Applications of barbed sutures

The human body consists of numerous types of tissues. The stiffness of these tissues encompasses an entire spectrum from soft tissues, that are easily bent, to bones that are very stiff Therefore the required stiffness of the barb in a barbed suture needs to be different for different tissues. This may be achieved by varying the barb geometry and the configuration of the barbs along the monofilament suture, as well as by selecting a specific polymer material with the required stiffness. 

31 Suture anchors and tissue pullout test (Leedle and Miller, 2005). 

The stresses experienced by the arteries depend upon their distance from the heart. The working stress experienced by a suture in a situation where it is used to suture a prosthetic valve to biological tissue is less than 1 MPa (1 N/mm or 0.1019 kgf/mm ) (Paez et al., 1994). We can see from Table 13.6 that the stresses exerted on an arterial anastomosis are comparatively low, say 0.02 N, that is, 2.03 gf (where 1 N = 101.97 gf) for a monofilament of cross-sectional area 1 mm (Schaumberg et al., 2001). 

The use of traditional knotted sutures for mitral valve reconstructive surgery has a number of disadvantages. A size 5-0 polypropylene suture has been reported to leave sharp tails or ears protruding from their knots that could damage the opposing anterior leaflet after quadrangular resection (Fig. 13.33) (Lam et al., 2003). The use of a barbed suture could be a possible alternative to traditional sutures, since the barbed suture would stay inside the eye so there would be no abrasion with surrounding tissue. Further, the 

32 Flexor tendon repair ((a) 4 strand (b) = 8 strand) with knotted sutures (Barrie eta ., 2000). 

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Despite having some limitations, barbed surgical sutures have become an established part of surgical practice (Cookson et al., 2011). This chapter reviews key aspects of barbed sutures, including their development, materials, design and manufacture. It also reviews testing and characterization as well as key properties. Finally, the chapter discusses the range of applications of barbed sutures. 

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