Online Articles

Malcolm D. Paul, MD, FACS Treating the Aging Neck http://www.psp-interactive.com/issues/articles/2007-11_02.asp

White Papers

Material Properties of Quill™ SRS Monoderm™ Sizes 0, 2-0 and 3-0
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Material Properties of Quill™ SRS PDO Sizes 3-0 and 4-0
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Meeting Abstracts

Leung JC, Ruff GL, Batchelor SD. Performance enhancement of a knotless suture via barb geometry modifications. 7th World Biomaterials Congress 2004 Proceedings. p1587.
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Ingle NP, King MW, Leung JC, Batchelor S. Barbed suture anchoring strength: Applicability to dissimilar polymeric materials. 7th World Biomaterials Congress 2004 Proceedings. p1260.
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Leung JC. Barbed suture technology: Recent advances. Medical Textiles 2004, Conference Proceedings, October 26-27, 2004, p62-80, Pittsburg, Pennsylvania.
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Rodeheaver GT, Pineros-Fernandez A, Salopek LS, Rodeheaver PA, Leung JC, Ruff GL, Batchelor SD. Barbed sutures for wound closure: In vivo wound security, tissue compatibility and cosmesis measurements. Society for Biomaterials 30th Annual Meeting Transactions. Transaction 229, p232.
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Leung JC, Pritt S. Barbed, bi-directional surgical sutures: In vivo strength and histopathology evaluations. Society of Biomaterials 29th Annual Meeting Transactions 2003. p100.
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Dattilo PP, King MW, Leung JC. Tissue holding performance of knotless absorbable sutures. Society for Biomaterials 29th Annual Meeting Transactions 2003. p101.
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Leung JC, Ruff GL, King MW, Dattilo PP Jr. Barbed, bi-directional surgical sutures. MEDTEX03, International Conference & Exhibition on Healthcare & Medical Textiles. Conference Proceedings, July 8-9, 2003. Bolton, UK.
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Leung JC, Ruff GL, Megaro MA. Barbed, bidirectional medical sutures: Biomechanical properties and wound closure efficacy studies. Society for Biomaterials 28th Annual Meeting Transactions 2002;25:724.
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Journal Article Abstracts

James A. Greenberg, MD*, and Jon I. Einarsson, MD, MPH. The Use of Bidirectional Barbed Suture in Laparoscopic Myomectomy and Total Laparoscopic Hysterectomy

From the Brigham & Women's/Faulkner Hospitals, Harvard Medical School (both authors), Boston, Massachusetts.

Bidirectional barbed suture is a new design that incorporates tiny barbs spaced evenly along the length of the suture cut facing in opposite directions from the midpoint. Unlike the smooth-textured traditional suture, the bidirectional barbs on this new product introduce a new paradigm in which wound tension is evenly distributed across the length of the suture line rather than at the knotted end. No knots are required with bidirectional barbed suture. We present a small case series with bidirectional barbed suture to close myometrial defects in laparoscopic myomectomies and vaginal cuffs in total laparoscopic hysterectomies. On the basis of our early experience, we are optimistic that this new suture material is a potentially valuable tool for gynecologic surgeons. Journal of Minimally Invasive Gynecology (2008) 2008 AAGL All rights reserved.

Michael E. Moran, M.D.,¹ Catherine Marsh, R.N., N.P.,² And Michael Perrotti, M.D.² Bidirectional-Barbed Sutured Knotless Running Anastomosis v Classic van Velthoven in a Model System

¹Department of Urology, Medical and Surgical Specialists, Naples, Florida.
²Capitol Region Urologic Surgeons, Albany, New York.

Background and Purpose: Robotic prostatectomy is exploding into popular utilization throughout much of the United States. It is expected that the rise in the number of these cases into 2006 will continue exponentially. A significant amount of research has begun to focus on the anastomosis, because the robot allows unprecedented illumination and dexterous control to make the quality of this repair equal to that of a microscopic approach. Here, we report our results with a circular anastomosis technique using an innovative bidirectionalbarbed suture material for knotless, tension-free repair and compare it with a standard polyglecaprone single-knot technique. Materials and Methods: Using a previously described in-vitro model of microfiber synthetic material, a running anastomosis was performed using the da Vinci Surgical System® by one surgeon. Two pre-tied 3-0 polyglecaprone sutures on a tapered Rb-1 needle were compared with a bidirectional-barbed suture (3-0 PDO) designed specifically for our use (Quill Sutures, Research Triangle Park, NC). The times needed to perform the anastomosis, the accuracy in idealized phantoms, and the surgeon's security in the quality of his work (linear scale) were all recorded for 10 consecutive anastomoses. Results: The PDO suture was faster to deploy (17.3 minutes v 19.2 minutes), and the security score by the surgeon was greater. The accuracy was equivalent for both types of running closure comparing the classic van Velthoven with the PDO-sutured anastomosis. Conclusions: It appears from our preliminary work that a bidirectional-barbed suture might improve the vesicourethral anastomosis during a robotic radical prostatectomy. Further investigations should be done to measure the disruptive force necessary to distract these sutures, whether the applied forces of the barbs are adequate for maintaining a watertight seal, and the reproducibility of our results by other surgeons. All of these investigations are in progress in our laboratory.

