|2009 Annual Meeting Abstracts
Barbed Suture Impact on Wound Healing in Body Contouring Surgery
Michele A. Shermak, M.D., Jessie Mallalieu, P.A.-C, David Chang, Ph.D., MPH, MBA.
Johns Hopkins Hospital, Baltimore, MD, USA.
PURPOSE: Body contouring procedures are growing in prevalence due to the growth of the massive weight loss (MWL) population. The artistry of body contouring procedures is being refined, and the next step in improving surgery is streamlining the most labor- and time-intensive aspect of these cases: wound closure. Absorbable barbed suture is one potential solution to decreasing time required for wound closure as well as alleviating side-effects associated with subcutaneous knots. This holds true for both cosmetic and reconstructive procedures, including closure of abdominal donor sites for microsurgical procedures. As our experience with barbed suture grew, we had concerns that the benefit of efficiency was counterbalanced by wound problems, with visible suture within wounds months after surgery and inflammatory spread across the length of the body region closed. We present here our experience with absorbable barbed suture in wound closure for different body regions.
METHODS: Review of operative and clinic notes of 496 patients who had body contouring procedures from March 1998 to September 2008 was performed. Variables studied included age, gender, BMI, medical history and operative data. Use of barbed suture was noted, and complications were tabulated for all cases. Multi-level analysis (with wound and patient treated as separate levels) was performed using Generalized Estimate Equation (GEE) method.
RESULTS: The record of 910 operations in 496 patients were analyzed. Procedures were performed on multiple body regions in combination or alone, including abdomen (493), chest (124), back (104), thigh (104), and arm (88). Barbed suture was used in 114 cases starting in July 2007: abdomen (98), bilateral thigh (8), bilateral arm (7), and bilateral chest (1). There were 115 postoperative wound healing problems for the entire study group. Barbed suture was present in wounds in 17 cases, presenting up to 3 months after surgery. On unadjusted analysis, the wound complication rate with barbed suture was 17.5% (20/114), compared to 12.0% when barbed suture was not used (95/795), although the difference did not achieve statistical significance (p=0.093). On multi-level multivariable analysis, we found only age (OR 1.04) and BMI at contour (OR 1.05) to be the most significant factors impairing wound healing (p<0.01); barbed suture was not associated with wound complication on multivariable analysis. However, in subset analysis, we found that barbed suture use was associated with significantly higher wound complication rate in the arm (OR 8.4, p=0.046) but not in the abdomen or thigh.
CONCLUSION: Barbed suture, while presenting a benefit in efficiency of wound closure and obliteration of granulomas seen with subcutaneous knots, may present problems with wound healing particularly in the arm, due to the increased surface area with the barbs, continuous suturing technique, and prolonged absorption period. We look forward to seeing evolution in barbed suture technology and evaluating other technologies designed to improve the speed and outcome of wound closure, particularly for lengthy body contouring procedures.