• 1. Trimbos JB. Security of various knots commonly used in surgical practice. Obstet Gynecol 1984; 64: 274280.

  • 2. Shaw AD, Duthie GS. A simple assessment of surgical sutures and knots. J R Coll Surg Edinb 1995; 40: 388391.

  • 3. Marturello DM, McFadden MS, Bennett A, et al. Knot security and tensile strength of suture materials. Vet Surg 2014; 43: 7379.

  • 4. Richey ML, Roe SC. Assessment of knot security in continuous intradermal wound closures. J Surg Res 2005; 123: 284288.

  • 5. Paul MD. Bidirectional barbed sutures for wound closure: evolution and applications. J Am Col Certif Wound Spec 2009; 1: 5157.

  • 6. Ruff G. Techniques and uses for absorbable barbed sutures. Aesthet Surg J 2006; 26: 620628.

  • 7. Hammond DC. Barbed sutures in plastic surgery: a personal experience. Aesthet Surg J 2013; 33: 32S39S.

  • 8. Ruff GL. The history of barbed sutures. Aesthet Surg J 2013; 33: 12S16S.

  • 9. Matarasso A. Introduction to the barbed sutures supplement: the expanding applications of barbed sutures. Aesthet Surg J 2013; 33 (suppl 3):7S11S.

    • Search Google Scholar
    • Export Citation
  • 10. Murtha AP, Kaplan AL, Paglia MJ, et al. Evaluation of a novel technique for wound closure using a barbed suture. Plast Reconstr Surg 2006; 117: 17691780.

    • Search Google Scholar
    • Export Citation
  • 11. Villa MT, White LE, Alam M, et al. Barbed sutures: a review of the literature. Plast Reconstr Surg 2008; 121: 102e108e.

  • 12. Hurwitz DJ, Reuben B. Quill barbed sutures in body contouring surgery: a 6-year comparison with running absorbable braided sutures. Aesthet Surg J 2013; 33: 44S56S.

    • Search Google Scholar
    • Export Citation
  • 13. Nett M, Avelar R, Sheehan M, et al. Water-tight knee arthrotomy closure: comparison of a novel single bidirectional barbed self-retaining running suture versus conventional interrupted sutures. J Knee Surg 2011; 24: 5559.

    • Search Google Scholar
    • Export Citation
  • 14. Moya AP. Barbed sutures in body surgery. Aesthet Surg J 2013; 33: 57S71S.

  • 15. Pham KN, Sack BS, O'Connor RC, et al. V-Loc urethrointestinal anastomosis during robotic cystectomy with orthotopic urinary diversion. Can Urol Assoc J 2013; 7: E663E666.

    • Search Google Scholar
    • Export Citation
  • 16. Sato M, Matsumura H, Gondo M, et al. Flexor tendon repair with barbed suture: an experimental study. Eur J Orthop Surg Traumatol 2014; 24: 14211424.

    • Search Google Scholar
    • Export Citation
  • 17. Lin TE, Lakhiani C, Lee MR, et al. Biomechanical analysis of knotless flexor tendon repair using large-diameter unidirection barbed suture. Hand (N Y) 2013; 8: 315319.

    • Search Google Scholar
    • Export Citation
  • 18. Iavazzo C, Mamais I, Gkegkes ID. The role of knotless barbed suture in gynecologic surgery: systematic review and meta-analysis. Surg Innov 2015; 22: 528539.

    • Search Google Scholar
    • Export Citation
  • 19. Greenberg JA, Goldman RH. Barbed suture: a review of the technology and clinical uses in obstetrics and gynecology. Rev Obstet Gynecol 2013; 6: 107115.

    • Search Google Scholar
    • Export Citation
  • 20. Spah CE, Elkins AD, Wehrenberg A, et al. Evaluation of two novel self-anchoring barbed sutures in a prophylactic laparoscopic gastropexy compared with intracorporeal tied knots. Vet Surg 2013; 42: 932942.

