"Evaluating wound closure innovations in spinal surgery: impacts on efficiency and patient outcomes".

This study evaluates contemporary wound closure techniques in spinal surgery, focusing on the efficacy of barbed sutures, skin staples, and negative-pressure wound therapy (NPWT), compared to traditional methods. Barbed sutures, like STRATAFIX™ Symmetric, and skin staples demonstrate significant advantages, including reduced wound closure time, lower infection rates, and improved surgical outcomes, particularly in multilevel or revisional procedures. In contrast, plastic surgery closures do not show a substantial reduction in postoperative complications despite being used in more complex cases. NPWT is highlighted as an effective adjunct therapy for managing surgical site infections and reducing the need for hardware removal. The findings suggest that while modern techniques offer clear benefits, traditional methods remain valuable in specific contexts. The review advocates for further research through large-scale, long-term studies and emphasizes the need for personalized wound closure strategies based on individual patient risk factors.

Advanced Multi-Layer Watertight Closure versus Conventional Closure in Total Hip and Knee Replacement Surgery.

Background: In total joint replacement procedures, surgeons have increasingly adopted advanced multi-layer, watertight closure. The objective of the study was to compare the clinical and economic outcomes for advanced multi-layer, watertight closure patients to those with conventional closure with sutures and skin staples. Methods: Patients aged ≥18 years were included in the study if they underwent total joint arthroplasty of the hip or knee as an elective, primary, inpatient procedure between January 2014 and March 2019. Cohorts having advanced multi-layer, watertight closure or conventional closure were compared using multivariable regression analysis of surgical site infections, length of stay, operating room time, procedure time, discharge status, readmissions, reoperations, and hospital emergency department visits. Results: A total of 1828 patients received at least one total hip or knee replacement, of which 434 (23.7%) had advanced multi-layer, watertight closure and 1394 (76.3%) had conventional closure. Unadjusted time to readmission, when occurring, was considerably longer following advanced multi-layer, watertight closure (89.9 vs 51.1 days, p < 0.0001), and a lower proportion of the advanced multi-layer, watertight closure cohort required reoperation within 90 days (0.0% vs 2.6%, p < 0.0001). Adjusted mean hospital length of stay was approximately half of a day shorter for advanced multi-layer, watertight closure patients (1.10 vs 1.65 days; p < 0.001), and they were also more likely to be discharged to home (Odds Ratio: 4.61; p = 0.002). Conclusion: Among patients undergoing total hip and knee arthroplasty in a highly optimized real-world clinical practice, advanced multi-layer, watertight closure was associated with significantly shorter inpatient length of stay and increased likelihood of being discharged to home compared with conventional closure. These findings suggest that advanced multi-layer, watertight closure is a valuable component of an optimal workflow for total hip or knee replacement, and may be especially valuable for high-risk patients.

Safety and Efficacy of Barbed Sutures Compared to Non-barbed Sutures in Bariatric Surgery: An Updated Systematic Review and Meta-analysis.

PURPOSE: Mastering intracorporeal suturing is challenging in the evolution from conventional to laparoscopic bariatric surgery. Among various techniques competing for superiority in overcoming this hurdle, we focus on exploring the potential of barbed sutures through a meta-analysis that compares outcomes to those of conventional non-barbed sutures in bariatric surgery. MATERIALS AND METHODS: We conducted a comprehensive search on PubMed, Scopus, and Embase to identify studies comparing barbed sutures with non-barbed sutures in bariatric surgeries, focusing on outcomes such as operative time, suturing time, postoperative complications, and hospital stay. The statistical analysis was carried out using RStudio version 4.3.2. Heterogeneity was assessed using the Cochrane Q test and I2 statistics. RESULTS: Incorporating data from 11 studies involving a total of 27,442 patients, including 3,516 in the barbed suture group across various bariatric surgeries, our analysis demonstrates a significant reduction in suturing time (mean difference -4.87; 95% CI -8.43 to -1.30; p < 0.01; I2 = 99%) associated with the use of barbed sutures. Specifically, in Roux-en-Y gastric bypass, we observed a significant decrease in operative time (mean difference -12.11; 95% CI -19.27 to -4.95; p < 0.01; I2 = 93%). Subgroup analyses and leave-one-out analyses consistently supported these findings. Furthermore, we found that the mean body mass index did not significantly predict the mean difference in operative time outcome. No significant differences emerged in hospital stay or postoperative complications, including leak, bleeding, stenosis, and bowel obstruction (p > 0.05). CONCLUSION: Our study findings address barbed sutures as a potential alternative for laparoscopic intracorporeal suturing in bariatric surgery.

