Comparative Evaluation of Wound Healing of Knotless Barbed Absorbable Suture and Monofilament Absorbable Suture for Closure of Intraoral Incisions in Maxillofacial Trauma: A Prospective Randomized Controlled Clinical Study.

Maxillofacial surgical practice frequently involves closure of wounds which may be traumatic or surgical incisions. Currently, the options for wound closure are numerous and range from suture materials (resorbable and non-resorbable) to non-suture materials such as cyanoacrylates, fibrin glue and adhesive tapes. Nevertheless, suturing remains the most commonly employed method of wound closure in intra-oral surgery whose objectives     include the following; anatomic re-approximation of tissues, hemostasis and prevention of wound contamination through microleakage or entrapment of food. Further, for various surgical               procedures, suturing must provide an ideal tissue-seal that prevents the underlying implants or grafts from getting infected. Numerous suture materials which vary in structure and composition are currently being used for intra-oral wound closure. These require placement of knots to secure the suture material to the tissues. However, intra-oral suturing presents the        following clinical challenges related to knotting (1) Difficulty in placing the first tie and achieving the desired tissue approximation in areas of restricted access and instrumentation   such as retromolar region and palate. (2) Propensity for knot slippage which compromises wound closure and necessitates a knot holding instrument or an assistant (3) Knot related tissue irritation, and (4) Knot being a nidus for food debris and microbial               colonization. Knotless suture is a novel suture device which may be an ideal alternative to eliminate the above mentioned drawbacks. In addition, numerous knot related complications have been documented in literature such as accumulation of food debris leading to infection and soft tissue irritation and eventually wound dehiscence. Literature also reveals that knots over the wound can cause ischemia due to additional pressure which predisposes the wound to infection. Improper suturing leads to complications such as wound dehiscence, infection, and post-operative pain and hemostasis in the postoperative phase. Knotless suturing is an innovative method of wound closure used in the fields of bariatric surgery, abdominoplasty, facial rejuvenation procedures, laparoscopic myomectomy, partial nephrectomy, and in various minimally invasive procedures. The rationale of this study is to evaluate role of knotless barbed absorbable suture for intraoral wound closure in terms of wound healing compared to conventional monofilament absorbable suture.