    • Search Google Scholar
    • Export Citation
  • 21. Miller J, Zaruby J, Kaminskaya K. Evaluation of a barbed suture device versus conventional suture in a canine enterotomy model. J Invest Surg 2012; 25: 107111.

    • Search Google Scholar
    • Export Citation
  • 22. Ehrhart NP, Kaminskaya K, Miller JA, et al. In vivo assessment of absorbable knotless barbed suture for single layer gastrotomy and enterotomy closure. Vet Surg 2013; 42: 210216.

    • Search Google Scholar
    • Export Citation
  • 23. Nelson BB, Hassel DM. In vitro comparison of V-Loc versus Biosyn in a one-layer end-to-end anastomosis of equine jejunum. Vet Surg 2014; 43: 8084.

    • Search Google Scholar
    • Export Citation
  • 24. Templeton MM, Krebs AI, Kraus KH, et al. Ex vivo biomechanical comparison of V-Loc 180 absorbable wound closure device and standard polyglyconate suture for diaphragmatic herniorrhaphy in a canine model. Vet Surg 2015; 44: 6569.

    • Search Google Scholar
    • Export Citation
  • 25. Alvarez WA, Scharf VF, Case JB. Comparison of laparoscopic and open cystopexy in a cadaveric canine model. Vet Surg 2015; 44: 4449.

    • Search Google Scholar
    • Export Citation
  • 26. Arbaugh M, Case JB, Monnet E. Biomechanical comparison of glycomer 631 and glycomer 631 knotless for use in canine incisional gastropexy. Vet Surg 2013; 42: 205209.

    • Search Google Scholar
    • Export Citation
  • 27. Ragle CA, Yiannikouris S, Tibary AA, et al. Use of a barbed suture for laparoscopic closure of the internal inguinal rings in a horse. J Am Vet Med Assoc 2013; 242: 249253.

    • Search Google Scholar
    • Export Citation
  • 28. Imhoff DJ, Cohen A, Monnet E. Biomechanical analysis of laparoscopic incisional gastropexy with intracorporeal suturing using knotless polyglyconate. Vet Surg 2015; 44: 3943.

    • Search Google Scholar
    • Export Citation
  • 29. Greenberg JA, Walden S, Hammer CM, et al. A comparison of barbed and smooth suture for ovine cesarean delivery. Int J Gynaecol Obstet 2011; 113: 215217.

    • Search Google Scholar
    • Export Citation
  • 30. Kadimcherla P, Lovy AJ, Sambaziotis C, et al. Knee arthrotomy closure with barbed suture in flexion versus extension: a porcine study. J Arthroplasty 2014; 29: 22112213.

    • Search Google Scholar
    • Export Citation
  • 31. Jordan MC, Hölscher-Doht S, Jakubietz MG, et al. Suture material for flexor tendon repair: 3–0 V-Loc versus 3–0 Stratafix in a biomechanical comparison ex vivo. J Orthop Surg Res 2014; 9: 72.

    • Search Google Scholar
    • Export Citation
  • 32. Zaruby J, Gingras K, Taylor J, et al. An in vivo comparison of barbed suture devices and conventional monofilament sutures for cosmetic skin closure: biomechanical wound strength and histology. Aesthet Surg J 2011; 31: 232240.

    • Search Google Scholar
    • Export Citation
  • 33. Fong ED, Bartlett AS, Malak S, et al. Tensile strength of surgical knots in abdominal wound closure. ANZ J Surg 2008; 78: 164166.

    • Search Google Scholar
    • Export Citation
  • 34. Paul MD. Using barbed sutures in open/subperiosteal mid-face lifting. Aesthet Surg J 2006; 26: 725732.

  • 35. Zhao C, Hsu C, Moriya T, et al. Beyond the square knot: a novel knotting technique for surgical use. J Bone Joint Surg Am 2013; 95: 10201027.

