 0.48; 95% CI 0.25, 0.89), and surgical difficulty (WMD - 1.98 VAS score; 95% CI - 2.83, - 1.13). No difference between VBS and CS was found regarding total postoperative complications or length of stay. Many of the outcomes showed high heterogeneity, likely due to the inclusion of different surgery types and comparators. Most results were shown to be robust in the sensitivity analysis except for the reduction in granulation tissue formation.

CONCLUSION

This meta-analysis indicates that V-Loc™ barbed sutures are safe and effective in gynecological surgeries as they reduce operation time, suture time, blood loss, infections, and surgical difficulty without increasing post-operative complications or length of stay compared to conventional sutures.

Biomechanical comparison of different suture materials with different techniques in tendon repair: An ex-vivo study

OBJECTIVES

Sheep Achilles tendons are used as an effective preclinical model of flexor tendon repair in plastic surgery, due to their biomechanical properties, which are similar to humans. The aim of this study was to examine the efficacy and biomechanical outcomes of suture materials and tendon repair techniques in flexor tendon repair.

MATERIAL AND METHODS

72 sheep tendons were obtained for a total of 12 different scenarios. Tendons were repaired using 4 different suture types and 3 different suture techniques. After repair, the tendons were fixed at both ends and subjected to biomechanical tests. Ultimate Failure Load (UFL) and 2-mm Gap Load (GL) per scenario were compared statistically within and between groups.

RESULTS

UFL and GL of all sutures were significantly different between the modified Kessler, Bunnell and Krackow techniques (P < 0.05), and between Monosorb, Ti-Cron and V-loc sutures (P < 0.05). UFL and GL according to repair technique were not significantly different for the Propilen suture (P > 0.05).

CONCLUSION

When UFL and GL were considered together, our findings indicate that optimal strength scenarios were for the modified Kessler technique using Monosorb or V-loc sutures.

Effect of loading speed on gap resistance and tensile strength of flexor tendon repair under cyclic loading test

Postoperative digit motion is important for the functional recovery of injured tendons. To date, it is unknown whether the loading speed impacts the biomechanical properties of a repaired tendon. This study investigated the effect of loading speed on the gap resistance and tensile strength of tendon repairs. One hundred porcine flexor tendons were repaired with two core sutures, 4-strand modified Kessler and double Q, and cyclically loaded at the speeds of 10, 40, 80, 160, and 320 mm/min. The number of tendons that formed an initial or 2 mm gap at the repair site during cyclic loading, stiffness at the 1st and 20th loading cycles, gap size between tendon ends when cyclic loading ended, and the ultimate strength were recorded. Under the lowest loading speed, the tendons repaired with the 4-strand modified Kessler suture developed significantly larger gaps and smaller stiffness than those with a greater loading speed. The loading speed did not affect the maximum strength of both tendon repairs. The findings suggest that very slow motion promotes gap formation of tendon repair with inferior gap resistance. The rate corresponds to regular hand action or the tendon core suture possessing a strong gap resistance increases the safety margin during early active finger movement. Our findings help to guide the exercise regimens after tendon surgery.

Evaluating the Compartment-Specific Effects in Superficial Facial Fat Compartments After Thread-Lifts by the Tensiometer and FACE-Q

Background

The thread-lifts have been popularized because they offered minimally invasive procedures of facial rejuvenation, but not evaluated by the objective assessment system.

Objectives

The purpose of this study is to evaluate the compartment-specific effects after thread-lifts by the tensiometer and FACE-Q.

Methods

Retrospective cohort study was performed on 369 consecutive patients undergoing the thread-lifts with V-Loc devices (n = 173) and the limited scar face lifts (n = 196), with the mean follow-up period of 32.2 ± 5.2 months, between January 2014 and December 2015. Two hundred-seventy patients had intraoperative tension measurements performed. In an online survey, the blinded study coordinator registered all data in 12 FACE-Q scales.

Results

The average age was 46.0 ± 10.1 years. The complication rate was 4.8%. The mean value of the tensions was 9.5 ± 1.9 N. Patients were better satisfied with the appearance of their marionette (44.3 ± 24.8) lifted by device 3&4 (10.1 ± 1.6 N), compared with satisfaction with the appearance of their nasolabial folds (37.9 ± 20.7) lifted by device 1&2 (8.7 ± 2.1 N). The satisfaction of patients of the 40s and 50s&60s was higher than that of patients of the 20s&30s with decision. The satisfaction of patients undergoing limited scar face lifts was higher than that of patients undergoing thread-lifts with social and psychological functions.

