A New Suturing Method for Optimal Wound Healing: Technique and Experience

Abstract

Background: Wound closure utilizing barbed sutures has been associated with healing problems, such as thread extrusion, infection, and the increase of an inflammatory response around the scar. Objectives: In our study, the senior author described a novel technique of skin incision and wound closure based on de-epithelization and bi-layer tension-free closure that minimizes complications. Methods: In this retrospective study, the authors reviewed the evolution of wound healing for the novel technique developed by the senior author by analyzing clinical reports of 817 patients who underwent surgery for abdominoplasty or breast reduction utilizing power-assisted liposuction mammaplasty with the new incision and closure technique. In addition , three separate plastic surgeons reviewed the wound characteristics and overall appearance by analyzing photographs that were taken over the course of 12 months to document the healing process. Results: The overall complication rate was 14.1%, with 0.4% hematoma, 1.25% infection, 0.8% seroma, 1.5% necrosis, 3.75% erythema, 3.3% delayed wound healing, and 3.1% suture extrusion. The authors reported the rate of step-off border (9%), contour irregularities (6.5%), margin separation (1.25%), edge inversion (3.2%), excessive distortion (0.9%), and bad overall appearance (6.4%) of the cases. Conclusions: This new technique in wound incision and closure based on de-epithelization and bilayer tension-free closure reduces the complications associated with barbed sutures. The last decade has witnessed increasing trends toward utilizing barbed sutures for wound closure in plastic and reconstructive surgeries, namely in body contouring procedures. 1-4 Barbed sutures have many advantages, such as lowering the rate of wound healing problems, securing better wound closure, and reducing the operative time. 5 Barbed sutures provide a knotless su-ture technique that prevents complications from buried knots, such as painful granulomas, knot visibility, and palpability. 4,6-9 Also, barbed sutures have been shown to be more valuable than standard nonbarbed sutures. 10 However, many concerns related to wound healing exist with the use of barbed sutures. Complications such as thread extrusion, infection, and the increase of an in-flammatory response around the scar are commonly described. 5,6,11-13