It’s been said that the single most important invention that allowed for the development of the Western United States was barbed wire. It provided an effective and inexpensive way of keeping livestock where you wanted them. Imagine what it would have been like to have tried to do this with thousands of miles of picket fences! The wind would have knocked them down, it would have cost a fortune to put them up, and maintaining them would have been a nightmare! Furthermore, there were not enough trees in the Great Plains to furnish wood for all those fences!

A similar revolution has been occurring in plastic surgery with the invention of barbed sutures. “Yikes!” you might say. “Doesn’t that hurt?” The answer is, “No!” All sutures are  soft and a barbed suture is equally soft. It simply has little prongs that stick out from its sides that engage the body’s tissues and prevent the suture from loosening up. The stitch dissolves in a few weeks, anyway, once it’s done its job.

Imagine that you pull a rope tight and then come back the next day, only to find that it has loosened up. That’s what happens with a conventional non-barbed suture. The small prongs on the barbed suture keep the suture from loosening up and thus keep the skin edge closure nice and tight. You can achieve the same effect with conventional suture, but it requires more deep sutures and that takes more surgical time.

How do barbed sutures work? When a surgeon is closing up the skin, there are deep stitches placed that hold the skin edges loosely together and another superficial stitch just under the skin surface that runs from one end to the other of the wound that snugs the skin edges tightly together. If the surgeon is using a conventional “non-barbed” superficial suture, more of the deep stitches are needed to provide holding power. On the other hand, if a barbed suture is used, only 1/3rd the number of deep stitches is required because of the additional holding power of the barbed stitch. This allows for less operating time + less anesthesia time. Not only is there a cost savings, but less operating time means a lower complication rate.

Until recently, barbed sutures have been quite expensive. With competition comes better pricing, however, and the cost per suture has now decreased by 50%. The first generation of barbed sutures was more likely to cause skin irritation than “non-barbed” sutures, but changes in the composition of the suture have eliminated these issues. A recent study in The Aesthetic Journal found the complication rate to be no higher with barbed sutures than conventional sutures, the cosmetic results to be equal, and the skin closure time to be 40% less. Sounds like a revolutionary idea to me!

Please feel free to comment.

George Sanders, M.D.