Conclusions

The tension measurements correlate with compartment-specific effects and play the same role as the indicator between gravitational and volumetric theories, but the limited effectiveness of thread-lifts was found to look 2.3 years younger during a mean follow-up of 2.5 years.

Level of Evidence 3

Barbed suture Extrusion and Exposure in palatoplasty for OSA: What does it mean?

PURPOSE

Analyze Extrusion&Exposion (E&E), its implications in the functional, anatomical results and subjective discomfort in OSA patients treated with Barbed Reposition Pharyngoplasty (BRP).

MATERIALS AND METHODS

488 patients treated with BRP or multilevel TORS. Stratafix wire was used in 230 patients, V-Loc in 258. E&E, timing and localization evaluated at follow-up. Polygraphy used to assess the impact of E&E on functional results, PPOPS questionnaire used for subjective discomfort.

RESULTS

E&E in the entire group was 18,4%, with significant difference between Stratafix and V-Loc wire (p = 0,002), but not between BRP alone and multilevel surgery (p = 0,68). 28,9% of extrusion happened within the first seven days, 76,7% between seven days and two months, 5,5% after two months. Symptomatic clinical profile has been seen in 62,2%, asymptomatic one in 37,8% of patients. 35,5% of E&E were localized in tonsillar bed, 46,7% in soft palate and 20% in other sites. Mean delta-AHI of E&E patients was -15,87 ± 16.82 compared with one of those who did not have E&E was -16.34 ± 22,77 (p = 0,38). Mean PPOPS of 183 patients analyzed was 12,32 ± 4,96. Mean PPOPS of extruded group was 12,94 ± 4,68 and 11,92 ± 5,11 in not extruded one (p = 0,166).

CONCLUSIONS

E&E are suture-type sensitive (V-Loc > Stratafix), reported more frequent when BRP is performed alone than BRP-TORS with no statistical significance. 76,7% of the E&E occur after patient discharge and within 2 months. About half of the E&E were localized in soft palate. There is no need to fear Extrusion&Exposition because it does not affect in a negative way subjective and PSG outcome.

Biomechanical Comparison of Tendon Coaptation Methods With a Meshed Suture Construct

PURPOSE

Tendon-to-tendon attachment constructs for tendon reconstructions or transfers need to be secure in order to allow early mobilization after surgery. The purpose of this study was to biomechanically compare 2 common constructs secured with a novel mesh suture versus a nonabsorbable braided suture.

METHODS

We used 100 cadaveric tendons to create 5 different tendon coaptation constructs (a to e) (10 coaptations per group): (a) Pulvertaft weave with a braided suture (PTe); (b) mesh suture (PTm); (c) single-pass, side-to-side (SP-STS) coaptation with 30-mm overlap using a mesh suture (SP-STS-30m); (d) SP-STS 50-mm overlap with a mesh suture (SP-STS-50m); and (e) SP-STS with 30-mm tendon overlap using a braided suture (SP-STS-30e). The tensile strength, bulk, gliding resistance, and failure type were compared.

RESULTS

There was no difference between the various tendon constructs and the suture type in terms of coaptation bulk. All SP-STS constructs with mesh suture had higher peak gliding resistance than any of the PT constructs regardless of suture type. Compared with the PT constructs, the SP-STS constructs with mesh or braided suture had a higher peak load, peak load normalized to repair length, and stiffness. Within each tendon coaptation construct group, Pulvertaft or SP-STS, the suture type did not affect any of the investigated parameters.

CONCLUSIONS

The SP-STS constructs are significantly stronger and stiffer than the PT constructs. The SP-STS with mesh suture exhibited greater gliding resistance than the PT constructs and may result in greater gliding resistance through physiological tissue planes. However, the use of a mesh suture did not affect strength, bulk, gliding resistance, or failure type when compared within a construct group.

CLINICAL RELEVANCE

The use of SP-STS constructs for tendon coaptations produces a stronger and stiffer construct than the PT weave; however, the use of a mesh suture may not provide any benefit over a braided suture.

Endoscopic Transoral Hybrid Supracricoid Partial Laryngectomy with Cricohyoidoepiglottopexy

Objectives:

The hybrid supracricoid partial laryngectomy with cricohyoidoepiglottopexy (SCPL-CHEP, that is, open partial horizontal laryngectomies OPHL Type IIa) has been described using a flexible next generation robotic surgical platform for manipulation. We sought to evaluate the feasibility of performing this procedure using endoscopic transoral (EndoT) surgical techniques without robotics.

