Documente Academic
Documente Profesional
Documente Cultură
Wound Closure Manual
Încărcat de
JonDrepturi de autor
Formate disponibile
Partajați acest document
Partajați sau inserați document
Vi se pare util acest document?
Este necorespunzător acest conținut?
Raportați acest documentDrepturi de autor:
Formate disponibile
Wound Closure Manual
Încărcat de
JonDrepturi de autor:
Formate disponibile
TO
NEEDLES
V I E W T H E E - C ATA L O G G O T O T H E
H E A LT H C A R E P R O F E S S I O N A L
SECTION OF
W W W. E T H I C O N . C O M
ADHESIVES
SURGICAL MESH
ETHICON, INC. , PO BOX 151, SOMERVILLE, NJ 08876-0151
* TRADEMARK
SM
ETHICON, INC.
2005, ETHICON, INC.
WOUND C LOSURE M ANUAL
SUTURES
WOUND HEALING
W O U N D C L O S U R E M A N UA L
PREFACE
his manual has been prepared for the medical professional who
would like to learn more about the practice of surgerythe
dynamics of tissue healing, the principles of wound closure, and the
materials available to todays practitioners. Most important, it
touches on some of the critical decisions which must be made on a
daily basis to help ensure proper wound closure.
ETHICON PRODUCTS, a Johnson & Johnson company, is the
worlds leading marketer of surgical sutures and is the only U.S.
company that offers an adhesive with microbial protection as an
alternative to sutures for topical skin closure.
ETHICON enjoys a reputation for developing quality products to
enhance the lives of patients and for providing outstanding service
to customers. We hope you find this manual useful. But, above all,
we hope that it reflects our high regard for the men and women
who have chosen the medical profession as a career.
ETHICON PRODUCTS
CONTRIBUTING EDITOR
David, L. Dunn, M.D., Ph. D.
Jay Phillips Professor and Chairman of Surgery,
University of Minnesota
We thank Dr. Dunn for his contributions to the Wound Closure
Manual. Dr. Dunn is currently the Jay Phillips Professor and
Chairman of Surgery at the University of Minnesota. This
department has a long-standing tradition and has attained
national and international recognition for excellence in training
academic general surgeons and surgical scientists. He is also the
Division Chief of General Surgery, Head of Surgical Infectious
Diseases, Director of Graduate Studies, and Residency Program
Director of the Department of Surgery.
Dr. Dunn has published over 400 articles and book chapters in the
areas of Surgical Infectious Diseases and Transplantation. He has
received regional and nationwide recognition in several
academic organizations and is a Past-President of the Surgical
Infection Society, the Association for Academic Surgery, the
Minnesota Chapter of the American College of Surgeons, the
Society of University Surgeons and the Society of University
Surgeons Foundation.
4!",% /& #/.4%.43
7/5.$ (%!,).'
!.$ -!.!'%-%.4
4HE 7OUND
2ECOVERY OF 4ENSILE 3TRENGTH
0ATIENT &ACTORS THAT !FFECT 7OUND (EALING
3URGICAL 0RINCIPLES
#LASSIFICATION OF 7OUNDS
4YPES OF 7OUND (EALING
(EALING BY 0RIMARY )NTENTION
(EALING BY 3ECOND )NTENTION
$ELAYED 0RIMARY #LOSURE
4(% 35452%
7HAT IS A 3UTURE
0ERSONAL 3UTURE 0REFERENCE
3UTURE #HARACTERISTICS
3IZE AND 4ENSILE 3TRENGTH
-ONOFILAMENT VS -ULTIFILAMENT
!BSORBABLE VS .ONABSORBABLE 3UTURES
3PECIFIC 3UTURING -ATERIALS
3YNTHETIC !BSORBABLE 3UTURES
.ONABSORBABLE 3UTURES
3YNTHETIC .ONABSORBABLE 3UTURES
#OMMON 3UTURING 4ECHNIQUES
,IGATURES
4HE 0RIMARY 3UTURE ,INE
#ONTINUOUS 3UTURES
)NTERRUPTED 3UTURES
$EEP 3UTURES
"URIED 3UTURES
0URSE
3TRING 3UTURES
3UBCUTICULAR 3UTURES
4HE 3ECONDARY 3UTURE ,INE
3TITCH 0LACEMENT
+NOT 4YING
+NOT 3ECURITY
+NOT 4YING 4ECHNIQUES -OST /FTEN 5SED
3QUARE +NOT
3URGEONS OR &RICTION +NOT
$EEP 4IE
,IGATION 5SING A (EMOSTATIC #LAMP
)NSTRUMENT 4IE
%NDOSCOPIC +NOT 4YING 4ECHNIQUES
#UTTING THE 3ECURED 3UTURES
3UTURE 2EMOVAL
3UTURE (ANDLING 4IPS
3UTURE 3ELECTION 0ROCEDURE
3URGERY WITHIN THE !BDOMINAL 7ALL #AVITY
#LOSING THE !BDOMEN
#LOSING #ONTAMINATED OR )NFECTED 7OUNDS
4(% 352')#!, .%%$,%
%LEMENTS OF .EEDLE $ESIGN
0RINCIPLES OF #HOOSING A 3URGICAL .EEDLE
!NATOMY OF A .EEDLE
4HE .EEDLE %YE
4HE .EEDLE "ODY
3TRAIGHT .EEDLE
(ALF
#URVED .EEDLE
#URVED .EEDLE
#OMPOUND #URVED .EEDLE
4HE .EEDLE 0OINT
4YPES OF .EEDLES
#ONVENTIONAL #UTTING .EEDLES
2EVERSE #UTTING .EEDLES
3IDE #UTTING .EEDLES
4APER 0OINT .EEDLES
4APER 3URGICAL .EEDLES
"LUNT 0OINT .EEDLES
.EEDLEHOLDERS
.EEDLEHOLDER 5SE
0LACING THE .EEDLE IN 4ISSUE
.EEDLE (ANDLING 4IPS
0!#+!').'
!N )NTEGRAL 0ART OF THE 0RODUCT
2%,!9
3UTURE $ELIVERY 3YSTEM
-ODULAR 3TORAGE 2ACKS
$ISPENSER "OXES
0RIMARY 0ACKETS
%
0!#+
0ROCEDURE +IT
%XPIRATION $ATE
3UTURE 3TERILIZATION
!NTICIPATING 3UTURE .EEDS
3TERILE 4RANSFER OF 3UTURE 0ACKETS
3UTURE 0REPARATION IN THE 3TERILE &IELD
3UTURE (ANDLING 4ECHNIQUE
4/0)#!, 3+). !$(%3)6%3
$%2-!"/.$
4OPICAL 3KIN !DHESIVE
/4(%2 352')#!,
02/$5#43
!DHESIVE 4APES
)NDICATIONS AND 5SAGE
!PPLICATION
!FTER #ARE AND 2EMOVAL
3KIN #LOSURE 4APES
0OLYESTER &IBER 3TRIP
5MBILICAL 4APE
3URGICAL 3TAPLES
)NDICATIONS AND 5SAGE
!FTERCARE AND 2EMOVAL
02/8)-!4%
3KIN 3TAPLERS
,OOPED 3UTURE
2ETENTION 3UTURE $EVICES
02/$5#4 4%2-3
!.$ 42!$%-!2+3
02/$5#4 ).&/2-!4)/.
