# Evaluating barbed sutures: A porcine biomechanical comparison of Z-plasty and turndown flap according to Silfverskiöld

## TL;DR

This study compares barbed sutures to traditional ones in tendon repair techniques, showing improved strength and fewer complications.

## Contribution

The study introduces a biomechanical comparison of barbed sutures in Z-plasty and turndown flap techniques using a porcine model.

## Key findings

- Z-plasty with Stratafix barbed sutures showed a 32% improvement in maximum force compared to traditional PDS sutures.
- Z-plasty outperformed turndown flap in maximum force when using Stratafix sutures.
- Barbed sutures reduced the risk of complications from suture knots.

## Abstract

It is not possible to add an infinite amount of suture material to tendon plasties and repairs in vivo. Each additional knot can reduce the tensile strength by up to 50 %. Therefore, barbed sutures, as a knotless suturing system, should be investigated as a potential alternative to traditional sutures to minimize knot-related weakening.

Superficial porcine flexors were randomized into five groups. A non-contact measurement was utilized. The Z-plasty and the turndown flap according to Silfverskiöld were used. The Stratafix barbed knotless suture was compared to regular smooth polydioxanone. The biomechanical protocol included a creep test, a cyclic test, and a tear-off test.

The Z-plasty with Stratafix showed significantly improved maximum force compared to the Z-plasty with Polydioxanon (PDS 108.5 ± 22.2N, Stratafix 142.3 ± 23.5N, p < .01). The Z-plasty was significantly superior to the turndown flap in maximum Force (turndownflap with Stratafix 52.4 ± 14.6N, Z-plasty with Stratafix 108.5 ± 22.2N, p < .001).

The Stratafix barbed suture can significantly improve the Z-plasty in maximum tension by up to 32 % when compared to regular PDS. To formulate a more precise indication, biological factors must be further investigated.

•32 % improvement in maximum force without the use of additional suture material.•Comparative evaluation of rupture mechanism with barbed sutures.•Reduced risk of complications associated with suture knots.•A potentially more effective method of performing Z-plasty in Achilles tendons.

32 % improvement in maximum force without the use of additional suture material.

Comparative evaluation of rupture mechanism with barbed sutures.

Reduced risk of complications associated with suture knots.

A potentially more effective method of performing Z-plasty in Achilles tendons.