title: Evaluation of a novel technique for wound closure using a barbed suture.
abstract: BACKGROUND
  Suture knots present several disadvantages in wound closure, because they are tedious to tie and place ischemic demands on tissue. Bulky knots may be a nidus for infection, and they may extrude through skin weeks after surgery. Needle manipulations during knot-tying predispose the surgeon to glove perforation. A barbed suture was developed that is self-anchoring, requiring no knots or slack management for wound closure. The elimination of knot tying may have advantages over conventional wound closure methods.
  
  
  METHODS
  This prospective, randomized, controlled trial was designed to show that the use of barbed suture in dermal closure of the Pfannenstiel incision during nonemergent cesarean delivery surgery produces scar cosmesis at 5 weeks that is no worse than that observed with conventional closure using 3-0 polydioxanone suture. Cosmesis was assessed by review of postoperative photographs by a blinded, independent plastic surgeon using the modified Hollander cosmesis score. Secondary endpoints included infection, dehiscence, pain, closure time, and other adverse events.
  
  
  RESULTS
  The study enrolled 195 patients, of whom 188 were eligible for analysis. Cosmesis scores did not significantly differ between the barbed suture group and the control group. Rates of infection, dehiscence, and other adverse events did not significantly differ between the two groups. Closure time and pain scores were comparable between the groups.
  
  
  CONCLUSIONS
  The barbed suture represents an innovative option for wound closure. With a cosmesis and safety profile that is similar to that of conventional suture technique, it avoids the drawbacks inherent to suture knots.
authors.affiliation: Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Amy P
authors.initials: AP
authors.lastname: Murtha
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Kaplan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Paglia
authors.forename: Benjie B
authors.initials: BB
authors.lastname: Mills
authors.forename: Michael L
authors.initials: ML
authors.lastname: Feldstein
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Ruff
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000379:methods*; D002921:Cicatrix / Q000209:etiology / Q000517:prevention & control; D004867:Equipment Design; D004954:Esthetics; D005260:Female; D006801:Humans; D009339:Needles; D010149:Postoperative Pain / Q000453:epidemiology; D011247:Pregnancy; D011446:Prospective Studies; D016037:Single-Blind Method; D013529:Surgical Wound Dehiscence / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology; D013536:Suture Techniques; D013537:Sutures; D013718:Tensile Strength; D014945:Wound Healing