).$%8
CHAPTER 1
WOUND HEALING
AND MANAGEMENT
7/5.$ (%!,).' -!.!'%-%.4
4(% 7/5.$
)NJURY TO ANY OF THE TISSUES OF
THE BODY ESPECIALLY THAT CAUSED
BY PHYSICAL MEANS AND WITH
INTERRUPTION OF CONTINUITY IS DEFINED
AS A WOUND 4HOUGH MOST OFTEN
THE RESULT OF A PHYSICAL CAUSE A
BURN IS ALSO CONSIDERED A WOUND
"OTH FOLLOW THE SAME PROCESSES
TOWARDS THE RESTORATION TO
HEALTH n OTHERWISE KNOWN
AS HEALING
7OUND HEALING IS A NATURAL AND
SPONTANEOUS PHENOMENON 7HEN
TISSUE HAS BEEN DISRUPTED SO SEVERELY
THAT IT CANNOT HEAL NATURALLY
WITHOUT COMPLICATIONS OR POSSIBLE
DISFIGURATION DEAD TISSUE AND
FOREIGN BODIES MUST BE REMOVED
INFECTION TREATED AND THE TISSUE
MUST BE HELD IN APPOSITION UNTIL THE
HEALING PROCESS PROVIDES THE WOUND
WITH SUFFICIENT STRENGTH TO WITHSTAND
STRESS WITHOUT MECHANICAL SUPPORT
! WOUND MAY BE APPROXIMATED
WITH SUTURES STAPLES CLIPS SKIN
CLOSURE STRIPS OR TOPICAL ADHESIVES
4ISSUE IS DEFINED AS A COLLECTION OF
SIMILAR CELLS AND THE INTERCELLULAR
SUBSTANCES SURROUNDING THEM
4HERE ARE FOUR BASIC TISSUES IN THE
BODY EPITHELIUM CONNECTIVE
TISSUES INCLUDING BLOOD BONE AND
CARTILAGE MUSCLE TISSUE AND
NERVE TISSUE 4HE CHOICE OF
WOUND CLOSURE MATERIALS AND THE
TECHNIQUES OF USING THEM ARE PRIME
FACTORS IN THE RESTORATION OF
CONTINUITY AND TENSILE STRENGTH TO
THE INJURED TISSUES DURING THE
HEALING PROCESS
4HE PARAMETERS FOR MEASURING THE
STRENGTH OF NORMAL BODY TISSUE ARE
s 4ENSILE 3TRENGTH4HE LOAD PER
CROSS
SECTIONAL AREA UNIT AT THE
POINT OF RUPTURE RELATING TO THE
NATURE OF THE MATERIAL RATHER THAN
ITS THICKNESS
s "REAKING 3TRENGTH4HE LOAD
REQUIRED TO BREAK A WOUND REGARD
LESS OF ITS DIMENSION THE MORE
CLINICALLY SIGNIFICANT MEASUREMENT
s "URST 3TRENGTH4HE AMOUNT OF
PRESSURE NEEDED TO RUPTURE A
VISCUS OR LARGE INTERIOR ORGAN
4HE RATE AT WHICH WOUNDS REGAIN
STRENGTH DURING THE WOUND HEALING
PROCESS MUST BE UNDERSTOOD AS A
BASIS FOR SELECTING THE MOST
APPROPRIATE WOUND CLOSURE MATERIAL
2%#/6%29 /&
4%.3),% 342%.'4(
4ENSILE STRENGTH AFFECTS THE TISSUEgS
ABILITY TO WITHSTAND INJURY BUT IS
NOT RELATED TO THE LENGTH OF TIME IT
TAKES THE TISSUE TO HEAL !S COLLAGEN
ACCUMULATES DURING THE REPARATIVE
PHASE STRENGTH INCREASES RAPIDLY BUT
IT IS MANY MONTHS BEFORE A PLATEAU
IS REACHED 5NTIL THIS TIME THE
WOUND REQUIRES EXTRINSIC SUPPORT
FROM THE METHOD USED TO BRING IT
TOGETHER n USUALLY SUTURES 7HILE
SKIN AND FASCIA THE LAYER OF FIRM
CONNECTIVE TISSUE COVERING MUSCLE
ARE THE STRONGEST TISSUES IN THE BODY
THEY REGAIN TENSILE STRENGTH SLOWLY
DURING THE HEALING PROCESS 4HE
STOMACH AND SMALL INTESTINE ON THE
OTHER HAND ARE COMPOSED OF MUCH
WEAKER TISSUE BUT HEAL RAPIDLY
6ARIATIONS IN TISSUE STRENGTH MAY
ALSO BE FOUND WITHIN THE SAME
ORGAN 7ITHIN THE COLON FOR
EXAMPLE THE SIGMOID REGION IS
APPROXIMATELY TWICE AS STRONG AS THE
CECUMBUT BOTH SECTIONS HEAL AT
THE SAME RATE &ACTORS THAT AFFECT
TISSUE STRENGTH INCLUDE THE SIZE AGE
AND WEIGHT OF THE PATIENT THE
THICKNESS OF TISSUE THE PRESENCE OF
EDEMA AND DURATION THE DEGREE TO
WHICH THE TISSUE HAS HARDENED IN
RESPONSE TO PRESSURE OR INJURY
0!4)%.4 &!#4/23 4(!4
!&&%#4 7/5.$ (%!,).'
4HE GOAL OF WOUND MANAGEMENT
IS TO PROVIDE INTERVENTIONS THAT
EFFICIENTLY PROGRESS WOUNDS THROUGH
THE BIOLOGIC SEQUENCE OF REPAIR OR
REGENERATION 4HE PATIENTgS OVERALL
HEALTH STATUS WILL AFFECT THE SPEED OF
THE HEALING PROCESS 4HE FOLLOWING
ARE FACTORS THAT SHOULD BE CONSIDERED
BY THE SURGICAL TEAM PRIOR TO AND
DURING THE PROCEDURE
!'% 7ITH AGING BOTH SKIN
AND MUSCLE TISSUE LOSE THEIR TONE
AND ELASTICITY -ETABOLISM ALSO
SLOWS AND CIRCULATION MAY BE
IMPAIRED "UT AGING ALONE IS NOT
A MAJOR FACTOR IN CHRONIC WOUND
HEALING !GING AND CHRONIC
DISEASE STATES OFTEN GO TOGETHER
AND BOTH DELAY REPAIR PROCESSES
DUE TO DELAYED CELLULAR RESPONSE
TO THE STIMULUS OF INJURY DELAYED
COLLAGEN DEPOSITION AND
DECREASED TENSILE STRENGTH IN THE
REMODELED TISSUE !LL OF THESE
FACTORS LENGTHEN HEALING TIME
7%)'(4 /BESE PATIENTS
OF ANY AGE HAVE EXCESS FAT AT THE
WOUND SITE THAT MAY PREVENT
SECURING A GOOD CLOSURE )N
ADDITION FAT DOES NOT HAVE A RICH
BLOOD SUPPLY MAKING IT THE MOST
VULNERABLE OF ALL TISSUES TO TRAUMA
AND INFECTION
.542)4)/.!, 34!453
/VERALL MALNUTRITION ASSOCIATED
WITH CHRONIC DISEASE OR CANCER
OR SPECIFIC DEFICIENCIES IN
#(!04%2
&)'52%
2%,!4)6%
4)335%
342%.'4(
,OWER
RESPIRATORY
TRACT 7EAK
$UODENUM
3TRONG
#ECUM
7EAK
)LEUM
7EAK
3TOMACH
7EAK
3MALL
INTESTINE
7EAK
&EMALE
REPRODUCTIVE
ORGANS
7EAK
"LADDER
7EAK
CARBOHYDRATES PROTEINS ZINC AND
VITAMINS ! " AND # CAN IMPAIR
THE HEALING PROCESS !DEQUATE
NUTRITION IS ESSENTIAL TO SUPPORT
CELLULAR ACTIVITY AND COLLAGEN
SYNTHESIS AT THE WOUND SITE
$%(9$2!4)/. )F THE
PATIENTgS SYSTEM HAS BEEN
DEPLETED OF FLUIDS THE RESULTING
ELECTROLYTE IMBALANCE CAN AFFECT
CARDIAC FUNCTION KIDNEY
FUNCTION CELLULAR METABOLISM
OXYGENATION OF THE BLOOD AND
HORMONAL FUNCTION 4HESE EFFECTS
WILL NOT ONLY IMPACT UPON THE
PATIENTgS OVERALL HEALTH STATUS AND
RECOVERY FROM SURGERY BUT MAY
ALSO IMPAIR THE HEALING PROCESS
).!$%15!4% ",//$
3500,9 4/ 4(% 7/5.$
3)4% /XYGEN IS NECESSARY FOR
CELL SURVIVAL AND THEREFORE
HEALING 3KIN HEALING TAKES PLACE
MOST RAPIDLY IN THE FACE AND
NECK WHICH RECEIVE THE GREATEST