Clinical outcomes of triclosan-coated barbed suture in open hernia repair: a retrospective cohort study.

PURPOSE: We assessed clinical outcomes of patients undergoing open hernia repair using STRATAFIX™ Symmetric, a barbed triclosan-coated suture (TCS; Ethicon), versus conventional polydioxanone suture (PDS) for abdominal wall closure. METHODS: This single-center retrospective cohort study identified patients undergoing hernia repair. The site used PDS from 2013 to 2016 and switched exclusively to barbed TCS in 2017. Outcomes were assessed at 30, 60, and 90 days. Multivariate regression analyses and Cox proportional hazards models were used. RESULTS: Of 821 hernia repairs, 446 used barbed TCS and 375 used conventional PDS. Surgical site infections (SSIs) were significantly less frequent with barbed TCS (60 days, 5.9% vs. 11.4%; P = 0.0083; 90 days, 5.9% vs. 11.7%; P = 0.006) and this remained consistent after multivariate adjustment (60 days, OR [95% CI]: 0.5 [0.3-0.9]; 90 days, 0.5 [0.3-0.9]). Among patients with SSI, deep SSIs were less frequent with barbed TCS (60 days, 9.1% vs. 35.7%; P = 0.022; 90 days, 9.1% vs. 34.9%; P = 0.0252). Barbed TCS significantly reduced the risk of perioperative complications (HR [95% CI]: 0.5[0.3-0.8]; P = 0.0058). Hospital length of stay was 2.5 days shorter with barbed TCS (mean [95% CI]: 5.7[4.9-6.6] vs. 8.2[7.3-9.1] days; P < 0.0001). No differences in reoperation rate over time were observed by type of suture (HR[95% CI]:1.3 [0.5-3.4]; P = 0.4793). CONCLUSIONS: This study showed that patients who underwent open hernia repair appeared to recover equally well regardless of the suture type. In addition, the use of barbed TCS was associated with significantly reduced risk of perioperative complications and hospital length of stay.

The efficacy of STRATAFIX® spiral PDS for vesicourethral anastomosis during robot-assisted laparoscopic radical prostatectomy: a single-center retrospective study.

PURPOSE: To investigate the efficacy of continuous suturing using barbed suture for vesicourethral anastomosis (VUA) during robot-assisted laparoscopic radical prostatectomy (RARP). MATERIALS AND METHODS: Seventy-three consecutive patients who underwent RARP by a single surgeon between 2020 and 2022 were retrospectively divided based on the suture type used for VUA: group A, 3-0 poliglecaprone-25 RB-1 needle (Monocryl®), n = 46; group B, 3-0 spiral polydioxanone (PDS) barbed suture with RB-1 needle (STRATAFIX®), n = 27. RESULTS: There was no significant difference in patient background characteristics between groups, including age, body mass index, and clinical stage. However, group B had a significantly shorter operative time, console time, hospital stay, and duration of urethral catheterization. The VUA time was significantly shorter in group B than in group A (17.9 min vs. 10.6 min; p < 0.001). Only 1 case of minor leakage was observed during the intraoperative leak test (1 patient in group A). There was no significant difference in the number of pads used at 1, 3, 6 months and 1 year postoperatively. There were no urethral strictures, and there was no significant difference in pathologic results or postoperative prostate-specific antigen progression between groups. CONCLUSIONS: Our study suggests that the use of barbed suture during VUA for RARP is associated with reduced VUA time.

Cadaveric Evaluation of Load to Failure in Canine Gingiva Apposed With Varied Suture Patterns Using Poliglecaprone 25.

