Finite element analysis of barbed sutures in skin and tendon tissues

Barbed surgical sutures are a new type of knotless suture that are currently being used clinically in cosmetic and plastic surgery procedures for faster healing and better cosmesis. Clinical studies are also underway to evaluate their performance in other deep tissue applications. However, little is known about their intrinsic mechanical behavior and their interactions with surrounding tissues. The primary objective of the current study was to analyze the mechanical behavior of barbed sutures using a finite element analysis approach. First, the effect of applying a point-pressure load to the tip of the barb and measuring its effect on barb displacement was studied. Second, the effect of an applied displacement to a barb anchored either in skin or tendon material for both the suture and the surrounding tissue. The results indicate that the flexibility of the barb can be increased or decreased by changing the barb geometry. It was concluded that the barb geometry and design need to be modified for use with different types of tissue. For example, in order to achieve the best mechanical anchoring with skin tissue the barb should be more flexible compared to the one designed to work with tendon tissue. The uniqueness of this study is that it is the first to establish a virtual prototyping and designing method for barbed sutures. For example, a new and improved virtual design of barb geometry is proposed and validated. It also provides the first report on how to develop a virtual bench top suture/tissue pullout testing environment.