Barbed Suture Needle Rescue Procedure
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SLEEP AND OTOLARYNGOLOGY (H GOUVERIS, SECTION EDITOR)
Barbed Suture Needle Rescue Procedure Manuele Casale 1 & Antonio Moffa 1,2 Vittorio Rinaldi 1,3
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Michele Cassano 2
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Mario Mantovani 3
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Lorenzo Pignataro 3
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Accepted: 29 October 2020 / Published online: 2 December 2020 # Springer Nature Switzerland AG 2020
Abstract Recently, the use of barbed sutures (BS) for the treatment of retro-palatal collapse and vibration in patients affected by snoring and obstructive sleep apnea (OSA) has significantly increase and surgeons have become more familiar with advantages and disadvantages of using this new technology. However, in the common surgical practice, there are some problems related to the use of BS and few technical solutions have been described. One problem still unsolved is when the needle becomes unusable. Today, there is still no recognized procedure for this critical intraoperative problem that forces the surgeon to cut the thread and start the procedure all over again. We describe an easily repeatable technique called “barbed suture needle rescue procedure” to solve this critical problem and allow the surgeon to complete the procedure. Keywords Barbed sutures . Barbed snore surgery . Obstructive sleep apnea . Needle rescue procedure . Technical solutions and new technologies
Introduction In the last few years, the use of barbed sutures for the treatment of retropalatal collapse and vibration in patients affected by snoring and obstructive sleep apnea (OSA) has significantly increase and surgeons have become more familiar with advantages and disadvantages of using this new technology [1, 2]. This particular stitch consists of a permanent suture that has directional projections (or barbs) along its entire length, which imparts tensile strength without the need for tying. The stitch is passed into the tissue in the opposite direction to the splay of the barb, allowing the suture to pass easily. When a force is applied in the opposite direction, the barb of the suture grasps
the surrounding tissue and secures the tissue in place. This new conservative and non-resective surgical technique was described in 2012 and it is designed on three key points: the respect of the oropharyngeal fibromuscular structures; the use of fibro-osseous holds (such as posterior nasal spine, hamuli of the pterygoid processes, pterygomandibular raphe); and the application of knotless barbed sutures. In particular, the barbed sutures distribute the tension along the full length of the thread remodeling the structure of the soft palate and lateral pharyngeal walls [3, 4]. There is increasing evidence that knotless, barbed, self-anchoring suture devices are as safe and well tolerated as conventional stitches in tissue suturing and that their use seems to be associated with reduced surgical closure times,
This article is part of the Topical Collection on Sleep and Otolaryngology * Antonio Moffa [email protected] Manuele Casale [email protected]
Vittorio Rinaldi [email protected] 1
Integrated Sleep Surgery Team UCBM
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