A High-Strength, Absorbable, Antibacterial Knotless Tissue Control Device for Fascial Closure

Abstract

Purpose of ReviewThis review provides an overview of the STRATAFIX™ SYMMETRIC PDS™ Plus Knotless Tissue Control Device design and performance characteristics and highlights the device’s relevance for use in gynecological procedures. Various device testing was conducted on tensile strength, fixation tab mass comparison to conventional suture knot tower, initiation stitch strength, and wound holding strength to highlight the STRATAFIX™ SYMMETRIC PDS™ Plus Device’s key product attributes that may benefit general and minimally invasive gynecological procedures.Recent FindingsThis article serves as a technological assessment of the latest barbed suture offered by Ethicon—STRATAFIX™ SYMMETRIC PDS™ Plus Knotless Tissue Control Device. This device is indicated for soft tissue approximation and can be used to close high tension areas, such as fascia.SummaryBarbed sutures were successfully introduced to gynecologic surgery many years ago, and their safety and effectiveness have been demonstrated in a variety of gynecological surgical procedures. By eliminating the need to tie surgical knots, barbed suture provides a few key advantages over conventional suture, such as reducing operating room time, eliminating potential knot-related complications, and reducing suturing difficulty in open and minimally invasive gynecological procedures. Additionally, there are tensile strength and wound holding strength advantages (vs. conventional PDS™ Plus Suture) described in the product testing highlighted in this review that may be relevant for gynecological procedures.

Influence of barbed epitendinous sutures combined with a core locking‐loop suture to repair experimental flexor tendon lacerations

“…18 This barbed design is integrally formed onto the core, contributing to the overall strength of the suture. 19 To the best of our knowledge, the force required to overcome the barb-tissue interaction against the direction of barb orientation is unknown. It has previously been demonstrated in skin and tendinous tissues that increasing the cut angle of the barbs decreases the shear stress and force required to peel a barb from its anchor point in tissues.…”

Biomechanical properties of canine staphylectomies closed with barbed or smooth suture

“…27,31,46 Intraoral knots add foreign body mass to implanted suture and are sources of tissue irritation and niduses for food debris and microbial colonization, factors associated with incisional complications and dehiscence in man. 27,37,46 For biomechanical testing, the anatomy of the soft palate and the caudal position of the staphylectomy incision pose a unique problem. Researchers studying the effects of respiration on soft palate movement in people during eating found that pressure gradients develop during high velocity airflow and combine with forces of the tongue and levator musculature of the palate to pull the palate upward and posteriorly.…”

“…26,27,31 Tightly approximated wounds and overly tight sutures can lead to ischemia, inflammation, reduced wound strength, dehiscence, or excessive fibrosis, particularly undesirable outcomes in staphylectomy, a surgical site where wound complications can impact quality of life or prove life threatening. [26][27][28][29][30][31][32][33][34][35][36][37][38]41,42 By contrast, engaged barbs provide uniform tension in the apposed tissues in a sustained manner during surgery and in the postoperative period, which may prevent incisional complications and dehiscence. 26,27,31 Surgical knots introduce stress concentrations into the strand and thin and stretch the material which greatly reduces suture tensile strength.…”

“…Upsizing barbed suture as described improves mechanical resistance by providing similar or greater tensile strength compared with comparable smooth monofilament suture and may account for the similar biomechanical performance of the Q, MC, and MI groups in this study. 33,34,37,[45][46][47][48][49] Previous researchers have reported increased speed and ease with which suturing is accomplished to be a consistent advantage of barbed sutures, especially in confined spaces such as the oral cavity or during minimally invasive procedures. Specifically with regard to oral surgery, Quill barbed suture has been described for intraoral closures after extensive dental extractions in cats, and surgical durations of closure were reduced by over 41% with barbed suture compared with smooth monofilament suture.…”

“…The use of barbed sutures has been shown to reduce operative times and tissue ischemia as well as improve tissue apposition, distribution of tension across the suture line, and wound healing. [26][27][28][29][30][31][32][33][34][35][36][37] Using barbed sutures in dogs, cats, and pigs for intraoral closure, tracheal resection and anastomosis, diaphragmatic herniorrhaphy, gastrotomy, gastropexy, enterotomy, cystotomy, tenorrhaphy, and closure of body wall and skin have yielded findings comparable with smooth suture with some distinct advantages, particularly higher forces to failure in biomechanical testing of incisional gastropexy and decreased duration of closure for all tissues studied. [38][39][40][41][42][43][44][45][46][47][48][49] The objective of this study was to compare the duration of closure and biomechanical properties of staphylectomies closed with absorbable bidirectional barbed suture or smooth monofilament suture in a simple continuous or interrupted pattern.…”