Absorbable Barbed Continuous versus Nonabsorbable Nonbarbed Interrupted Suturing Methods for Donor-site Closure of the Rectus Abdominis Myocutaneous Flap

Abstract

Background: Abdominal incisional hernia is a complication of the rectus abdominis myocutaneous (RAMC) flap harvest. This study aimed to compare the incidence of abdominal incisional hernia and donor-site closure time between absorbable barbed continuous (ABC) and non-absorbable non-barbed interrupted (nAnBI) methods. Methods: This study included 145 patients who underwent free RAMC flap reconstruction after head and neck cancer surgery at Kobe University Hospital between January 2012 and March 2020. The nAnBI method was selected between January 2012 and August 2016, and the ABC method was selected between September 2016 and March 2020. The incidence of abdominal incisional hernia and the average time required for donor-site closure were compared between the two groups. Results: Of the 145 patients surveyed, 116 (57 and 59 in the nAnBI and ABC groups, respectively) were followed-up for at least 90 days after the surgery. The incidence rates of abdominal incisional hernia were 0% and 5.1% (n = 3) in the nAnBI and ABC groups, respectively, with no significant differences (p = 0.244). The average donor-site closure times were 127.6 and 111.3 minutes in the nAnBI and ABC groups, respectively, with no significant differences (p = 0.122). Conclusions: No significant differences in the incidence of abdominal incisional hernia and donor-site closure time were observed between the nAnBI and ABC groups. However, there was a tendency for increased hernia occurrence and shorter wound closure time in the ABC group. A randomized prospective multicenter study is warranted to validate our findings of the ABC method.

Initial Experience with Unidirectional Barbed Suture for Abdominal Donor Site Closure in Deep Inferior Epigastric Perforator Flap Breast Reconstruction

“…Despite the study yielding no significant differences in the incidence of postoperative bulge and hernia according to suture type, there was a tendency for shorter wound closure times with the barbed continuous suture. 22 No patients in the current study developed a hernia, whereas only one patient developed a bulge postoperatively. This rate compares favorably to the incidence of hernia and bulge following DIEP flap breast reconstruction reported in the literature, which ranges from upwards of 7% for hernia to 33% for bulge.…”

“…Complications were not a focus of their technique-focused article, apart from the discussion of one male patient who underwent a VRAM flap and developed a postoperative hernia. Kitano et al 22 recently published a retrospective comparison of abdominal donor site closure with absorbable barbed continuous and nonabsorbable, nonbarbed interrupted suture following rectus abdominis myocutaneous flaps to the head and neck. 22 However, it is important to note that polypropylene mesh was simultaneously placed in all abdominal fascial repairs.…”

“…Kitano et al 22 recently published a retrospective comparison of abdominal donor site closure with absorbable barbed continuous and nonabsorbable, nonbarbed interrupted suture following rectus abdominis myocutaneous flaps to the head and neck. 22 However, it is important to note that polypropylene mesh was simultaneously placed in all abdominal fascial repairs. Despite the study yielding no significant differences in the incidence of postoperative bulge and hernia according to suture type, there was a tendency for shorter wound closure times with the barbed continuous suture.…”

“…Despite the study yielding no significant differences in the incidence of postoperative bulge and hernia according to suture type, there was a tendency for shorter wound closure times with the barbed continuous suture. 22 …”

Assessing the application of barbed sutures in comparison to conventional sutures for surgical applications: a global systematic review and meta-analysis of preclinical animal studies

“…In addition, the stability of sutures, including mechanical resistance and resistance to degradation 78 , 79 , assumes a critical role in ensuring reliability, particularly over the long-term. However, limited attention has been devoted to assessing the degradation of absorbable barbed sutures, yielding inconclusive findings 80 . Furthermore, the assessment of the absorbable conventional sutures has raised concerns over the potential diminution in tensile strength of absorbable materials 81 , which was exacerbated by various pH conditions, biochemistry (enzyme), and temperature in vivo 79 , 82 , 83 .…”