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Rater-Blinded, Controlled Comparison With Nonbarbed Sutures of Various Calibers

Rashid Rashid, MD, PhD; Mark Sartori, BS; Lucile E. White, MD; Mark T. Villa, MD; Simon S. Yoo, MD; Murad Alam, MD, MSCI

Arch Dermatol. 2007;143(7):869-872.

Objectives  To assess the strength of 2.0 barbed polypropylene suture, and, specifically, to determine the load required to break this suture, and to compare this with the strength of nonbarbed polypropylene suture.

Design  Rater-blinded, controlled trial. The individual responsible for setting up the experimental conditions was not blinded.

Setting  Biomechanics laboratory in an academic medical center.

Materials  This study did not include human subjects. Materials used included six 2.0 barbed polypropylene sutures and 3 each of 2.0, 3.0, 4.0, and 5.0 nonbarbed polypropylene sutures. Each suture was randomly selected from a different batch or box of similar sutures.

Intervention  Each suture was strung between 2 (top and bottom) cylinders and tied with a surgeon's knot. A tensile testing device was used to apply increasing force until the suture broke. Data were acquired through an analog-to-digital board on an IBM-compatible computer using commercially available software.

Main Outcome Measures  Ultimate strength, stiffness, and elongation before suture rupture.

Results  Strength of the barbed sutures (mean [SD] ultimate strength, 39.5 [9.0] N) was intermediate between that of 2.0 (55.0 N) and 3.0 (36.4 N) nonbarbed sutures and was not significantly different from that of 3.0 nonbarbed sutures (P = .5). Barbed 2.0 polypropylene sutures differed significantly (P < .001) from each of the other types of nonbarbed sutures on measures of stiffness and elongation. Elongation of barbed sutures was closest to that of 3.0 nonbarbed sutures (P = .002). Stiffness of the barbed sutures (mean [SD], 4.7 [0.7] N/mm) was markedly in excess of that of any of the other suture types (P < .001).

Conclusions  Barbed 2.0 polypropylene sutures seem to be at least as strong as 3.0 nonbarbed polypropylene sutures. As such, barbed sutures are significantly stronger than their rated strength, which has been stated as comparable to 4.0 nonbarbed sutures. This has implications for the long-term in vivo safety of barbed sutures.

Author Affiliations: Division of Dermatology, Stritch School of Medicine, Loyola University, Maywood, Illinois (Dr Rashid); Musculoskeletal Biomechanics Laboratory, Department of Veterans Affairs, Edward Hines Jr Veterans Administration Hospital, Hines, Illinois (Mr Sartori); Departments of Dermatology (Drs White, Yoo, and Alam), Otolaryngology–Head and Neck Surgery (Drs Yoo and Alam), and Surgery (Dr Alam), Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and Section of Plastic and Reconstructive Surgery, University of Chicago, Chicago (Dr Villa).