Methods:

Preclinical cadaveric study using two human cadavers. Hybrid SCPL-CHEP was performed with a flexible endoscope for visualization and hand-held instruments for manipulation (SILS Hook monopolar and Dissect, HAVAS LaryngoFIT malleable straight jaw instruments, and Stratafix 4-0 spiral knotless barbed suture).

Results:

EndoT hybrid SCPL-CHEP was successfully performed. The hand-manipulated rigid instruments allowed for transoral incisions and mucosal suturing. We provide the procedural steps of EndoT hybrid techniques.

Conclusions:

EndoT hybrid SCPL-CHEP was technically feasible in the preclinical cadaveric laboratory setting and appeared comparable to the hybrid SCPL-CHEP via transoral robotic surgery (TORS). Selected handheld instruments and flexible endoscopy appear to facilitate minimally invasive surgery of the larynx. This novel procedure and technique warrant further clinical study for consideration of feasibility, applicability, and patient benefit.

Asymmetric 6-Strand Flexor Tendon Repair - Biomechanical Analysis Using Barbed Suture

Background: This study investigates the biomechanical performance of the Asymmetric flexor tendon repair technique using barbed suture. The Asymmetric repair technique using monofilament nylon suture was previously reported to have a higher tensile strength than the modified Lim-Tsai repair technique, but its repair stiffness and load to gap force were significantly lower. There is hence an unmet need to improve this technique and the substitution of nylon suture with barbed sutures may be the solution. Methods: Two groups consisting of 10 porcine tendons each were repaired with the six-strand Asymmetric repair technique using V-Loc^® 3-0 and Supramid^® 4-0 respectively. The repairs were subjected to a mechanical tester for static testing. The ultimate tensile strength, load to 2 mm gap force, repair stiffness, time taken to complete a repair and failure mechanism of the repairs were recorded and analyzed. Results: All the repairs using V-Loc^® 3-0 sutures had significantly higher median values of ultimate tensile strength (64.1 N; 56.9 N), load to 2 mm gap force (39.2 N; 19.7 N), repair stiffness (6.4 N/mm; 4.7 N/mm) and time taken to complete a repair (9.4 mins; 7.7 mins). All the repairs using V-Loc^® sutures failed by suture breakage while 80% of repairs using Supramid^® sutures failed by suture pullout. Conclusions: The use of the barbed sutures in the Asymmetric repair technique, whilst more time consuming, has shown promising improvement to its biomechanical performance (i.e. better ultimate tensile strength, stiffness and resistance to gap formation).

A review of cyclic testing protocols for flexor tendon repairs

BACKGROUND

Cyclic testing of flexor tendons aims to simulate post-operative rehabilitation and is more rigorous than static testing. However, there are many different protocols, making comparisons difficult. We reviewed these protocols and suggested two protocols that simulate passive and active mobilization.

METHODS

Literature search was performed to look for cyclic testing protocols used to evaluate flexor tendon repairs. Preload, cyclic load, number of cycles, frequency and displacement rate were categorised.

FINDINGS

Thirty-five studies with 42 different protocols were included. Thirty-one protocols were single-staged, while 11 protocols were multiple-staged. Twenty-nine out of 42 protocols used preload, ranging from 0.2 to 5 N. Preload of 2 N was used in most protocols. The cyclic load that was most commonly used was between 11 and 20 N. Cyclic load with increment of 10 N after each stage was used in multiple-staged protocols. The most commonly used number of cycles was between 100 and 1000. Most protocols used a frequency of <1 Hz and displacement rate between 0 and 20 mm/min.

INTERPRETATION

We propose two single-staged protocols as examples. Protocol 1: cyclic load of 15 N to simulate passive mobilization with preload of 2 N and 2000 cycles at frequency of 0.2 Hz.; Protocol 2: cyclic load of 38 N to simulate active mobilization, with the same preload, number of cycles, and frequency as above. This review consolidates the current understanding of cyclic testing and may help clinicians and investigators improve the design of flexor tendon repairs, allow for comparisons of different repairs using the same protocol, and evaluate flexor tendon repairs more rigorously before clinical applications.

The application of barbed suture during the partial nephrectomy may modify perioperative results: a systematic review and meta-analysis

Background

Barbed sutures can avoid knot tying and speed the suture placement in the PN(partial nephrectomy). On account of the impact on clinical outcomes are ambiguous, this study is determined to identify the application of barbed suture during PN.