BLOOD SUPPLY AND MOST SLOWLY IN
THE EXTREMITIES 4HE PRESENCE OF
ANY CONDITION THAT COMPROMISES
THE SUPPLY OF BLOOD TO THE
WOUND SUCH AS POOR CIRCULATION
TO THE LIMBS IN A DIABETIC PATIENT
OR ARTERIOSCLEROSIS WITH VASCULAR
COMPROMISE WILL SLOW AND CAN
EVEN ARREST THE HEALING PROCESS
)--5.% 2%30/.3%3
"ECAUSE THE IMMUNE RESPONSE
PROTECTS THE PATIENT FROM
INFECTION IMMUNODEFICIENCIES
MAY SERIOUSLY COMPROMISE THE
OUTCOME OF A SURGICAL PROCEDURE
0ATIENTS INFECTED WITH ()6 AS
WELL AS THOSE WHO HAVE RECENTLY
UNDERGONE CHEMOTHERAPY OR WHO
HAVE TAKEN PROLONGED HIGH
DOSAGES OF CATABOLIC STEROIDS MAY
HAVE DEBILITATED IMMUNE SYSTEMS
3OME PATIENTS HAVE ALLERGIES TO
SPECIFIC SUTURING MATERIALS METAL
ALLOYS OR LATEX 4HESE ON THE
OTHER HAND WILL CAUSE A HEIGHT
ENED IMMUNE RESPONSE IN THE
FORM OF AN ALLERGIC REACTION
4HIS MAY ALSO INTERFERE WITH THE
HEALING PROCESS 4HEREFORE
THE SURGEON SHOULD ALWAYS
CHECK BEFOREHAND ON A
PATIENTgS ALLERGIES
#(2/.)# $)3%!3%
! PATIENT WHOSE SYSTEM HAS
ALREADY BEEN STRESSED BY CHRONIC
ILLNESS ESPECIALLY ENDOCRINE
DISORDERS DIABETES MALIGNANCIES
LOCALIZED INFECTION OR DEBILITATING
INJURIES WILL HEAL MORE SLOWLY AND
WILL BE MORE VULNERABLE TO POST
SURGICAL WOUND COMPLICATIONS
!LL OF THESE CONDITIONS MERIT
CONCERN AND THE SURGEON MUST
CONSIDER THEIR EFFECTS UPON THE
TISSUES AT THE WOUND SITE AS WELL
AS THEIR POTENTIAL IMPACT UPON
THE PATIENTgS OVERALL RECOVERY
FROM THE PROCEDURE
-ALIGNANCIES IN ADDITION MAY
ALTER THE CELLULAR STRUCTURE OF
TISSUE AND INFLUENCE THE
SURGEONgS CHOICE OF METHODS AND
CLOSURE MATERIALS
2!$)!4)/. 4(%2!09
2ADIATION THERAPY TO THE SURGICAL
SITE PRIOR TO OR SHORTLY AFTER
SURGERY CAN PRODUCE CONSIDERABLE
IMPAIRMENT OF HEALING AND LEAD
TO SUBSTANTIAL WOUND COMPLICA
TIONS 3URGICAL PROCEDURES FOR
MALIGNANCIES MUST BE PLANNED
TO MINIMIZE THE POTENTIAL FOR
THESE PROBLEMS
4RADEMARK
7/5.$ (%!,).'
352')#!, 02).#)0,%3
-ANY FACTORS THAT AFFECT THE HEALING
PROCESS CAN BE CONTROLLED BY THE
SURGICAL TEAM IN THE OPERATING ROOM
BY THE OBSTETRICAL TEAM IN LABOR AND
DELIVERY OR BY THE EMERGENCY TEAM
IN THE TRAUMA CENTER 4HEIR FIRST
PRIORITY IS TO MAINTAIN A STERILE
AND ASEPTIC TECHNIQUE TO PREVENT
INFECTION /RGANISMS FOUND
WITHIN A PATIENTgS OWN BODY MOST
COMMONLY CAUSE POSTOPERATIVE
INFECTION BUT MICROORGANISMS
CARRIED BY MEDICAL PERSONNEL ALSO
POSE A THREAT 7HATEVER THE SOURCE
THE PRESENCE OF INFECTION WILL DETER
HEALING )N ADDITION TO CONCERNS
ABOUT STERILITY THE FOLLOWING MUST
BE TAKEN INTO CONSIDERATION WHEN
PLANNING AND CARRYING OUT AN
OPERATIVE PROCEDURE
4(% ,%.'4( !.$
$)2%#4)/. /& 4(%
).#)3)/. ! PROPERLY
PLANNED INCISION IS SUFFICIENTLY
LONG TO AFFORD SUFFICIENT OPTIMUM
EXPOSURE 7HEN DECIDING UPON
THE DIRECTION OF THE INCISION THE
SURGEON MUST BEAR THE FOLLOWING
IN MIND
s 4HE DIRECTION IN WHICH WOUNDS
NATURALLY HEAL IS FROM SIDE
TO
SIDE NOT END
TO
END
s 4HE ARRANGEMENT OF TISSUE FIBERS
IN THE AREA TO BE DISSECTED WILL
VARY WITH TISSUE TYPE
s 4HE BEST COSMETIC RESULTS MAY BE
ACHIEVED WHEN INCISIONS ARE MADE
PARALLEL TO THE DIRECTION OF THE
TISSUE FIBERS 2ESULTS MAY VARY
DEPENDING UPON THE TISSUE
LAYER INVOLVED
$)33%#4)/.
4%#(.)15% 7HEN INCISING
TISSUE A CLEAN INCISION SHOULD
BE MADE THROUGH THE SKIN WITH
ONE STROKE OF EVENLY APPLIED
PRESSURE ON THE SCALPEL 3HARP
DISSECTION SHOULD BE USED TO CUT
THROUGH REMAINING TISSUES 4HE
SURGEON MUST PRESERVE THE
INTEGRITY OF AS MANY OF THE
UNDERLYING NERVES BLOOD VESSELS
AND MUSCLES AS POSSIBLE
4)335% (!.$,).'
+EEPING TISSUE TRAUMA TO A
MINIMUM PROMOTES FASTER
HEALING 4HROUGHOUT THE
OPERATIVE PROCEDURE THE SURGEON
MUST HANDLE ALL TISSUES VERY
GENTLY AND AS LITTLE AS POSSIBLE
2ETRACTORS SHOULD BE PLACED WITH
CARE TO AVOID EXCESSIVE PRESSURE
SINCE TENSION CAN CAUSE SERIOUS
COMPLICATIONS IMPAIRED BLOOD
AND LYMPH FLOW ALTERING OF THE
LOCAL PHYSIOLOGICAL STATE OF THE
WOUND AND PREDISPOSITION TO
MICROBIAL COLONIZATION
(%-/34!3)3 6ARIOUS
MECHANICAL THERMAL AND
CHEMICAL METHODS ARE AVAILABLE TO
DECREASE THE FLOW OF BLOOD AND
FLUID INTO THE WOUND SITE
(EMOSTASIS ALLOWS THE SURGEON TO
WORK IN AS CLEAR A FIELD AS POSSIBLE
WITH GREATER ACCURACY 7ITHOUT
ADEQUATE CONTROL BLEEDING FROM
TRANSECTED OR PENETRATED VESSELS
OR DIFFUSED OOZING ON LARGE
DENUDED SURFACES MAY INTERFERE
WITH THE SURGEONgS VIEW OF
UNDERLYING STRUCTURES
!CHIEVING COMPLETE HEMOSTASIS
BEFORE WOUND CLOSURE ALSO WILL
PREVENT FORMATION OF POSTOPERA
TIVE HEMATOMAS #OLLECTIONS OF
BLOOD HEMATOMAS OR FLUID
SEROMAS IN THE INCISION CAN
PREVENT THE DIRECT APPOSITION OF
TISSUE NEEDED FOR COMPLETE UNION
OF WOUND EDGES &URTHERMORE
THESE COLLECTIONS PROVIDE AN IDEAL
CULTURE MEDIUM FOR MICROBIAL
GROWTH AND CAN LEAD TO SERIOUS
INFECTION
7HEN CLAMPING OR LIGATING A
VESSEL OR TISSUE CARE MUST BE
TAKEN TO AVOID EXCESSIVE TISSUE
DAMAGE -ASS LIGATION THAT
INVOLVES LARGE AREAS OF TISSUE MAY
PRODUCE NECROSIS OR TISSUE DEATH
AND PROLONG HEALING TIME
-!).4!).).' -/)3452%
). 4)335%3 $URING LONG
PROCEDURES THE SURGEON MAY
PERIODICALLY IRRIGATE THE WOUND
WITH WARM PHYSIOLOGIC NORMAL
SALINE SOLUTION OR COVER EXPOSED
SURFACES WITH SALINE
MOISTENED
SPONGES OR LAPAROTOMY TAPES TO
PREVENT TISSUES FROM DRYING OUT
2%-/6!, /& .%#2/4)#
4)335% !.$ &/2%)'.
