title: A randomized study comparing traditional monofilament knotted sutures with barbed knotless sutures for donor leg wound closure in coronary artery bypass surgery.
abstract: OBJECTIVE
  Surgical knots on the suture line provide an anchoring function, but also represent a potential source of infection and irritation on the donor leg after coronary artery bypass surgery. Knotless barbed sutures were designed to prevent knot-related complications. This study compared knot-related wound complication rates between patients receiving traditional monofilament sutures and those receiving barbed knotless sutures for closure of the donor leg.
  
  
  METHODS
  One hundred and forty-two patients were randomized into two groups. Group 1 (n = 70) received traditional monofilament sutures and Group 2 (n = 72) received barbed knotless sutures. All wounds were assessed on postoperative days 3 and 5 and weeks 2, 4 and 6 using a validated wound scoring system. Antibiotics usage and general practitioner and district nurse visits were recorded.
  
  
  RESULTS
  No demographic differences were observed between groups. Leg wound skin closure times were significantly shorter in Group 2 compared with Group 1 (P < 0.001). Group 1 demonstrated a greater incidence of excessive scarring (P < 0.001), itching (P < 0.001), irritation (P < 0.001) and adverse skin tissue reactions (P < 0.001) than Group 2. Fewer general practitioner visits were recorded in Group 1 compared with Group 2 (P = 0.051).
  
  
  CONCLUSIONS
  Knotless barbed suture usage significantly reduces the incidence of knot-related leg wound complications compared with traditional monofilament knotted sutures. This may be related to differences in the rate of absorption of the suture material or an associated decrease in the incidence of adverse skin tissue reactions that may delay postoperative wound healing.
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK bhuvaneswari.bibleraaj@uhsm.nhs.uk.
authors.forename: Bhuvaneswari
authors.initials: B
authors.lastname: Krishnamoorthy
authors.affiliation: The Transplant Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: Niamh
authors.initials: N
authors.lastname: Shepherd
authors.affiliation: The Transplant Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: William R
authors.initials: WR
authors.lastname: Critchley
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: Janesh
authors.initials: J
authors.lastname: Nair
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: Nehru
authors.initials: N
authors.lastname: Devan
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: Abdul
authors.initials: A
authors.lastname: Nasir
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: James B
authors.initials: JB
authors.lastname: Barnard
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: Rajamiyer V
authors.initials: RV
authors.lastname: Venkateswaran
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Waterworth
authors.affiliation: The Transplant Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: James E
authors.initials: JE
authors.lastname: Fildes
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: Nizar
authors.initials: N
authors.lastname: Yonan
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg / Q000098:blood supply / Q000601:surgery*; D008297:Male; D012501:Saphenous Vein / Q000637:transplantation*; D013529:Surgical Wound Dehiscence / Q000517:prevention & control*; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014945:Wound Healing
keywords: Barbed sutures; Cardiac surgery; Coronary artery bypass; Monofilament sutures; Vein harvesting