Methods

ClinicalTrials.gov, Cochrane Register of Clinical Studies, PubMed and EMBASE were searched for RCTs(randomized controlled trials) and cohort studies focusing on the comparison of barbed and traditional sutures in PN(last updated on Feb in 2015). According to Cochrane Library’s suggestion, quality assessment was performed. Review Manager was applied to analyze all the data and sensitivity analyses were performed through omitting each study sequentially.

Results

Eight cohort studies and none of RCTs proved eligible (risk of bias: moderate to low,431 patients). Warm ischemia time(MD = − 6.55,95% CI -8.86 to − 4.24, P < 0.05) decreased statistically in the barbed suture group, as well as operative time(MD = − 11.29,95% CI -17.87 to-4.71, P < 0.05). Postoperative complications also reduced significantly(OR = 0.44, 95% CI 0.24 to0.80, P < 0.05). Unidirectional barbed suture resulted in fewer postoperative complications based on the subgroup analysis(OR = 0.48,95% CI 0.24 to 0.94, P < 0.05).

Conclusions

The barbed suture may be a useful surgical innovation which can modify perioperative results for surgeons and patients. Randomly-designed studies with longer follow up and larger sample sizes are in the need of to explore the applicability.

Electronic supplementary material

The online version of this article (10.1186/s12894-018-0435-3) contains supplementary material, which is available to authorized users.

Failure of a Unidirectional Barbed-Suture Device at the Arthrotomy Repair Site Following Total and Unicondylar Knee Arthroplasty: A Case Report

CASE

We report the failure of a routine arthrotomy repair following knee arthroplasty. Five additional cases of arthrotomy failure occurred within a 14-month period during which a specific unidirectional knotless barbed suture device had been used for arthrotomy closure.

CONCLUSION

Additional study on larger cohorts may be useful to understand the effectiveness of barbed suture for arthrotomy closure in knee arthroplasty.

Comparison of Standard Suture vs Barbed Suture for Closing the Porcine Knee Joint: Evaluation of Biomechanical Integrity and Permeability

BACKGROUND

This study aimed to compare the biomechanical strength and permeability of barbed vs traditional suture for closure of the porcine knee joint.

METHODS

This study used Duroc pig knee joints. For each specimen, a 5-cm medial parapatellar arthrotomy was performed with the knee at 30° of flexion. We closed the arthrotomy wound using barbed suture (size 1/0 V-Loc 180) or traditional suture (size 1/0 PDS II). Specimens were divided into a PDS II (n = 9) and a V-Loc group (n = 9) for biomechanical testing, and a PDS II (n = 9) and a V-Loc group (n = 9) for permeability testing. In biomechanical testing, a continuous load was applied and the wound was pulled apart at 50 mm/min. We compared the maximum load under which each suture type could maintain wound closure. In permeability testing, the knee joints were flexed and extended for 200 cycles at 0.5 Hz from 0° to 120° of flexion. A tube was fixed in the articular cavity of the specimen and connected to a 1.5-m high water capsule. The time taken to wound effusion was compared.

RESULTS

There was no significant difference between the mean load at initial failure for PDS II (424 ± 192 N) vs V-Loc (471 ± 100 N, P = .529), or between the mean time until effusion for PDS II (6.8 ± 3.4 seconds) vs V-Loc (5.5 ± 2.5 seconds, P = .390).

CONCLUSION

Standard and barbed suture had similar wound holding strength and permeability. The barbed suture was as stable as traditional suture.

Comparison of surgical time and complication rate of subcutaneous and skin closure using barbed suture or traditional knotted suture in dogs

This prospective study evaluated the handling, intraoperative and postoperative complication rates of a barbed knotless suture for closure of subcutaneous tissue and skin in 17 client-owned dogs (group A) following a tibial plateau leveling osteotomy procedure. Clinical characteristics, surgical time, and complication rates were compared to a control group of 17 client-owned dogs (group B) with subcutaneous tissue and skin closure using traditional suture material. Signalment was not significantly different between groups and did not have an effect on complication rates. Surgical times were not significantly different for subcutaneous tissue or skin closure between the 2 groups. There were significantly more intraoperative complications in the barbed suture group (A: 4/17; B: 0/17; P = 0.033) but no difference in minor or major postoperative complication rates (minor A: 2/16; B: 1/14; P = 0.626, major A: 2/16; B: 0/14; P = 0.171).

