Ex vivo comparison of intradermal closures with conventional monofilament suture vs unidirectional barbed suture in...

To evaluate the mechanical properties, strength, and quality of seal provided by continuous intradermal suture lines closed with barbed suture vs monofilament suture.

Experimental study.

Forty-eight full-thickness wounds in canine cadavers.

Four-centimeter-long parasagittal cutaneous wounds were created in canine cadavers. Each intradermal closure was closed with smooth monofilament suture and terminated with a 2 + 1 Aberdeen knot (n = 24) or a unidirectional barbed suture terminated with a single end pass (n = 24). Wounds (n = 12/group) were harvested, and a servohydraulic machine applied tensile load perpendicular to the long axis of the suture line. A load-displacement curve was generated; maximum load, displacement, stiffness, and mode of construct failure were recorded. Harvested wounds were placed in a watertight construct to measure the volume of fluid leaking over 3 minutes at 1.0 ± 0.1 psi.

Stiffness did not differ between constructs (P > .05). Incisions closed with monofilament sutures sustained higher maximum load (311.21 N ± 87.40) and displacement at failure (21.19 mm ± 4.51) compared with those with barbed sutures (116.38 N ± 42.82 and 15.03 mm ± 2.32, respectively, P < .05). Closures with monofilament sutures leaked more (4.38 mL ± 7.90) compared with those with barbed sutures (0.15 mL ± 0.43, P < .05).

Monofilament sutures resulted in stronger constructs, whereas barbed suture constructs provided a better watertight seal.

While unidirectional barbed sutures may improve watertight skin closure, surgeons should consider using conventional monofilament sutures when mechanical strength of the closure is of primary concern.