The purpose of the study was to determine the effect of suture pattern and repair length on the load to failure in an ex vivo canine gingival model. Healthy mandibular gingiva and mucosa were harvested from fresh cadavers euthanized for purposes unrelated to the study. Samples were randomly assigned by length and pattern. Lingual and buccal free gingival margins were apposed using a simple interrupted (SI), cruciate (XT), simple continuous (SC), or unidirectional knotless continuous barbed suture (SF) closure technique with USP 4-0 poliglecaprone 25i, ii applied over 2 lengths (3 cm and 6 cm). A custom template was used to ensure uniform suture bite application. Surgical time was recorded. Using a soft tissue mechanical testing frame, samples were tensioned to failure. Testing was video recorded and reviewed in conjunction with the tension trace data for tension at initial failure (Tfail) and maximum tension sustained (Tmax). Two factor ANOVA by length and pattern was performed followed by individual one way T-tests. Statistically significant findings were XT-SC-SF patterns were quicker to perform than SI. SF was more likely to fail by suture breakage than tissue tearing, and SF withstood less tension at the 3 cm length than SI-XT-SC. No significant difference was detected in Tmax or Tfail between SI and SC or XT. The study demonstrates that SC and XT are comparable to SI in tension resistance and faster to perform suggesting that SC and XT could replace SI for extraction site closure although further in vivo testing is required.

Barbed vs conventional sutures in bariatric surgery: a propensity score analysis from a high-volume center.

The use of barbed sutures for constructing an anastomosis is favoured by a few bariatric surgeons as compared to conventional sutures. The aim of this study is to assess safety and efficacy of barbed sutures to close the gastric pouch-jejunal anastomosis (GPJA) in laparoscopic gastric bypass (Roux-en-Y gastric bypass-RYGB, and One-Anastomosis gastric bypass-OAGB) using propensity score-matching (PSM) analysis. A retrospective analysis of patients who underwent primary laparoscopic gastric bypasses between January 2012 and December 2017 was performed. Patients were divided into two different groups (RYGB-G and OAGB-G). PSM analysis was performed to minimize patient selection bias between the two types of sutures (barbed-BS and conventional-CS) in each group. A total of 808 patients were reviewed. After PSM, 488 (244 BS vs 244 CS) patients in RYGB-G and 48 in OAGB-G (24 BS vs 24 CS) patients were compared. Median operative time was significantly shorter (p < 0.001) for BS in RYGB-G. In OAGB-G, BS were associated with a shorter operative time, although no significant difference was observed (p = 0.183). Post-operative hospital stay was significantly shorter for BS in both the groups (p < 0.001). Post-operative 30th-day complications were comparable: no leakage or bleeding of GPJA was observed in BS groups. At median follow-up of 28.78 months, no late complications were observed. Barbed sutures appear to be effective to close GPJA during gastric bypass and as safe as conventional suture. Further studies are necessary to draw definitive conclusions.

New Continuous Barbed Suture Device with Stratafix for the Vaginal Stump in Laparoscopic Hysterectomy.

AIMS: Closure of the vaginal stump in total laparoscopic hysterectomy (TLH) performed by interrupted suture is time-consuming and requires sufficient experience. Stratafix (SF) is a new type of antibacterial monofilament absorbable suture which has multiple small anchors on the string surface. There is no information concerning the efficacy of SF for vaginal stump suture in minimally invasive hysterectomy. MATERIALS AND METHODS: We retrospectively evaluated the operative complications and SF (n = 20) advantages for the vaginal stump in TLH and compared with a cohort of patients with conventional sutures (n = 20). The differences in performance based on operators' skill levels were also considered. RESULTS: The time taken to close vaginal stump in the SF suture group was significantly lower than the conventional group (median times: 13.1 vs. 18.0 min, respectively; P = 0.038). Closure by a less experienced operator using SF suture was reduced by 7.2 min. The junior operator median vaginal suture time was only 2.6 min longer than the senior operator median time in SF suture group (P = 0.218), whereas an 8.4 min difference was recorded in the conventional suture group (P = 0.043). Total operation times did not significantly correlate with vaginal suturing techniques (median times: 126 vs. 145 min, respectively; P = 0.718). Complications regarding the vaginal stump closure techniques including organ injury, bleeding, wound separation, and pain did not occur in both groups. CONCLUSIONS: SF suturing facilitates the vaginal stump closure in TLH without increasing the complications. SF allowed vaginal stump approximation and reduced the operative burden, especially in less experienced operators.

Laparoscopic Linear Stapled Running Enterotomy Closure in Roux-en-Y Gastric Bypass Using Absorbable Unidirectional Barbed Suture (Stratafix® 2/0).