Comparison of Barbed Sutures in Porcine Flexor Tenorrhaphy

Background: Barbed suture use has become more popular as technology and materials have advanced. Minimal data exist regarding performance of the 2 commercially available products, V-LocTM and StratafixTM in tendon repairs. The purpose of this study was to compare gap resistance and ultimate tensile strength of both suture materials and nonbarbed suture in a porcine ex vivo model. Methods: Porcine flexor tendons were harvested and divided into 3 groups of 10 of varying suture material (3-0 PDS™, 3-0 V- V-Loc 180™, or 3-0 Stratafix™). A modified 4-strand cruciate technique was used to repair each tendon. Knotless repair was performed using barbed suture, whereas a buried 6-throw square knot was done using conventional suture. A servohydrolic tester was used for biomechanical testing of linear 2-mm gap resistance and maximum tensile strength. Results: No difference was found in 2-mm gap resistance among the 3 groups. No difference was found in ultimate tensile strength between V-Loc™ (76.0 ± 9.4 N) and Stratafix™ (68.1 ± 8.4 N) repairs, but the ultimate strength of the PDS™ control group (83.4 ± 10.0 N) was significantly higher than that of Stratafix™. Conclusions: Barbed (knotless) and nonbarbed suture repairs demonstrate equivalent 2-mm gap resistance. Stratafix™ repairs show slightly inferior performance to nonbarbed repairs in ultimate tensile strength, although this occurred at gap distances far beyond the 2-mm threshold for normal tendon gliding. Both barbed and nonbarbed 4-strand cruciate flexor tendon repairs may require peripheral repair to withstand physiologic loads.

Laparoscopic Treatment of Choledochal Cyst Using Barbed Sutures

PURPOSE

The usage of barbed sutures is increasingly being reported in the field of laparoscopic surgery. However, there have been reports of suture-related complications such as small bowel obstruction or anastomosis stricture. We present our experience of hepaticojejunostomy (HJ) using V-loc, during laparoscopic cyst excision for choledochal cyst.

METHODS

At our center, from August 2014 to January 2015, 4 patients were treated for choledochal cyst. Laparoscopic cyst excision with Roux-en-Y HJ was performed, and HJ was performed with intracorporeal suturing using unidirectional barbed sutures. After surgery, the patients were followed up in the outpatient clinic every 3 months to monitor for long-term complications such as biliary stricture.

RESULTS

There were no short-term complications. Among the 4 patients, 3 patients did not experience any long-term complications. As of this writing, the follow-up period for the 4 patients is 16 months for the first 2 patients and 11 months for the later 2 patients. Biliary stricture was diagnosed in 1 patient at 7 month follow-up. HJ revision was performed with an open right subcostal incision. The anastomosis showed dense fibrosis and stricture. The patient recovered uneventfully after the surgery.

CONCLUSIONS

HJ using barbed sutures was relatively easy to perform, but barbed sutures may have a tendency to cause stricture when used in biliary enteric anastomosis. Caution must be taken to prevent overtightening of the suture.

The Efficacy and Safety of Knotless Barbed Sutures in the Surgical Field: A Systematic Review and Meta-analysis of Randomized Controlled Trials

The knotless barbed suture is an innovative type of suture that can accelerate the placement of sutures and eliminate knot tying. However, the outcomes of previous studies are still confounding. This study reviewed the application of different types of barbed sutures in different surgeries. We searched PubMed, EMBASE, CENTRAL and ClinicalTrials.gov to identify randomized controlled trials (RCTs) addressing the application of barbed sutures up to Feb. 2015. Two reviewers independently screened the literature and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. Sensitivity analysis and subgroup analysis was performed. Seventeen RCTs (low to moderate risk of bias) involving 1992 patients were included. Compared with conventional sutures, the barbed suture could reduce suture time (SMD=−0.95, 95%CI −1.43 to −0.46, P = 0.0001) and the operative time (SMD=−0.28, 95%CI −0.46 to −0.10, P = 0.003), not significantly increase the estimated blood loss (SMD=−0.09, 95%CI −0.52 to 0.35, P = 0.70), but could lead to more postoperative complications (OR = 1.43, 95%CI 1.05 to 1.96, P = 0.03), These results varied in subgroups. Thus, barbed sutures are effective in reducing the suture and operative time, but the safety evidences are still not sufficient. It need be evaluated based on special surgeries and suture types before put into clinical practice.