-!4%2)!,3 !DEQUATE
DEBRIDEMENT OF ALL DEVITALIZED
TISSUE AND REMOVAL OF INFLICTED
FOREIGN MATERIALS ARE ESSENTIAL
TO HEALING ESPECIALLY IN TRAUMATIC
WOUNDS 4HE PRESENCE OF
FRAGMENTS OF DIRT METAL GLASS
ETC INCREASES THE PROBABILITY
OF INFECTION
#(/)#% /& #,/352%
-!4%2)!,3 4HE SURGEON
MUST EVALUATE EACH CASE INDIVIDU
ALLY AND CHOOSE CLOSURE MATERIAL
WHICH WILL MAXIMIZE THE
OPPORTUNITY FOR HEALING AND
MINIMIZE THE LIKELIHOOD OF
INFECTION 4HE PROPER CLOSURE
#(!04%2
MATERIAL WILL ALLOW THE SURGEON
TO APPROXIMATE TISSUE WITH AS
LITTLE TRAUMA AS POSSIBLE AND WITH
ENOUGH PRECISION TO ELIMINATE
DEAD SPACE 4HE SURGEONgS
PERSONAL PREFERENCE WILL PLAY A
LARGE ROLE IN THE CHOICE OF CLOSURE
MATERIAL BUT THE LOCATION OF THE
WOUND THE ARRANGEMENT OF TISSUE
FIBERS AND PATIENT FACTORS INFLU
ENCE HIS OR HER DECISION AS WELL
#%,,5,!2 2%30/.3% 4/
#,/352% -!4%2)!,3
7HENEVER FOREIGN MATERIALS SUCH
AS SUTURES ARE IMPLANTED IN TISSUE
THE TISSUE REACTS 4HIS REACTION
WILL RANGE FROM MINIMAL TO
MODERATE DEPENDING UPON THE
TYPE OF MATERIAL IMPLANTED 4HE
REACTION WILL BE MORE MARKED IF
COMPLICATED BY INFECTION ALLERGY
OR TRAUMA
NITIALLY THE TISSUE WILL DEFLECT THE
PASSAGE OF THE SURGEONgS NEEDLE
AND SUTURE /NCE THE SUTURES
HAVE BEEN IMPLANTED EDEMA OF
THE SKIN AND SUBCUTANEOUS TISSUES
WILL ENSUE 4HIS CAN CAUSE
SIGNIFICANT PATIENT DISCOMFORT
DURING RECOVERY AS WELL AS
SCARRING SECONDARY TO ISCHEMIC
NECROSIS 4HE SURGEON MUST TAKE
THESE FACTORS INTO CONSIDERATION
WHEN PLACING TENSION UPON THE
CLOSURE MATERIAL
BLOOD SUPPLY 3ERUM OR BLOOD
MAY COLLECT PROVIDING AN IDEAL
MEDIUM FOR THE GROWTH
OF MICROORGANISMS THAT CAUSE
INFECTION 4HE SURGEON MAY
ELECT TO INSERT A DRAIN OR APPLY
A PRESSURE DRESSING TO HELP
ELIMINATE DEAD SPACE IN THE
WOUND POSTOPERATIVELY
4ENDONS AND THE EXTREMITIES MAY
ALSO BE SUBJECTED TO EXCESSIVE
TENSION DURING HEALING 4HE
SURGEON MUST BE CERTAIN THAT
THE APPROXIMATED WOUND IS
ADEQUATELY IMMOBILIZED TO
PREVENT SUTURE DISRUPTION
FOR A SUFFICIENT PERIOD OF TIME
AFTER SURGERY
#,/3).' 4%.3)/.
7HILE ENOUGH TENSION MUST BE
APPLIED TO APPROXIMATE TISSUE AND
ELIMINATE DEAD SPACE THE SUTURES
MUST BE LOOSE ENOUGH TO PREVENT
EXAGGERATED PATIENT DISCOMFORT
ISCHEMIA AND TISSUE NECROSIS
DURING HEALING
)--/"),):!4)/.
!DEQUATE IMMOBILIZATION OF THE
APPROXIMATED WOUND BUT NOT
NECESSARILY OF THE ENTIRE ANATOMIC
PART IS MANDATORY AFTER SURGERY
FOR EFFICIENT HEALING AND MINIMAL
SCAR FORMATION
0/34/0%2!4)6%
$)342!#4)/. &/2#%3
4HE PATIENTgS POSTOPERATIVE
ACTIVITY CAN PLACE UNDUE STRESS
UPON A HEALING INCISION
!BDOMINAL FASCIA WILL BE PLACED
UNDER EXCESSIVE TENSION AFTER
SURGERY IF THE PATIENT STRAINS TO
COUGH VOMIT VOID OR DEFECATE
#,!33)&)#!4)/.
/& 7/5.$3
4HE #ENTERS FOR $ISEASE #ONTROL
AND 0REVENTION #$# USING AN
ADAPTATION OF THE !MERICAN #OLLEGE
OF 3URGEONS WOUND CLASSIFICATION
SCHEMA DIVIDES SURGICAL WOUNDS
INTO FOUR CLASSES CLEAN WOUNDS
CLEAN
CONTAMINATED WOUNDS
&)'52%
$%!$ 30!#%
). ! 7/5.$
%,)-).!4)/. /& $%!$
30!#% ). 4(% 7/5.$
$EAD SPACE IN A WOUND RESULTS
FROM SEPARATION OF PORTIONS OF
THE WOUND BENEATH THE SKIN
EDGES WHICH HAVE NOT BEEN
CLOSELY APPROXIMATED OR FROM AIR
OR FLUID TRAPPED BETWEEN LAYERS OF
TISSUE 4HIS IS ESPECIALLY TRUE IN
THE FATTY LAYER WHICH TENDS TO LACK
4RADEMARK
7/5.$ (%!,).'
