Tissue holding performance of barbed sutures

A new technology of knotless barbed surgical sutures has made its mark in cosmetic surgery around the world. Although this technology is still under development, it has been approved by the Federal Drug Administration in USA, and is now used for facelift and eyelid ptosis procedures. The objectives of this study were to review the different types of knotless sutures, assess the tissue holding capacity of barbed sutures and perform image analysis to better understand the mechanism of energy absorption by the barbs under loading by the forces of surrounding tissues. A two dimensional finite element analysis was also performed to identify the areas of stress concentration, which are the main precursors for the peeling of the barbs beyond the maximum tissue holding force for a particular polymer. It was found that barbed sutures exhibit tissue holding capacities comparable to that of knotted sutures. This technology needs to be investigated further so as to optimize the barb geometry for superior holding capacity in a variety of different tissues.