Use of Barbed Suture in Complex Back Closure Decreases Operative Time and Cost with Comparable Safety Profile

PURPOSE: Plastic surgery involvement in complex locoregional closure of back wounds following spine surgery has increased significantly within recent decades. Muscle flap closure, as opposed to traditional layer-by-layer approximation, has been shown to decrease rates of wound complications such as seroma, infection, and dehiscence. However, the impact of the use of barbed suture on operative time, surgical cost, and patient outcome for complex back closure remains unknown. METHODS: A retrospective analysis was conducted on all patients who underwent spine surgery followed by locoregional muscle flap complex closure between January 2016 and July 2021. Patients were divided into barbed suture and conventional suture cohorts (Figure 1). Operative characteristics, including duration of surgery, were extracted from the medical record. Postoperative complications such as seroma, infection, dehiscence, and need for reoperation were collected. An estimated cost savings was calculated using figures reported in the literature. RESULTS: Of 110 patients, 67.3% (74/110) underwent muscle flap-based reconstruction with barbed suture. Rates of seroma (p = 1.0), infection (p = 0.21), dehiscence (p = 0.66), and other complications were statistically similar between groups. After adjusting for the length of surgical closure, the mean time per centimeter was 3.1 min/cm versus 4.6 min/cm for barbed and conventional suture cohorts, respectively, resulting in a time savings of 1.5 min/cm (p < 0.001) (Table 1). The calculated time savings for muscle flap closure of average incision length was 34.5 min (18.6 – 50.4 min), and the overall financial savings was calculated to be $1094.10 ($513.75 – $1674.45) per case. CONCLUSION: The use of knotless barbed suture in complex closure of back wounds results in decreased operative time and hospital cost, while conferring similar rates of complication to conventional suture.