CONTAMINATED WOUNDS AND DIRTY OR
INFECTED WOUNDS ! DISCUSSION OF
EACH FOLLOWS
CONTAMINATED BY ENTRY INTO A
VISCUS RESULTING IN MINIMAL SPILLAGE
OF CONTENTS
3EVENTY
FIVE PERCENT OF ALL WOUNDS
WHICH ARE USUALLY ELECTIVE SURGICAL
INCISIONS FALL INTO THE CLEAN WOUNDS
CATEGORYAN UNINFECTED OPERATIVE
WOUND IN WHICH NO INFLAMMATION
IS ENCOUNTERED AND THE RESPIRATORY
ALIMENTARY GENITAL OR UNINFECTED
URINARY TRACTS ARE NOT ENTERED
4HESE ELECTIVE INCISIONS ARE MADE
UNDER ASEPTIC CONDITIONS AND ARE
NOT PREDISPOSED TO INFECTION
)NFLAMMATION IS A NATURAL PART OF
THE HEALING PROCESS AND SHOULD BE
DIFFERENTIATED FROM INFECTION IN
WHICH BACTERIA ARE PRESENT AND
PRODUCE DAMAGE
#ONTAMINATED WOUNDS INCLUDE
OPEN TRAUMATIC WOUNDS OR INJURIES
SUCH AS SOFT TISSUE LACERATIONS OPEN
FRACTURES AND PENETRATING WOUNDS
OPERATIVE PROCEDURES IN WHICH GROSS
SPILLAGE FROM THE GASTROINTESTINAL
TRACT OCCURS GENITOURINARY OR BILIARY
TRACT PROCEDURES IN THE PRESENCE
OF INFECTED URINE OR BILE AND
OPERATIONS IN WHICH A MAJOR BREAK
IN ASEPTIC TECHNIQUE HAS OCCURRED
AS IN EMERGENCY OPEN CARDIAC
MASSAGE -ICROORGANISMS
MULTIPLY SO RAPIDLY THAT WITHIN
HOURS A CONTAMINATED WOUND
CAN BECOME INFECTED
#LEAN WOUNDS ARE CLOSED BY PRIMARY
UNION AND USUALLY ARE NOT DRAINED
0RIMARY UNION IS THE MOST DESIRABLE
METHOD OF CLOSURE INVOLVING THE
SIMPLEST SURGICAL PROCEDURES AND
THE LOWEST RISK OF POSTOPERATIVE
COMPLICATIONS !PPOSITION OF TISSUE
IS MAINTAINED UNTIL WOUND TENSILE
STRENGTH IS SUFFICIENT SO THAT SUTURES
OR OTHER FORMS OF TISSUE APPOSITION
ARE NO LONGER NEEDED
$IRTY AND INFECTED WOUNDS HAVE
BEEN HEAVILY CONTAMINATED OR
CLINICALLY INFECTED PRIOR TO THE
OPERATION 4HEY INCLUDE PERFORATED
VISCERA ABSCESSES OR NEGLECTED
TRAUMATIC WOUNDS IN WHICH
DEVITALIZED TISSUE OR FOREIGN MATERIAL
HAVE BEEN RETAINED )NFECTION
PRESENT AT THE TIME OF SURGERY CAN
INCREASE THE INFECTION RATE OF ANY
WOUND BY AN AVERAGE OF FOUR TIMES
#LEAN CONTAMINATED WOUNDS ARE
OPERATIVE WOUNDS IN WHICH THE
RESPIRATORY ALIMENTARY GENITAL OR
URINARY TRACTS ARE ENTERED UNDER
CONTROLLED CONDITIONS AND WITHOUT
UNUSUAL CONTAMINATION 3PECIFICALLY
OPERATIONS INVOLVING THE BILIARY
TRACT APPENDIX VAGINA AND
OROPHARYNX ARE INCLUDED IN THIS
CATEGORY PROVIDED NO EVIDENCE
OF INFECTION OR MAJOR BREAK IN
TECHNIQUE IS ENCOUNTERED
!PPENDECTOMIES CHOLECYSTECTOMIES
AND HYSTERECTOMIES FALL INTO THIS
CATEGORY AS WELL AS NORMALLY
CLEAN WOUNDS WHICH BECOME
490%3 /&
7/5.$ (%!,).'
4HE RATE AND PATTERN OF HEALING FALLS
INTO THREE CATEGORIES DEPENDING
UPON THE TYPE OF TISSUE INVOLVED
AND THE CIRCUMSTANCES SURROUNDING
CLOSURE 4IMEFRAMES ARE GENERALIZED
FOR WELL
PERFUSED HEALTHY SOFT
TISSUES BUT MAY VARY
(%!,).' "9
02)-!29 ).4%.4)/.
%VERY SURGEON WHO CLOSES A WOUND
WOULD LIKE IT TO HEAL BY PRIMARY
UNION OR FIRST INTENTION WITH
MINIMAL EDEMA AND NO LOCAL
INFECTION OR SERIOUS DISCHARGE !N
INCISION THAT HEALS BY PRIMARY
INTENTION DOES SO IN A MINIMUM OF
TIME WITH NO SEPARATION OF THE
WOUND EDGES AND WITH MINIMAL
SCAR FORMATION 4HIS TAKES PLACE IN
THREE DISTINCT PHASES
)NFLAMMATORY PREPARATIVE n
$URING THE FIRST FEW DAYS AN
INFLAMMATORY RESPONSE CAUSES AN
OUTPOURING OF TISSUE FLUIDS AN
ACCUMULATION OF CELLS AND
FIBROBLASTS AND AN INCREASED BLOOD
SUPPLY TO THE WOUND ,EUKOCYTES
AND OTHER CELLS PRODUCE PROTEOLYTIC
ENZYMES WHICH DISSOLVE AND REMOVE
DAMAGED TISSUE DEBRIS 4HESE ARE
THE RESPONSES WHICH PREPARE THE SITE
OF INJURY FOR REPAIR 4HE PROCESS
LASTS TO DAYS !NY FACTOR WHICH
INTERFERES WITH THE PROGRESS MAY
INTERRUPT OR DELAY HEALING $URING
THE ACUTE INFLAMMATORY PHASE THE
TISSUE DOES NOT GAIN APPRECIABLE
TENSILE STRENGTH BUT DEPENDS SOLELY
UPON THE CLOSURE MATERIAL TO HOLD IT
IN APPROXIMATION
0ROLIFERATIVE n !FTER THE
DEBRIDEMENT PROCESS IS WELL ALONG
FIBROBLASTS BEGIN TO FORM A COLLAGEN
MATRIX IN THE WOUND KNOWN AS
GRANULATION TISSUE #OLLAGEN A
PROTEIN SUBSTANCE IS THE CHIEF
CONSTITUENT OF CONNECTIVE TISSUE
#OLLAGEN FIBER FORMATION DETERMINES
THE TENSILE STRENGTH AND PLIABILITY OF
THE HEALING WOUND !S IT FILLS WITH
NEW BLOOD VESSELS THE GRANULATION
BECOMES BRIGHT BEEFY RED TISSUE
4HE THICK CAPILLARY BED WHICH FILLS
#(!04%2
$AMAGED
TISSUE
DEBRIS
&IBROBLASTS
4ISSUE FLUIDS
&)'52%
0(!3%3 /&
7/5.$
(%!,).'
0ROTEOLYTIC
ENZYMES
#OLLAGEN FIBERS
)NCREASED BLOOD SUPPLY
0(!3% n
)NFLAMMATORY RESPONSE AND
DEBRIDEMENT PROCESS
0(!3% n
#OLLAGEN FORMATION
SCAR TISSUE
THE MATRIX SUPPLIES THE NUTRIENTS
AND OXYGEN NECESSARY FOR THE WOUND
TO HEAL 4HIS PHASE OCCURS FROM
DAY ONWARD
)N TIME SUFFICIENT COLLAGEN IS LAID
DOWN ACROSS THE WOUND SO THAT IT
CAN WITHSTAND NORMAL STRESS 4HE
LENGTH OF THIS PHASE VARIES WITH THE
TYPE OF TISSUE INVOLVED AND THE
STRESSES OR TENSION PLACED UPON THE
WOUND DURING THIS PERIOD
7OUND CONTRACTION ALSO OCCURS DUR
ING THIS PHASE 7OUND CONTRACTION
IS A PROCESS THAT PULLS THE WOUND
EDGES TOGETHER FOR THE PURPOSE OF
CLOSING THE WOUND )N ESSENCE IT
REDUCES THE OPEN AREA AND IF
SUCCESSFUL WILL RESULT IN A SMALLER
WOUND WITH LESS NEED FOR REPAIR BY
SCAR FORMATION 7OUND CONTRACTION
CAN BE VERY BENEFICIAL IN THE CLOSURE
OF WOUNDS IN AREAS SUCH AS THE BUT
TOCKS OR TROCHANTER BUT CAN BE VERY
HARMFUL IN AREAS SUCH AS THE HAND
OR AROUND THE NECK AND FACE WHERE
IT CAN CAUSE DISFIGUREMENT AND
EXCESSIVE SCARRING
3URGICAL WOUNDS THAT ARE CLOSED
BY PRIMARY INTENTION HAVE MINIMAL
CONTRACTION RESPONSE 3KIN GRAFTING
IS USED TO REDUCE AVOIDED CONTRAC
TION IN UNDESIRABLE LOCATIONS
0(!3% n
3UFFICIENT COLLAGEN LAID DOWN
2EMODELLING n !S COLLAGEN DEPOSI
TION IS COMPLETED THE VASCULARITY OF
THE WOUND GRADUALLY DECREASES AND
ANY SURFACE SCAR BECOMES PALER 4HE
AMOUNT OF COLLAGEN THAT IS FINALLY
FORMED n THE ULTIMATE SCAR n IS
DEPENDENT UPON THE INITIAL VOLUME
OF GRANULATION TISSUE
(%!,).' "9
3%#/.$ ).4%.4)/.
