An In Vivo Comparison of Barbed Suture Devices and Conventional Monofilament Sutures for Cosmetic Skin Closure: Biomechanical Wound Strength and Histology

Background: Very little biomechanical or histological data exist in the peer-reviewed literature comparing absorbable monofilament sutures to commercially-available knotless, absorbable barbed suture devices for cosmetic closure of skin incisions. Objectives: The authors compare two commercially-available knotless, barbed suture devices against a conventional monofilament suture in a porcine model for biomechanical wound strength and histological quality of healing. Methods: This prospective randomized trial included 18 animals randomly assigned among three groups, with six in each. A total of 192 incisions were closed in a porcine in vivo model and assessed for biomechanical strength and histology at postoperative Days 0, 3, 10, and 21. Each animal received all three test devices in a randomized, three-way matched design. Immediately following euthanasia, the skin incisions were excised for ex vivo biomechanical testing. Results: In the ex vivo analysis, Biosyn proved significantly stronger than the V-Loc 90 device at Day 0 and Quill Monoderm at Day 3. At no time point was there any difference in biomechanical strength between the two barbed suture devices. Differences in barb geometry, barb number, and helicity between the two barbed suture devices resulted in failure modes that were significantly different. All three test articles resulted in mild tissue reaction scores on histology. The V-Loc 90 device consistently had the lowest tissue reaction scores at all time periods, with the difference between the V-Loc 90 device and Quill being significant at postoperative Day 10. Conclusions: Knotless, absorbable barbed suture devices are a safe and efficacious alternative for cosmetic skin closures and yield wound strength and tissue reaction scores that are comparable to those from closures performed with absorbable monofilament sutures and secured with knots.