Most studies conclude that there are no differences in scarring aesthetics when dermal layers are closed using barbed sutures compared to traditional suturing techniques, according to a systematic review in the journal Plastic and Reconstructive Surgery.
The review, which relied on PubMed, Embase and Cochrane databases, consisted of six prospective controlled trials encompassing 926 patients whose cosmetic scar results were evaluated an average of 8.1 months after wound closure.
The review authors from Langone Health in New York City note that barbed sutures have become increasingly popular for body contouring and breast surgeries, with the potential advantages of time and cost savings over customary suturing.
Five of the six studies found that the aesthetic results of wounds closed with barbed sutures to be equivalent to those closed with traditional sutures. The remaining study demonstrated significantly superior aesthetic results with barbed sutures.
Furthermore, barbed sutures achieved shorter operating time in four of the five studies that timed incision closure.
Complication rates were similar for both techniques in all evaluated studies.
Faster wound closure without knot tying is probably the most important factor driving widespread adoption of barbed sutures, according to the authors. “In fact, closure of skin and subcutaneous tissue is the most popular application of this technology,” they write.
Barbed sutures may also be safer than customary sutures because knotless closure may decrease the rate of wound-healing complications, which are mainly knot-related. Wound dehiscence may also lessen, largely due to strangulation in suture loops that cause necrosis of tissue at the wound margins.
Based on a cost-benefit analysis at Langone Health, barbed sutures is less expensive than customary sutures, despite the unit cost for barbed sutures being roughly $28 per suture versus about $5 for a traditional suture.
Part of the cost savings for barbed sutures is realized in the operating room by reducing procedure time – even by only a few seconds.
The authors point out, however, that barbed sutures require a steep learning curve and that clinician competency may greatly influence the end cosmetic result.