7HEN THE WOUND FAILS TO HEAL BY
PRIMARY UNION A MORE COMPLICATED
AND PROLONGED HEALING PROCESS TAKES
PLACE (EALING BY SECOND INTENTION
IS CAUSED BY INFECTION EXCESSIVE
TRAUMA TISSUE LOSS OR IMPRECISE
APPROXIMATION OF TISSUE
)N THIS CASE THE WOUND MAY BE LEFT
OPEN AND ALLOWED TO HEAL FROM THE
INNER LAYER TO THE OUTER SURFACE
'RANULATION TISSUE FORMS AND
CONTAINS MYOFIBROBLASTS 4HESE
SPECIALIZED CELLS HELP TO CLOSE THE
WOUND BY CONTRACTION 4HIS
PROCESS IS MUCH SLOWER THAN PRIMARY
INTENTION HEALING %XCESSIVE
GRANULATION TISSUE MAY BUILD UP
AND REQUIRE TREATMENT IF IT PROTRUDES
ABOVE THE SURFACE OF THE WOUND
PREVENTING EPITHELIALIZATION
$%,!9%$ 02)-!29
#,/352%
4HIS IS CONSIDERED BY MANY
SURGEONS TO BE A SAFE METHOD OF
MANAGEMENT OF CONTAMINATED AS
WELL AS DIRTY AND INFECTED TRAUMATIC
WOUNDS WITH EXTENSIVE TISSUE LOSS
AND A HIGH RISK OF INFECTION 4HIS
METHOD HAS BEEN USED EXTENSIVELY IN
THE MILITARY ARENA AND HAS PROVEN
SUCCESSFUL FOLLOWING EXCESSIVE
TRAUMA RELATED TO MOTOR VEHICLE
ACCIDENTS SHOOTING INCIDENTS OR
INFLICTION OF DEEP PENETRATING
KNIFE WOUNDS
4HE SURGEON USUALLY TREATS THESE
INJURIES BY DEBRIDEMENT OF
NONVIABLE TISSUES AND LEAVES THE
WOUND OPEN INSERTING GAUZE
PACKING WHICH IS CHANGED TWICE A
DAY 0ATIENTS SEDATION OR A RETURN TO
THE OPERATING ROOM WITH GENERAL
ANESTHESIA GENERALLY IS ONLY REQUIRED
IN THE CASE OF LARGE COMPLEX
WOUNDS 7OUND APPROXIMATION
USING ADHESIVE STRIPS PREVIOUSLY
PLACED BUT UNTIED SUTURES STAPLES
AFTER ACHIEVING LOCAL ANESTHESIA CAN
OCCUR WITHIN
DAYS IF THE WOUND
DEMONSTRATES NO EVIDENCE OF
INFECTION AND THE APPEARANCE OF RED
GRANULATION TISSUE 3HOULD THIS NOT
4RADEMARK
7/5.$ (%!,).'
OCCUR THE WOUND IS ALLOWED TO
HEAL BY SECONDARY INTENTION 7HEN
CLOSURE IS UNDERTAKEN SKIN EDGES
AND UNDERLYING TISSUE MUST BE ACCU
RATELY AND SECURELY APPROXIMATED
). 4(%
.%84 3%#4)/.
4HE MATERIALS DEVICES AND
TECHNIQUES USED TO REPAIR WOUNDED
TISSUE WILL BE DISCUSSED AT LENGTH
!S YOU WILL SEE THE NUMBER OF
OPTIONS AVAILABLE IS EXTENSIVE "UT
NO MATTER HOW MANY CHOICES THE
SURGEON HAS HIS OR HER OBJECTIVE
REMAINS SINGULAR TO RESTORE THE
PATIENT TO HEALTH WITH AS LITTLE
OPERATIVE TRAUMA AS POSSIBLE AND
AN EXCELLENT COSMETIC RESULT
2%&%2%.#%3
3TEDMANS -EDICAL $ICTIONARY
TH EDITION
(ENRY -ICHAEL AND 4HOMPSON
*EREMY #LINICAL 3URGERY 7"
3AUNDERS
3KERRIS $AVID ! -AYO #LINIC
"ASIC 3URGERY 3KILLS -AYO #LINIC
3CIENTIFIC 0RESS
3USSMAN #ARRIE 7OUND #ARE
!SPEN 0UBLISHERS
..)3 -ANUAL #$#
-(!
CHAPTER 2
THE SUTURE
4(% 35452%
7(!4 )3
! 35452%
4HE WORD SUTURE DESCRIBES ANY
STRAND OF MATERIAL USED TO LIGATE TIE
BLOOD VESSELS OR APPROXIMATE BRING
CLOSE TOGETHER TISSUES 3UTURES ARE
USED TO CLOSE WOUNDS 3UTURES AND
LIGATURES WERE USED BY BOTH THE
%GYPTIANS AND 3YRIANS AS FAR BACK AS
"# 4HROUGH THE CENTURIES A
WIDE VARIETY OF MATERIALSSILK
LINEN COTTON HORSEHAIR ANIMAL
TENDONS AND INTESTINES AND WIRE
MADE OF PRECIOUS METALSHAVE BEEN
USED IN OPERATIVE PROCEDURES 3OME
OF THESE ARE STILL IN USE TODAY
4HE EVOLUTION OF SUTURING MATERIAL
HAS BROUGHT US TO A POINT OF REFINE
MENT THAT INCLUDES SUTURES DESIGNED
FOR SPECIFIC SURGICAL PROCEDURES
$ESPITE THE SOPHISTICATION OF
TODAYgS SUTURE MATERIALS AND SURGICAL
TECHNIQUES CLOSING A WOUND STILL
INVOLVES THE SAME BASIC PROCEDURE
USED BY PHYSICIANS TO THE 2OMAN
EMPERORS 4HE SURGEON STILL USES A
SURGICAL NEEDLE TO PENETRATE TISSUE
AND ADVANCE A SUTURE STRAND TO ITS
DESIRED LOCATION
3UCCESSFUL USE OF SUTURE MATERIALS
DEPENDS UPON THE COOPERATION OF
THE SUTURE MANUFACTURER AND THE
SURGICAL TEAM
4HE MANUFACTURER MUST HAVE A
THOROUGH KNOWLEDGE OF SURGICAL
PROCEDURES ANTICIPATE THE SURGICAL
TEAMgS NEEDS AND PRODUCE SUTURE
MATERIALS THAT MEET THESE
STRINGENT CRITERIA
s 4HEY MUST HAVE THE GREATEST
TENSILE STRENGTH CONSISTENT WITH
SIZE LIMITATIONS
s 4HEY MUST BE EASY TO HANDLE
s 4HEY MUST BE SECURED IN
PACKAGING WHICH PRESENTS THEM
STERILE FOR USE IN EXCELLENT
CONDITION AND ENSURES THE
SAFETY OF EACH MEMBER OF THE
SURGICAL TEAM
4HE NURSE MUST MAINTAIN THE
STERILITY OF SUTURES WHEN STORING
HANDLING AND PREPARING THEM FOR
USE 4HE INTEGRITY AND STRENGTH OF
EACH STRAND MUST REMAIN INTACT
UNTIL IT IS IN THE SURGEONgS HANDS
4HE SURGEON MUST SELECT SUTURE
MATERIALS APPROPRIATE FOR THE
PROCEDURE AND MUST PLACE THEM
IN THE TISSUES IN A MANNER CONSISTENT
WITH THE PRINCIPLES THAT PROMOTE
WOUND HEALING
7ITH THE MANUFACTURER AND
SURGICAL TEAM WORKING IN CONCERT
THE PATIENT REAPS THE FINAL
BENEFITTHE WOUND IS CLOSED IN A
MANNER THAT PROMOTES OPTIMUM
HEALING IN MINIMUM TIME
0%23/.!, 35452%
