Closing Surgical Wounds with Barbed Sutures

    In the first few decades of total joint replacement, orthopaedic surgeons focused on implants and techniques – better implants, more accurate cuts, and improved techniques.

    Today, surgeons are more focused on improving patient satisfaction – better pain control, smaller incisions, tissue-sparing techniques, infection control, and better cosmesis.

    At ICJR’s annual Modern Trends in Joint Replacement meeting in Palm Springs, California, Jonathan P. Garino, MD, discussed one innovation that is not only improving cosmesis for patients, but is also speeding up the process of wound closure for the surgeon: the use of barbed sutures.

    Dr. Garino, who is Clinical Professor of Orthopaedic Surgery at Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, noted that historically, orthopaedic surgeons closed their surgical wounds with either interrupted sutures or staples. Both have drawbacks:

    • Tying knot after knot with interrupted sutures is a time-consuming process.
    • If non-absorbable sutures are used, any retained sutures can put the patient at risk for infection.
    • Staples are faster in the operating room, but removing them is also time-consuming.
    • Wound issues often occur with the use of staples.

    About 5 years ago, Dr. Garino began using barbed suture closures instead of staples. Barbed sutures are similar to polydioxanon (PDS) monofilaments, but modified with barbs. It keeps about 80% of its strength at 6 weeks, and it disappears at 6 months.

    Dr. Garino said that using barbed sutures has definite advantages:

    • The closure is fast and tissue friendly – no more tying knots, which can strangulate tissue and cause necrosis.
    • The barbed suture has a needle on each end, allowing two people to work on closing the wound at the same time.
    • Generally only one strand of barbed suture is needed to close a wound, with enough suture material to over-sew the wound and reinforce deep closure – over-sewing “locks” the suture in place.

    Dr. Garino uses barbed sutures for the first two layers of wound closure, and then switches to Vicryl sutures for the subcuticular layer (he had some issues with the barbs “spitting” when used in the subcuticular layer). He finishes closure with Dermabond and an antibacterial dressing.

    Click the link below to watch Dr. Garino’s presentation.