Incidence of dehiscence and erythema in tibial plateau leveling osteotomy incisions closed with barbed, bidirectional monoderm suture is equal to external nylon sutures.

Objective: To compare the efficacy and complication rate of nylon suture in an interrupted cruciate pattern versus barbed knotless monoderm suture for closure of tibial plateau leveling osteotomy (TPLO) incisions.

Methods: 183 client-owned dogs (189 incisions) underwent TPLO surgery for cranial cruciate ligament rupture between September 2022 and July 2023. A prospective clinical trial compared TPLO incision closure with the use of external nylon sutures (n = 89) and intradermal, barbed monoderm suture (100). Incisions were monitored over an 8-week recovery period for evidence of complications.

Results: Univariable analysis identified that the rate of dehiscence at 2 weeks postoperatively in the nylon group was 22% (95% CI, 15% to 32%) compared to 11% (95% CI, 6% to 19%) in the barbed suture group. The risk of dehiscence at 2 weeks postoperatively was 2.0 times (relative risk 95% CI, 1.0 to 4.0) greater when nylon was used compared to barbed suture. Incisions closed with barbed suture had less erythema. There was no difference in the odds of dehiscence between groups when analyses were adjusted for surgeon (OR 95% CI, 0.3 to 2.7). The proximal third of the incision was the most likely location for dehiscence to occur in TPLO incisions.

Conclusions: Barbed bidirectional suture can be used to close TPLO incisions with a similar dehiscence rate compared to nylon.

Clinical relevance: Barbed suture for closure of TPLO incisions is acceptable and comparable to external nylon sutures. Extra care should be taken when suturing the most proximal aspect of TPLO incisions.