02%&%2%.#%
-OST SURGEONS HAVE A BASIC
SUTURE ROUTINE A PREFERENCE FOR
USING THE SAME MATERIALS UNLESS
CIRCUMSTANCES DICTATE OTHERWISE
4HE SURGEON ACQUIRES SKILL
PROFICIENCY AND SPEED IN HANDLING
BY USING ONE SUTURE MATERIAL
REPEATEDLYAND MAY CHOOSE
THE SAME MATERIAL THROUGHOUT HIS
OR HER ENTIRE CAREER
! NUMBER OF FACTORS MAY INFLUENCE
THE SURGEONS CHOICE OF MATERIALS
s (IS OR HER AREA OF SPECIALIZATION
s 7OUND CLOSURE EXPERIENCE DURING
CLINICAL TRAINING
s 0ROFESSIONAL EXPERIENCE IN THE
OPERATING ROOM
s +NOWLEDGE OF THE HEALING
CHARACTERISTICS OF TISSUES AND
ORGANS
s +NOWLEDGE OF THE PHYSICAL AND
BIOLOGICAL CHARACTERISTICS OF
VARIOUS SUTURE MATERIALS
s 0ATIENT FACTORS AGE WEIGHT
OVERALL HEALTH STATUS AND THE
PRESENCE OF INFECTION
3URGICAL SPECIALTY PLAYS A PRIMARY ROLE
IN DETERMINING SUTURE PREFERENCE &OR
EXAMPLE OBSTETRICIANGYNECOLOGISTS
FREQUENTLY PREFER COATED 6)#29,
2!0)$% POLYGLACTIN SUTURE
FOR EPISIOTOMY REPAIR AND COATED
6)#29,
POLYGLACTIN SUTURE
COATED 6)#29,
0LUS !NTIBACTERIAL
POLYGLACTIN SUTURE AND
-/./#29,
POLIGLECAPRONE
SUTURE FOR ALL TISSUE LAYERS EXCEPT
POSSIBLY SKIN -OST ORTHOPAEDIC
SURGEONS USE COATED 6)#29, SUTURE
COATED 6)#29, 0LUS 0$3
))
POLYDIOXANONE SUTURE AND
%4()"/.$
%8#%, POLYESTER
SUTURE -ANY PLASTIC SURGEONS PREFER
%4(),/.
NYLON SUTURE 6)#29,
SUTURE OR -/./#29, SUTURE
-ANY NEUROSURGEONS PREFER COATED
6)#29, SUTURE OR .52/,/.
NYLON SUTURE "UT NO SINGLE SUTURE
MATERIAL IS USED BY EVERY SURGEON WHO
PRACTICES WITHIN A SPECIALTY
4HE SURGEONgS KNOWLEDGE OF THE
PHYSICAL CHARACTERISTICS OF SUTURE
MATERIAL IS IMPORTANT !S THE
REQUIREMENTS FOR WOUND SUPPORT VARY
WITH PATIENT FACTORS THE NATURE OF THE
#(!04%2
-/./&),!-%.4 63
-5,4)&),!-%.4 342!.$3
3UTURES ARE CLASSIFIED ACCORDING TO
THE NUMBER OF STRANDS OF WHICH
THEY ARE COMPRISED -ONOFILAMENT
SUTURES ARE MADE OF A SINGLE STRAND
OF MATERIAL "ECAUSE OF THEIR
SIMPLIFIED STRUCTURE THEY ENCOUNTER
LESS RESISTANCE AS THEY PASS
THROUGH TISSUE THAN MULTIFILAMENT
SUTURE MATERIAL 4HEY ALSO RESIST
HARBORING ORGANISMS WHICH MAY
CAUSE INFECTION
3):% !.$ 4%.3),%
342%.'4(
3IZE DENOTES THE DIAMETER OF THE
SUTURE MATERIAL 4HE ACCEPTED
SURGICAL PRACTICE IS TO USE THE
SMALLEST DIAMETER SUTURE THAT
WILL ADEQUATELY HOLD THE MENDING
WOUNDED TISSUE 4HIS PRACTICE
MINIMIZES TRAUMA AS THE SUTURE IS
PASSED THROUGH THE TISSUE TO EFFECT
CLOSURE )T ALSO ENSURES THAT THE
MINIMUM MASS OF FOREIGN MATERIAL
IS LEFT IN THE BODY 3UTURE SIZE IS
STATED NUMERICALLY AS THE NUMBER OF
S IN THE SUTURE SIZE INCREASES THE
DIAMETER OF THE STRAND DECREASES &OR
EXAMPLE SIZE
OR IS
SMALLER IN DIAMETER THAN SIZE
OR
4HE SMALLER THE SIZE THE LESS
TENSILE STRENGTH THE SUTURE WILL HAVE
PROCEDURE AND THE TYPE OF TISSUE
INVOLVED THE SURGEON WILL SELECT
SUTURE MATERIAL THAT WILL RETAIN ITS
STRENGTH UNTIL THE WOUND HEALS
SUFFICIENTLY TO WITHSTAND STRESS ON
ITS OWN
35452%
#(!2!#4%2)34)#3
4HE CHOICE OF SUTURE MATERIALS GEN
ERALLY DEPENDS ON WHETHER THE
WOUND CLOSURE OCCURS IN ONE OR
MORE LAYERS )N SELECTING THE MOST
APPROPRIATE SUTURES THE SURGEON
TAKES INTO ACCOUNT THE AMOUNT OF
TENSION ON THE WOUND THE NUMBER
OF LAYERS OF CLOSURE DEPTH OF SUTURE
PLACEMENT ANTICIPATED AMOUNT OF
EDEMA AND ANTICIPATED TIMING OF
SUTURE REMOVAL
4HESE CHARACTERISTICS MAKE
MONOFILAMENT SUTURES WELL
SUITED
TO VASCULAR SURGERY -ONOFILAMENT
SUTURES TIE DOWN EASILY (OWEVER
BECAUSE OF THEIR CONSTRUCTION
EXTREME CARE MUST BE TAKEN WHEN
HANDLING AND TYING THESE SUTURES
#RUSHING OR CRIMPING OF THIS SUTURE
TYPE CAN NICK OR CREATE A WEAK SPOT
IN THE STRAND 4HIS MAY RESULT IN
SUTURE BREAKAGE
+NOT TENSILE STRENGTH IS MEASURED BY
THE FORCE IN POUNDS WHICH THE
SUTURE STRAND CAN WITHSTAND BEFORE
IT BREAKS WHEN KNOTTED 4HE TENSILE
STRENGTH OF THE TISSUE TO BE MENDED
ITS ABILITY TO WITHSTAND STRESS
DETERMINES THE SIZE AND TENSILE
STRENGTH OF THE SUTURING MATERIAL THE
SURGEON SELECTS 4HE ACCEPTED RULE IS
THAT THE TENSILE STRENGTH OF THE
SUTURE NEED NEVER EXCEED THE TENSILE
STRENGTH OF THE TISSUE (OWEVER
SUTURES SHOULD BE AT LEAST AS STRONG
AS NORMAL TISSUE THROUGH WHICH THEY
ARE BEING PLACED
/PTIMAL SUTURE QUALITIES INCLUDE
(IGH UNIFORM TENSILE STRENGTH
PERMITTING USE OF FINER SIZES
(IGH TENSILE STRENGTH RETENTION
IN VIVO HOLDING THE WOUND
SECURELY THROUGHOUT THE CRITICAL
HEALING PERIOD FOLLOWED BY
RAPID ABSORPTION
#ONSISTENT UNIFORM DIAMETER
3TERILE
0LIABLE FOR EASE OF HANDLING AND
KNOT SECURITY
&REEDOM FROM IRRITATING
SUBSTANCES OR IMPURITIES FOR
OPTIMUM TISSUE ACCEPTANCE
0REDICTABLE PERFORMANCE
-ULTIFILAMENT SUTURES CONSIST OF
