title: Severe scar problems following use of a locking barbed skin closure system in the foot.
abstract: BACKGROUND
  Barbed sutures provide a novel technique for knotless wound closure. They have mainly been used in plastic and general surgery. There are no reports about its use in the foot.
  
  
  METHODS
  We present a case series of 11 feet in 8 patients whose wounds were closed with barbed sutures. Ten had primary hallux valgus correction and one had a revision correction.
  
  
  RESULTS
  No problems were noted at 2-weeks follow-up. Four of the 11 cases required open suture excision due to an adverse reaction. Five were followed to delayed wound healing. Histology results from one scar showed a localised histiocytic reaction and superficial dermal abscess formation.
  
  
  CONCLUSIONS
  We feel the thin subcutaneous tissue of the foot, the amount of motion and pressure from the shoe causes the barbs to repeatedly irritate the soft tissue. Based on our short case series we cannot recommend the use of a barbed skin closure system in the foot.
authors.affiliation: ST6 Trauma and Orthopaedics, London Deanery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom. m.chowdhry@doctors.org.uk
authors.forename: Majid
authors.initials: M
authors.lastname: Chowdhry
authors.forename: Samrendu
authors.initials: S
authors.lastname: Singh
mesh_terms: D000328:Adult; D002921:Cicatrix / Q000209:etiology*; D062109:Dermatologic Surgical Procedures / Q000295:instrumentation*; D005528:Foot / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D013536:Suture Techniques; D013537:Sutures / Q000009:adverse effects*; D014945:Wound Healing