BACKGROUND: Laparoscopic running enterotomy closure for linear stapled Roux-en-Y gastric bypass (RYGB) may be enhanced by using unidirectional barbed sutures (Stratafix™ 2/0, Ethicon) as it eliminates the need for knot tying and assistance from a third hand. OBJECTIVES: The objective of this paper is to present our technique using unidirectional barbed sutures (Stratafix™ 2/0, Ethicon). METHODS: After stapling the gastrojejunostomy, we start the closure of the residual enterotomy unidirectional from left to right (single, full-thickness layer) which is cut without a knot. For the jejunojejunostomy, the residual enterotomy is closed perpendicular from top to bottom in order to avoid iatrogenic stricture formation (single, full-thickness layer). No backstitches are performed. CONCLUSIONS: We feel strongly that this technique might enhance running enterotomy closure for linear stapled RYGB.

A High-Strength, Absorbable, Antibacterial Knotless Tissue Control Device for Fascial Closure.

PURPOSE OF REVIEW: This review provides an overview of the STRATAFIX™ SYMMETRIC PDS™ Plus Knotless Tissue Control Device design and performance characteristics and highlights the device's relevance for use in gynecological procedures. Various device testing was conducted on tensile strength, fixation tab mass comparison to conventional suture knot tower, initiation stitch strength, and wound holding strength to highlight the STRATAFIX™ SYMMETRIC PDS™ Plus Device's key product attributes that may benefit general and minimally invasive gynecological procedures. RECENT FINDINGS: This article serves as a technological assessment of the latest barbed suture offered by Ethicon-STRATAFIX™ SYMMETRIC PDS™ Plus Knotless Tissue Control Device. This device is indicated for soft tissue approximation and can be used to close high tension areas, such as fascia. SUMMARY: Barbed sutures were successfully introduced to gynecologic surgery many years ago, and their safety and effectiveness have been demonstrated in a variety of gynecological surgical procedures. By eliminating the need to tie surgical knots, barbed suture provides a few key advantages over conventional suture, such as reducing operating room time, eliminating potential knot-related complications, and reducing suturing difficulty in open and minimally invasive gynecological procedures. Additionally, there are tensile strength and wound holding strength advantages (vs. conventional PDS™ Plus Suture) described in the product testing highlighted in this review that may be relevant for gynecological procedures.

The Hand-sewn Anastomosis with an Absorbable Bidirectional Monofilament Barbed Suture Stratafix® During Laparoscopic One Anastomosis Loop Gastric Bypass. Retrospective Study in 50 Patients.

BACKGROUND: Laparoscopic One Anastomosis Gastric Bypass (LOAGB) is one of the main bariatric procedures that require a safe and reproducible gastrojejunal anastomosis. Barbed suture has been widely used for surgery in recent years; however, few studies have reported their use for gastro-intestinal anastomosis. We proposed their use for totally hand-sewn anastomosis during LOAGB. OBJECTIVES: The objective of this study is to evaluate the risk of leaks and stenosis after a hand-sewn anastomosis using an absorbable bidirectional monofilament barbed suture: Stratafix®. SETTING: The study was done in a private practice setting. METHODS: Between April and November 2014, 50 consecutive patients undergoing a hand-sewn antecolic, antegastric gastrojejunal anastomosis (GJA) using Stratafix®. Pre, intra, and postoperative parameters were assessed for these patients. RESULTS: No fistulas or anastomotic stenosis had occurred up to 6 months after surgery. All procedures were completed laparoscopically, and no intraoperative complications occurred. The mean length of hospital stay was 3 days. CONCLUSION: The use of an absorbable bidirectional monofilament barbed suture for the GJA was safe. Further prospective studies with a higher number of patients are needed to address the safety and efficacy of the absorbable bidirectional monofilament barbed suture in bariatric surgery.

Clinical Applications of Barbed Suture in Aesthetic Breast Surgery.

The breadth of literature regarding barbed suture applications in plastic surgical procedures and of importance to this article, barbed suture applications in breast surgery, is growing dramatically as surgical practitioners are becoming more familiar with the advantages of this new suture technology. Barbed suture devices were first implemented by plastic surgeons for the use in various minimally invasive techniques for facial rejuvenation, but have now surpassed these applications and are now much more commonly used in Breast and Body closures.