Sir:
I am pleased to find scientific articles dedicated to using barbed threads intended for suturing surgical wounds.1 It is commonly known that barbed surgical suture materials have been suggested for closing wound edges by means of perpendicular single stitches (U.S. patent nos. 5053047, 5342376, and WO-A-98/52473); this has virtually failed to be implemented into practice, for various reasons.
My coworkers and I appear to have been the first in the world to develop barbed threads (Aptos Suture) as suture surgical material for uninterrupted subcutaneous and intracutaneous suturing of wound edges in Russia in 1999 (patent EP 1 075 843), having worked out the surgical technique. In their article, Murtha et al. report U.S. patents WO 2004/030517, WO 2004/030705, and WO 2004/030520, which are virtually identical to patent EP 1 075 843.
I am happy to point out that the authors of the article carried out a serious study. I would also like to make certain remarks.
The authors note that the thread’s strength gradually decreases with time from 80 percent by week 2 to 0 percent by week 8, but they fail to mention how long the fragments of the polydioxanone remain within the tissue. It is known that to connect the edges they must be kept in the approximated condition for 2 weeks; a longer stay of the suture thread in the subcutaneous fat is utterly undesirable. It swells with time, attracting infection and thus deteriorating the wound-healing process.2–6 That is why our colleagues had “purulent infections,” “seromas,” and “ligature fistulas” in 10.2 percent of cases. They attribute these complications to the relatively large diameter of the threads and their proper and superficial localization.
I have not used absorbable suture material for dermal sutures for a long time, and I use only nonabsorbable material that must be removed after the wound has healed.2,3,6 Unfortunately, the design of the proposed suture material does not envisage its removal from the wound. Therefore, the researchers have to leave them in the wound. I believe, therefore, that the material in the form suggested by the authors as well as the wound-suturing technique cannot be used to suture the cutaneous stage of the wound.
The authors presented no information about the long-term results of the scar’s condition, length, width, or trophicity, having failed to conduct a remote-period comparative analysis with a control group.
Finally, I hereby express my deep concern that Dr. Gregory L. Ruff (senior author of the article by Murtha et al.1), well aware of the European patent (EP 1 075 843) and having used the fact that the Russian authors had failed to duly patent their invention in the United States, “newly invented” the barbed suture for wound closure in 2004 and patented it (WO 2004/030517, WO 2004/030705 and WO 2004/030520) in his country. This is probably why there are no Russian sources in the reference list.
Marlen Sulamanidze, M.D.
Aptos
Nagatinskaya 27
Moscow 115533, Russia
[email protected]
REFERENCES
1. Murtha, A. P., Kaplan, A. L., Paglia, M. J., Mills, B. B., Feldstein, M. L., and Ruff, G. L. Evaluation of a novel technique for wound closure using a barbed suture.
Plast. Reconstr. Surg. 117: 1769, 2006.
2. Chusak, R. B., and Dibelli, D. G. Clinical experience with polydioxanone monofilament absorbable sutures in plastic surgery.
Plast. Reconstr. Surg. 72: 217, 1989.
3. Edlich, E. F., Panek, P. H., Rodeheaver, G. T., Turnbull, V. G., Kurtz, L. D., and Edgerton, M. T. Physical and chemical configuration of suture in the development of surgical infection.
Ann. Surg. 177: 679, 1973.
4. Gibson, T. The physical properties of skin. In J. M. Converse (Ed.),
Reconstructive Plastic Surgery: Principles and Procedures in Correction, Reconstruction, and Transplantation. Vol. 1: General Principles. Philadelphia: Saunders, 1977. P. 69.
5. Sulamanidze, M., and Mikhailov, G., inventors. Surgical thread for plastic surgery operations. European patient EP 1 075 843 A1, priority 03.03. 1999.
6. Sulamanidze, M., and Sulamanidze, G. A new variant of the cutaneous wound suturing technique.
Ann. Plast. Reconstr. Aesthetic Surg. 3: 54, 2006.
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