ARE SYMMETRICAL BARBED SUTURES AN ADVANTAGE IN KNEE ARTHROPLASTIES? PROSPECTIVE ANALYSIS

INTRODUCTION The number of knee replacements has increased significantly, and is projected to increase further by 2030. Wound closure is one of the research areas. Arthroplasties require a large incision to achieve adequate exposure. This implies long closure and healing times. Barbed sutures are not new as they were introduced in 1964. Since then, multiple improvements have been made to these sutures and their use has expanded to various fields. Despite the potential advantages, barbed sutures are not commonly used in knee replacements. This may be due to the higher cost and uncertain clinical benefits. The objective is to determine the effect of barbed sutures compared to traditional braided sutures in knee arthroplasties by analyzing certain clinical results. MATERIAL AND METHODS A prospective observational study was carried out analyzing the arthroplasties operated during one year. Those in which the barbed suture was used for the closure of the arthrotomy and/or subcutaneous cellular tissue were compared with those in which a traditional braided suture was used. RESULTS No statistically significant differences were observed between both sutures in terms of range of motion, functional status, and surgical complications. Regarding the time of surgery, a difference of 10 minutes was observed in favor of barbed sutures, the closure time being statistically significant. CONCLUSIONS Barbed sutures contribute to greater surgical effectiveness, cost savings, surgical time, and comparable complication rates.

Case Report: Bowel Occlusion Following the Use of Barbed Sutures in Abdominal Surgery. A Single-Center Experience and Literature Review

Introduction: A high level of surgical ability is required to perform endoscopic knot tying. Barbed sutures help in avoiding this procedure, thus reducing intraoperative time and lowering blood loss and hospitalization time when compared to traditional sutures. Some cases of bowel occlusion following the use of barbed sutures have been described in literature. All of them are characterized by the entanglement of an intestinal loop in wire barbs with bowel occlusion symptoms.Case Presentation: We report two more cases which occurred in our Institute in 2020 and review those which have been reported in the literature by searching on Pubmed, Scopus, and Embase. We used the search terms: “Barbed,” ”Suture,” “Bowel,” and ”Obstruction.” We examined in the literature the surgical procedures, the type of complications, the time to onset of the complications, and the type of barbed suture.Discussion: Twenty-two cases in total were reported in the literature from 2011 to 2020, and bowel complications were largely subsequent to interventions such as hernia surgical repair and myomectomy. In order to take advantage of barbed sutures while minimizing the risk of adverse events, such as intestinal occlusion, some precautions may be considered, such as the shortening of thread tails and use of antiadhesive barriers. Moreover, performing a few stitches backwards when ending the suture might be a useful suggestion. Further studies in this field may be useful in order to assess whether it might be better avoiding barbed suture application on serosal tissues to prevent bowel damage.

New Perspective for Soft Tissue Closure in Medication-Related Osteonecrosis of the Jaw (MRONJ) Using Barbed Sutures

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.