    • Search Google Scholar
    • Export Citation
  • 36. Helling ER, Okpaku A, Wang PTH, et al. Complications of facial suspension sutures. Aesthet Surg J 2007; 27: 155161.

  • 37. Sulamanidze M, Sulamanidze G. APTOS suture lifting methods: 10 years of experience. Clin Plast Surg 2009; 36: 281306.

  • 38. Gingras K, Zaruby J, Maul D. Comparison of V–Loc 180 wound closure device and Quill PDO knotless tissue-closure device for intradermal closure in a porcine in vivo model: evaluation of biomechanical wound strength. J Biomed Mater Res B Appl Biomater 2012; 100B:10531058.

    • Search Google Scholar
    • Export Citation
  • 39. van Rijssel EJC, Brand R, Admiraal C, et al. Tissue reaction and surgical knots: the effect of suture size, knot configuration, and knot volume. Obstet Gynecol 1989; 74: 6468.

    • Search Google Scholar
    • Export Citation
  • 40. Ingle NP, King MW. Optimizing the tissue anchoring performance of barbed sutures in skin and tendon tissues. J Biomech 2010; 43: 302309.

    • Search Google Scholar
    • Export Citation
  • 41. Smeak DD. Buried continuous intradermal suture closure. Compend Contin Educ Pract Vet 1992; 14: 907919.

  • 42. Covidien. V-Loc 90 and V-Loc 180 absorbable wound closure devices step-by-step guide to dermal wound closure applications. Available at: www.medtronic.com/content/dam/covidien/library/us/en/product/wound-closure/v-loc-wound-closure-devices-guide-to-wound-closure-applications.pdf. Accessed Oct 11 26, 2016.

    • Search Google Scholar
    • Export Citation
  • 43. Regier PJ, Smeak DD, Coleman K, et al. Comparison of volume, security, and biomechanical strength of square and Aberdeen termination knots tied with 4-0 polyglyconate and used for termination of intradermal closures in canine cadavers. J Am Vet Med Assoc 2015; 247: 260266.

    • Search Google Scholar
    • Export Citation

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Security and biomechanical strength of three end-pass configurations for the terminal end of intradermal closures performed with unidirectional barbed suture material in dogs

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  • 1 Department of Surgery, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523.
  • | 2 Department of Surgery, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523.
  • | 3 Department of Surgery, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523.

Abstract

OBJECTIVE To compare security of continuous intradermal suture lines closed by use of barbed suture with 3 end-pass configurations or without an end-pass configuration.

SAMPLE 40 full-thickness, 4-cm-long, parasagittal wounds in canine cadavers.

PROCEDURES Each continuous intradermal closure was terminated with 1 of 3 end-pass techniques or without an end-pass configuration (control group). A servohydraulic machine applied tensile load perpendicular to the long axis of the suture line. A load-displacement curve was generated for each sample; maximum load, displacement, stiffness, mode of construct failure, and load at first suture slippage at termination (ie, terminal end of the suture line) were recorded.

RESULTS Values for maximum load, displacement, and stiffness did not differ significantly among the 3 end-pass techniques, and load at first suture slippage at termination was not significantly different among the 4 groups. A 1-pass technique slipped in 5 of 9 samples; 3 of these 5 slips caused failure of wound closure. A 2-pass technique slipped in 3 of 9 samples, none of which caused failure of wound closure. Another 2-pass technique slipped in 4 of 10 samples; 2 of these 4 slips caused failure of wound closure. The control group had slippage in 10 of 10 samples; 9 of 10 slips caused failure of wound closure

CONCLUSIONS AND CLINICAL RELEVANCE An end-pass anchor was necessary to terminate a continuous intradermal suture line, and all 3 end-pass anchor techniques were suitable to prevent wound disruption. The 2-pass technique for which none of the suture slippages caused wound closure failure provided the most reliable configuration.

Contributor Notes

Address correspondence to Dr. Smeak (dan.smeak@colostate.edu).