Barbed Sutures and Wound Complications in Plastic Surgery
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GOALS: Technological advancements, along with their refinements, have substantially increased the amount of wound closure tools at the disposal of the surgeon. Barbed sutures, with a unique design containing circumferentially located barbs, could potentially decrease operation time and facilitate wound healing by eliminating the need to tie knots and providing even tension distribution across the wound. This study was conducted: 1) to determine whether using a barbed suture device in wound closure showed an increase, decrease, or no difference in wound complication development when compared to conventional non-barbed sutures 2) to analyze complication rates observed within the barbed suture population (Angiotech QuillTM SRS vs. Covidien V-LocTM) to test for any significant difference between the two competing brands. METHODS: An IRB-approved retrospective chart review identified 1709 patients undergoing plastic surgery procedures from January of 2008 to January of 2012. In our database, a barbed suture device was used in a total of 372 cases and the type used (Angiotech QuillTM SRS vs. Covidien V-LocTM) was recorded in each case. The QuillTM SRS device was used in 106 cases, while the V-LocTM device was used in 266 total cases. Outcomes following these procedures were compared to outcomes of the same CPT codes where a barbed suture device was not used. Wound complications were defined as one or more of the following: infection, dehiscence, erythema, necrosis, seroma, hematoma, and delayed wound healing. RESULTS: Using multivariate analysis, barbed sutures appear to be associated with an increased incidence of wound complications (p=0.012), to include dehiscence (p=0.007), erythema (p=0.008), and necrosis (p=0.03) when compared to their non-barbed counterparts. Further exploration within the barbed suture population found the Covidien brand associated with an increased incidence of wound complications (p=0.03), particularly dehiscence (p=0.009), while the Quill brand was found to have a higher association with erythema (p=0.001) along the incision site. CONCLUSIONS: Barbed sutures appear to be associated with an increased incidence of wound complications in plastic and reconstructive surgery procedures, with the Covidien V-LocTM device showing a higher incidence of wound complication development compared to Angiotech QuillTM SRS device.