Murtha AP, Kaplan AL, Paglia MJ, Mills BB, Feldstein ML, Ruff GL. Evaluation of a novel technique for wound closure using a barbed suture.

Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA

Background: Suture knots present several disadvantages in wound closure, because they are tedious to tie and place ischemic demands on tissue. Bulky knots may be a nidus for infection, and they may extrude through skin weeks after surgery. Needle manipulations during knot-tying predispose the surgeon to glove perforation. A barbed suture was developed that is self-anchoring, requiring no knots or slack management for wound closure. The elimination of knot tying may have advantages over conventional wound closure methods. Methods: This prospective, randomized, controlled trial was designed to show that the use of barbed suture in dermal closure of the Pfannenstiel incision during nonemergent cesarean delivery surgery produces scar cosmesis at 5 weeks that is no worse than that observed with conventional closure using 3-0 polydioxanone suture. Cosmesis was assessed by review of postoperative photographs by a blinded, independent plastic surgeon using the modified Hollander cosmesis score. Secondary endpoints included infection, dehiscence, pain, closure time, and other adverse events. Results: The study enrolled 195 patients, of whom 188 were eligible for analysis. Cosmesis scores did not significantly differ between the barbed suture group and the control group. Rates of infection, dehiscence, and other adverse events did not significantly differ between the two groups. Closure time and pain scores were comparable between the groups. Conclusions: The barbed suture represents an innovative option for wound closure. With a cosmesis and safety profile that is similar to that of conventional suture technique, it avoids the drawbacks inherent to suture knots.

Malcolm D. Paul, MD, Newport Beach, CA Using Barbed Sutures in Open/Subperiosteal Midface Lifting

The author has found that the use of barbed sutures simplifies midface suspension not only by stacking elevated soft tissue, but also by providing the ability to adjust sutures postoperatively. Complications, such as breaking of sutures, malposition, and failure to maintain support have been rare in his practice. (Aesthetic Surg J 2006;26:725–732.)

Malcolm D. Paul, MD, Newport Beach, CA Quill™ SRS Bidirectional Barbed Sutures for Wound Closure: Evolution and Applications

Wound closure has traditionally utilized absorbable and non-absorbable sutures. Traditional sutures have in common the need to tie knots with the inherent risk of extrusion, palpability, microinfarcts, breakage and slippage. Bidirectional barbed sutures with the barbs arranged in a helical fashion provide a method of evenly distributing tension along the incision line, a faster suture placement and closure time with no need to tie knots, and the possibility of improved cosmesis.

Recasens, MD, Ph.D. Knotless layered single suture skin and scalp closure

Scalp wounds, either the results of lacerations or of medical treatment (as with hair transplantation or other cranial surgery), present unique surgical challenges. Optimizing the aesthetic result requires balancing considerations of closure technique, suture material, and tissue characteristics while not violating the tissue's hair-bearing functions. Suboptimal selection can lead to compromised results manifested by infection, scarring, trauma-induced alopecia, and even dehiscence.

Gregory Ruff, MD, Chapel Hill, NC Technique and Uses for Absorbable Barbed Sutures

The author describes barbed sutures as a unique wound closure tool. Their advantages include the closure of wounds without any knots or the need for a third hand. They are also capable of shifting tissues differentially along the suture to redistribute tensile and compressive forces. The author discusses the development of these tools and their application. (Aesthetic Surg J 2006;26:620-628.)

Kyle J. Weld, Caroline D. Ames, Greg Hruby, Peter A. Humphrey, and Jaime Landman Evaluation of a Novel Knotless Self-Anchoring Suture Material for Urinary Tract Reconstruction

Objectives. To evaluate a novel prototype self-anchoring suture (SAS) material that incorporates unidirectional "barbs" designed to grip and approximate tissue without the need for suture ligation for urinary tract reconstructive procedures. Methods. The in vitro failure strength of various porcine tissue approximations with SAS was compared with the strength of similar approximations with standard ligated suture. For in vivo analysis, 3 pigs underwent laparoscopic pyeloplasty with SAS on one side and 2-0 Vicryl suture on the contralateral side. Nine pigs underwent bladder neck anastomoses (BNA) performed with SAS (n = 3) and standard ligated interrupted suturing (n = 3) or standard ligated running suturing (n = 3). The operative times were compared. One week after surgery, the integrity of each anastomosis was evaluated radiographically and histopathologically. Results. The in vitro analysis revealed no statistically different (P = 0.22) failure forces between the approximations performed with SAS (13.2 + 2.6 N) and standard suture (14.1 + 3.1 N). The in vitro analysis revealed no difference in operative times for the pyeloplasties (P = 0.72) or BNA (P = 0.31). None of the 1-week postoperative radiographic studies revealed extravasation. The histopathologic analysis revealed more fibrotic reaction associated with the SAS BNA procedures (P < 0.01). Conclusions. Self-anchoring suture secures tissue approximations at loads equivalent to tissue approximations with standard tied suture. Self-anchoring suture obviates the need for knot tying and provides a watertight anastomosis. With laparoscopic knot tying experience, anastomotic time with SAS and standard suture do not differ. Self-anchoring suture might induce more fibrosis. Long-term follow-up evaluation will be required before clinical application. UROLOGY 67: 1133–1137, 2006. © 2006 Elsevier Inc.