title: A novel barbed suture tie-over dressing for skin grafts: a comparison with traditional techniques.
abstract: BACKGROUND
  Barbed suture devices have a widespread application in plastic surgery. The unidirectional nature of the barbs facilitates a strong grip on tissues and reduces the need to constantly tension the suture manually. We hypothesized that a barbed suture tie-over suture to secure skin grafts would be quicker to perform than traditional tie-overs and would also exert a greater downward pressure on the skin graft.
  
  
  METHODS
  Thirty uniform areas of skin were excised from a cadaver. A pressure transducer was placed on the wound bed and covered with the excised skin along with a mineral oil-soaked wool dressing to act as a bolster. Three different sutures were used to secure the graft in place and the pressure was recorded. The tie-over techniques used were the classic silk tie-over, a running Vicryl Rapide™ tie-over and a running barbed tie-over.
  
  
  RESULTS
  The barbed tie-over exerted the most downward pressure (82.8 ± 7.3 mmHg) compared to the silk (46 ± 4.85 mmHg) and the Vicryl Rapide™ (18.6 ± 2.4 mmHg). Furthermore, the barbed tie-over was the quickest to perform (1:45 ± 22 s) when compared to the Vicryl Rapide™ (02:57 ± 27 s) and the silk tie-overs (04:26 ± 39 s).
  
  
  CONCLUSIONS
  Barbed sutures are a viable option for securing skin grafts. They are quick to perform and provide significantly improved downward pressure on the skin graft. We feel that this technique would be especially suited to the sole operator as it can be carried out without the need of an assistant.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Galway, Ireland. Electronic address: cjoyce78@hotmail.com.
authors.forename: C W
authors.initials: CW
authors.lastname: Joyce
authors.affiliation: Department of Plastic and Reconstructive Surgery, Galway, Ireland.
authors.forename: K M
authors.initials: KM
authors.lastname: Joyce
authors.affiliation: Department of Plastic and Reconstructive Surgery, Galway, Ireland.
authors.forename: N
authors.initials: N
authors.lastname: Mahon
authors.affiliation: Department of Plastic and Reconstructive Surgery, Galway, Ireland.
authors.forename: J C
authors.initials: JC
authors.lastname: Chan
authors.affiliation: Department of Plastic and Reconstructive Surgery, Galway, Ireland.
authors.forename: C M
authors.initials: CM
authors.lastname: Sugrue
authors.affiliation: Department of Anatomy, National University of Ireland, Galway, Ireland.
authors.forename: P
authors.initials: P
authors.lastname: Dockery
authors.affiliation: Saint Vincent's University Hospital, Dublin, Ireland.
authors.forename: S M
authors.initials: SM
authors.lastname: Carroll
authors.affiliation: Department of Plastic and Reconstructive Surgery, Galway, Ireland.
authors.forename: J L
authors.initials: JL
authors.lastname: Kelly
mesh_terms: D001458:Bandages; D002102:Cadaver; D004867:Equipment Design; D006801:Humans; D016038:Skin Transplantation / Q000379:methods*; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D014160:Transducers, Pressure
keywords: Barbed suture; Bolster; Skin graft; Tie-over dressing