What is a barbed suture?

A barbed suture is a suture which has very fine barbs all the way along its length.  This means that when you pass it through the tissues, the barbs catch and it will not pull back.
So that if you use it on either side of a wound and pull it tight, it will hold the tension and keep the wound closed without having to tie a knot in the suture.

These days patients ask a lot more detailed questions than they used to.

I guess it is one of the benefits of the information superhighway – that we can all become experts with a few clicks and a couple of hours on Google.

I welcome this and encourage patients to do their research.

…but sometimes people do go in to details and start worrying about things that aren’t really important.

…like ‘will you use a barbed suture for my tummy tuck?’

What’s that all about?

Most people don’t even know what they are asking much less why it might (or might not) be a good thing to use.

Having said that, it is always good to ask questions because you will be able to gauge from the reaction whether your Consultant is approachable and comfortable to engage.

…but I wouldn’t hold too much store on the reply.

Like most things, there are pros and cons.

Some surgeons use barbed sutures a lot, while others never use them.

Personally, I am in the latter category and I never use them.

Not because I think they are bad, I can see the benefits
…but I also see the downsides.

The Pros and cons of barbed sutures

The Pros Of Barbed Sutures

The great benefit in using a barbed suture is speed.

…and it is better to be quick than slow when performing surgery.

If you have a large open wound, like with a tummy tuck or a breast reduction, you can pass a barbed suture and close it very quickly because as the barbs pass through the tissues, they catch and won’t pass back and this keeps the tension on the wound without needing to tie knots.

If you use a normal (non-barbed) suture, then you have to tie a knot in the suture to keep the tension on.

This means that you have to tie multiple interrupted sutures rather than just passing one barbed suture.

…and this takes time.

BUT there is a benefit in tying multiple interrupted sutures.

The Cons Of Barbed Sutures

One of the challenges in closing tummy tucks or breast reductions is that we need to take care of the alignment of the tissues to prevent a dog ear and ensure that the closure is neat.
This is easier when doing interrupted sutures where you can adjust and correct as you go.

Once you have passed the barbed suture, you can’t adjust it.

The other worry that I have with the barbed suture is that the whole integrity of the wound closure is held on that one suture.

With multiple interrupted sutures, if one knot fails, it will not have a significant effect.

Furthermore, if you are unfortunate enough to get an infection, then we may need to remove the suture.

This is bad enough if it was just one deep suture, but if you are unlucky enough to get an infection in a barbed suture, it is very hard to treat because they are difficult to remove.

At the end of the day, a barbed suture is not going to be the difference between a good and a bad result.

The are good surgeons and bad surgeons and there are surgeons who use barbed sutures and those who don’t – they are not mutually exclusive.
It is more important to look for a good surgeon and that depends on a variety of factors.

• Qualifications and experience
• Attitude and empathy
• Surgical expertise
• Aftercare

The ins and outs of the techniques they use is a minor factor.
Yet some patients give disproportionate weight to it because it is a lot more tangible than these other attributes.

I still think it is good to be informed and to ask questions about your treatment about how and why something is going to be done.
…but try not to get too hung up on it.

Barbed sutures have a place, but in themselves, they will not give you a good result (or a bad result).

Spend timing choosing your surgeon, this is the most important decision for you to make.

If you need help finding a fully trained plastic surgeon, you can get my book ‘Never Accept A Lift From Strangers – how to choose the best plastic surgeon for your cosmetic breast surgery’.

It is available through amazon or my website .

As ever,  if you have any questions, you can always join me on Facebook where I do a live Q and A every Tuesday at 7 o’clock or call us on 0121 454 3680 if you would like to have a chat.

If you have any questions, feel free to get in touch or leave a comment and I would be happy to get back to you.

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