Composition
PDS / polydioxanone barbed sutures are sterile uncoated, synthetic, absorbable; monofilament wound closure devices which do not require knotting. These are made up of 100% polydioxanone (dyed violet during polymerization) which is non-antigenic and non-pyrogenic.
Design/ Characteristics
Barbed design (at 72 degree angle in spiral fashion) of PDS evenly distributes tension and increases efficiency. Barbs of the suture material anchor inside the tissue and hold it into place.
Types
Loop PDS suture offers a unique combination of security and speed. Barbs may be arranged in unidirectional (single armed suture – loop at the end) or bidirectional manner (double armed sutures). Spiral barb sutures are also available. Barbed sutures are anchored using the adjustable loop at the apex of the wound.
Tissue reaction
Barbed PDS sutures are also slightly reactive and incite grade 1 tissue reaction.
Looped PDS Suture Sizes
Available in 2-0, 0 and 1 USP sizes (single or double armed) with 1/2 circle taper point needle usually.
Indications
Barbed sutures are indicated in geriatric surgeries, gynaecological surgeries, cosmetic/ plastic/reconstruction surgeries, myomectomy, laparoscopic surgeries, hernial repairs, gastrointestinal surgeries, variety of open surgical procedures, robot-assisted surgical procedures, urology and vaginal cuff closures after hysterectomies. Ends should be cut short or buried properly to avoid inadvertent attachment to the small bowel or mesentery.
Advantages of barbed sutures:
- Better cosmetic outcome and easy to use.
- Time saving with fast and knot free closure (no initial and final knots).
- Less risk of excessive bleeding and perioperative complications.
- In gastrointestinal surgeries or oesophagojejunostomies it prevents leakage.
- Eliminates the risk of knot unraveling/breakage/slipping.
- Due to knotless closure it minimizes the inflammation related to size of the knot.
- Persistent suture tension and uniform pressure at site of implantation and eliminates the risk of necrosis due to minimal strangulation of the tissue.
- Multiple layers (subcutaneous and dermis) can be closed together with single continuous running sutures.
- There are no knots to be dissolved so less suture ‘spitting’.
- No suture sinus formation
Examples
Durabarb suture – PDS barbed sutures by Dolphin Sutures, Stratafix Symmentric PDS Plus Knotless Tissue Control Device by Ethicon, STRATAFIX spiral Knotless Tissue Control Device by Ethicon
Fig: Durabarb unidirectional barbed PDS suture by Dolphin Sutures
Fig: Durabarb bidirectional barbed PDS suture by Dolphin Sutures
Fig: Durabarb unidirectional barbed PDS suture by Dolphin Sutures
Fig. STRATAFIX Symmetric PDS Plus Knotless Tissue Control Device by Ethicon
STRATAFIX spiral Knotless Tissue Control Device
It provides more efficiency, security and consistency than traditional sutures. Available in single arm (end loop), double arm and without needle.
Fig: STRATAFIX spiral Knotless Tissue Control Device by Ethicon
FAQs
Barbed sutures like PDS/Polydioxanone or poliglecarpone 25 sutures are absorbable and get dissolved with the time. But barbed sutures of polypropylene don’t get absorbed because they are non-absorbable sutures.
Yes. Dissolvable stitches also may get infected due to surgical site infections.
How common is it that these specific absorbable sutures are not absorbed by a patient. Instead leaving sharp like plastic fragments within the vaginal walls after full Hysterectomy?