Nonabsorbable Barbed Sutures for Diastasis Recti. A Useful Device with Unexpected Risk: Two Case Reports

The introduction of nonabsorbable barbed sutures in plastic surgery has allowed the achievement of significant results in terms of efficacy and short- and long-term outcomes. However, a nonabsorbable material with no antibacterial coating could act as a substrate for subclinical bacterial colonization and thereby determine recurrent subacute and chronic infective-inflammatory processes. The authors report a clinical experience of subacute infectious complications after two cases of diastasis recti surgical correction. The authors present a two-case series in which a nonabsorbable barbed suture was used for the repair of diastasis recti. The postoperative course was complicated by surgical site infection. The origin of the infectious process was clearly localized in the fascial suture used for diastasis correction. The suture was colonized by bacteria resulting in the formation of multiple granulomas of the abdominal wall a few months postoperatively. In both the reported cases, the patients partially responded to the antibiotic targeted therapy and reoperation was required. The microbiological analyses confirmed the colonization of sutures by Staphylococcus aureus . Barbed nonabsorbable sutures should be avoided for diastasis recti surgical correction to minimize the risk of infectious suture-related complications. The paper's main novel aspect is that this is the first clinical report describing infectious complications after surgical correction of diastasis recti with barbed polypropylene sutures. The risk of microbiological subclinical colonization of polypropylene suture untreated with antibacterial coating, therefore, should be taken into account.