Barbed Sutures and Wound Complications in Plastic Surgery：An Analysis of Outcomes
Robert Cortez, M.S.II, Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, Jeffrey M. Kenkel, Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX and Jordan P. Farkas, Department of Plastic Surgery, UT Southwestern, Dallas, TX
Monday, April 15, 2013
Goals/Purpose :
Technological advancements, along with their refinements, have substantially increased the amount of wound closure tools at the disposal of the surgeon. Barbed sutures, with a unique design containing circumferentially located barbs, could potentially decrease operation time and facilitate wound healing by eliminating the need to tie knots and providing even tension distribution across the wound. This study was conducted :
1) to determine whether using a barbed suture device in wound closure showed an increase, decrease, or no difference in wound complication development when compared to conventional non-barbed sutures
2) to analyze complication rates observed within the barbed suture population (Angiotech QuillTM vs. Covidien V-LocTM) to test for any significant difference between the two competing brands.
Methods/Technique :
An IRB-approved retrospective chart review identified 1709 patients undergoing plastic surgery procedures from January of 2008 to January of 2012. The cohort was isolated using Current Procedural Technology (CPT) codes with the goal of assessing complications in a wide range of plastic and reconstructive surgery cases. In our database, a barbed suture device was used in a total of 372 cases. The usage of a barbed suture device for wound closure, along with the type used (Angiotech Quill™ vs. Covidien V-Loc™), was recorded in each case. The Angiotech Quill™ Device was used in 106 cases, while the Covidien V-Loc™ device was used in 266 total cases. Outcomes following these procedures were compared to outcomes of the same CPT codes where a barbed suture device was not used. Data collection was obtained through the electronic medical record and paper charts. In addition to barbed suture usage, over 100 variables were collected for each patient encounter, including comorbidities prior to surgery (tobacco use, diabetes, DVT risk, etc.), perioperative conditions (total time under anesthesia, minimum observed temperature, etc.), as well as the occurrence of wound complications recorded in follow up visits. Wound complications were defined as one or more of the following: infection, dehiscence, erythema, necrosis, seroma, hematoma, and delayed wound healing. Cases with insufficient follow up data (<30 days) were excluded from our database, with the majority followed for complications as long as the medical record would allow.
Results/Complications :
The two groups were well matched for procedure, age, BMI, diabetes, and tobacco use. The observed wound complications in the barbed cohort (n=372) were retrospectively analyzed with respect to the non-barbed cohort (n=1337) of the same CPT codes. Upon preliminary multivariate analysis, Barbed sutures appear to be associated with an Increased incidence of wound complications (28.76% vs. 22.81%, p=0.012), to include Dehiscence (8.33% vs. 4.71%, p=0.007), Erythema (9.14% vs. 5.39%, p=0.008), and Necrosis (3.76% vs. 1.80%, p=0.03) when compared to their non-barbed counterparts. Further exploration within the barbed suture population reveals several significant findings between the Angiotech Quill™ vs. Covidien V-Loc™ brands. The Covidien brand appears to be associated with an Increased incidence of wound complications (30.45% vs. 24.53%, p=0.03), particularly Dehiscence (9.40% vs. 5.66%, p=0.009), while the Quill brand was found to have a higher association with Erythema (7.14% vs. 14.15%, p=0.001) along the incision site.
Conclusion :
Barbed sutures appear to be associated with an increased incidence of wound complications in plastic and reconstructive surgery procedures, with the Covidien V-Loc™ device showing a higher incidence of wound complication development compared to the Angiotech Quill™ device. Despite preliminary findings, the investigators feel that the results and statistical analyses do not necessarily conclude that barbed suture devices are an inferior product, but that patient outcomes depend heavily on surgeon experience and employed technique. Future analysis involving single-surgeon cohorts along with logistic regression will attempt to address the inherent weaknesses in the performed study, while also closely looking to see if barbed sutures provide an opportunity to significantly decrease operation time among the same procedures.
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