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A Biomechanical Analysis of Barbed and Monofilament Suture in an Ex Vivo Skin Closure Model
Jacob G Mabey1, Alexander J Kammien2, Vikram G Mookerjee2
1Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale School of Medicine, PO Box 208041, New Haven, CT, USA.
Background:
Previous studies propose that barbed suture may have equivalent tensile strength and reduced suturing time compared to traditional suture materials, but this has not been tested in skin closure using tissue from living human donors.
Methods:
Twenty-four 5 cm by 2.5 cm samples were cut from twelve skin and subcutaneous tissue specimens that were obtained from abdominal wall procedures. Each sample was sectioned in half, and the skin was then closed using one of two techniques: knotless (running subcuticular with 3-0 barbed suture and skin glue) or layered closure (deep dermal sutures with 3-0 poliglecaprone, running subcuticular with 4-0 poliglecaprone and skin glue). Closure time and load to failure were recorded and compared using t-tests.
Results:
Mean closure time was significantly shorter for the knotless technique (2.2 ± 0.6 minutes) compared to layered closure (5.6 ± 0.5 minutes). Regarding tensile strength, mean load to failure for the knotless closure (46.5 ± 22.2 N) was significantly lower than the layered closure (79.3 ± 39.1 N). All techniques failed due to suture rupture.
Conclusions:
Knotless closures significantly reduced closure time but were weaker than layered closures. All closures exceeded estimates of clinical tension in wound closure, suggesting that knotless skin closures may be a viable option in some scenarios to reduce closure time and suture material.
Level Of Evidence Iii:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