SEVERAL FILAMENTS OR STRANDS TWISTED
OR BRAIDED TOGETHER 4HIS AFFORDS
GREATER TENSILE STRENGTH PLIABILITY AND
FLEXIBILITY -ULTIFILAMENT SUTURES MAY
ALSO BE COATED TO HELP THEM PASS RELA
TIVELY SMOOTHLY THROUGH TISSUE AND
ENHANCE HANDLING CHARACTERISTICS
#OATED MULTIFILAMENT SUTURES ARE
WELL
SUITED TO INTESTINAL PROCEDURES
-%42)# -%!352%3 !.$ 530
35452% $)!-%4%2 %15)6!,%.43
4!",%
530 3IZE
.ATURAL
#OLLAGEN
nnn
nnn
nnn
3YNTHETIC
!BSORBABLES
nnn
nnn
.ONABSORBABLE
-ATERIALS
4RADEMARK
4(% 35452%
!"3/2"!",% 63
./.!"3/2"!",% 35452%3
3UTURES ARE CLASSIFIED ACCORDING TO
THEIR DEGRADATION PROPERTIES
3UTURES THAT UNDERGO RAPID DEGRADA
TION IN TISSUES LOSING THEIR TENSILE
STRENGTH WITHIN DAYS ARE
CONSIDERED ABSORBABLE SUTURES
3UTURES THAT GENERALLY MAINTAIN
THEIR TENSILE STRENGTH FOR LONGER THAN
DAYS ARE NONABSORBABLE SUTURES
35452%
2!7 -!4%2)!,
3URGICAL 'UT
0LAIN
#HROMIC
&AST !BSORBING
3UBMUCOSA OF SHEEP
INTESTINE OR SEROSA OF BEEF
INTESTINE
0OLYGLACTIN
5NCOATED 6)#29, 3UTURE
#OPOLYMER OF GLYCOLIDE AND
LACTIDE WITH POLYGLACTIN
AND CALCIUM STEARATE IF COATED
#OATED COATED 6)#29,
POLYGLACTIN SUTURE
COATED 6)#29, 0LUS SUTURE
COATED 6)#29,
2!0)$%
POLYGLACTIN SUTURE
!BSORBABLE SUTURES MAY BE USED TO
HOLD WOUND EDGES IN APPROXIMATION
TEMPORARILY UNTIL THEY HAVE HEALED
SUFFICIENTLY TO WITHSTAND NORMAL
STRESS 4HESE SUTURES ARE PREPARED
EITHER FROM THE COLLAGEN OF HEALTHY
MAMMALS OR FROM SYNTHETIC
POLYMERS 3OME ARE ABSORBED
RAPIDLY WHILE OTHERS ARE TREATED OR
CHEMICALLY STRUCTURED TO LENGTHEN
ABSORPTION TIME 4HEY MAY ALSO BE
IMPREGNATED OR COATED WITH AGENTS
THAT IMPROVE THEIR HANDLING
PROPERTIES AND COLORED WITH AN
&$!
APPROVED DYE TO INCREASE
VISIBILITY IN TISSUE .ATURAL
ABSORBABLE SUTURES ARE DIGESTED BY
BODY ENZYMES WHICH ATTACK AND
BREAK DOWN THE SUTURE STRAND
3YNTHETIC ABSORBABLE SUTURES ARE
HYDROLYZEDA PROCESS BY WHICH
WATER GRADUALLY PENETRATES THE
SUTURE FILAMENTS CAUSING THE
BREAKDOWN OF THE SUTUREgS POLYMER
CHAIN #OMPARED TO THE ENZYMATIC
ACTION OF NATURAL ABSORBABLES
HYDROLYZATION RESULTS IN A LESSER
DEGREE OF TISSUE REACTION FOLLOWING
IMPLANTATION
CONSIDERABLE OVERLAP CHARACTERIZED
BY LOSS OF SUTURE MASS "OTH STAGES
EXHIBIT LEUKOCYTIC CELLULAR RESPONSES
WHICH SERVE TO REMOVE CELLULAR
DEBRIS AND SUTURE MATERIAL FROM THE
LINE OF TISSUE APPROXIMATION
$URING THE FIRST STAGE OF THE
ABSORPTION PROCESS TENSILE STRENGTH
DIMINISHES IN A GRADUAL ALMOST
LINEAR FASHION 4HIS OCCURS OVER THE
FIRST SEVERAL WEEKS POSTIMPLANTATION
4HE SECOND STAGE OFTEN FOLLOWS WITH
!LTHOUGH THEY OFFER MANY
ADVANTAGES ABSORBABLE SUTURES ALSO
HAVE CERTAIN INHERENT LIMITATIONS
)F A PATIENT HAS A FEVER INFECTION
OR PROTEIN DEFICIENCY THE SUTURE
ABSORPTION PROCESS MAY ACCELERATE
0OLYGLYCOLIC !CID
(OMOPOLYMER OF GLYCOLIDE
0OLIGLECAPRONE
-/./#29, SUTURE
#OPOLYMER OF GLYCOLIDE AND
EPSILON
CAPROLACTONE
0OLYGLYCONATE
#OPOLYMER OF GLYCOLIDE AND
TRIMETHYLENE CARBONATE
0OLYDIOXANONE
0$3
)) SUTURE
0OLYESTER OF POLY P DIOXANONE
4HE LOSS OF TENSILE STRENGTH AND
THE RATE OF ABSORPTION ARE SEPARATE
PHENOMENA ! SUTURE CAN LOSE
TENSILE STRENGTH RAPIDLY AND YET BE
ABSORBED SLOWLYOR IT CAN
MAINTAIN ADEQUATE TENSILE STRENGTH
THROUGH WOUND HEALING FOLLOWED
BY RAPID ABSORPTION )N ANY CASE
THE STRAND IS EVENTUALLY COMPLETELY
DISSOLVED LEAVING NO DETECTABLE
TRACES IN TISSUE
4!",%
!"3/2"!",%
35452%3
"!3)# 2!7
-!4%2)!,3
CAUSING TOO RAPID A DECLINE IN TENSILE
STRENGTH )N ADDITION IF THE SUTURES
BECOME WET OR MOIST DURING
HANDLING PRIOR TO BEING IMPLANTED
IN TISSUE THE ABSORPTION PROCESS
MAY BEGIN PREMATURELY 3IMILARLY
PATIENTS WITH IMPAIRED HEALING
ARE OFTEN NOT IDEAL CANDIDATES
FOR THIS TYPE OF SUTURE !LL OF
THESE SITUATIONS PREDISPOSE TO
POSTOPERATIVE COMPLICATIONS AS
THE SUTURE STRAND WILL NOT MAINTAIN
ADEQUATE STRENGTH TO WITHSTAND
STRESS UNTIL THE TISSUES HAVE
HEALED SUFFICIENTLY
.ONABSORBABLE SUTURES ARE THOSE
WHICH ARE NOT DIGESTED BY BODY
ENZYMES OR HYDROLYZED IN BODY
TISSUE 4HEY ARE MADE FROM A VARIETY
OF NONBIODEGRADABLE MATERIALS AND
ARE ULTIMATELY ENCAPSULATED OR
WALLED OFF BY THE BODYS FIBROBLASTS
.ONABSORBABLE SUTURES ORDINARILY
REMAIN WHERE THEY ARE BURIED
#(!04%2
WITHIN THE TISSUES 7HEN USED FOR
SKIN CLOSURE THEY MUST BE REMOVED
POSTOPERATIVELY .ONABSORBABLE
SUTURES MAY BE USED IN A VARIETY
OF APPLICATIONS
s %XTERIOR SKIN CLOSURE TO BE
REMOVED AFTER SUFFICIENT HEALING
HAS OCCURRED
s 7ITHIN THE BODY CAVITY WHERE
THEY WILL REMAIN PERMANENTLY
ENCAPSULATED IN TISSUE
s 0ATIENT HISTORY OF REACTION TO
ABSORBABLE SUTURES KELOIDAL
TENDENCY OR POSSIBLE TISSUE
HYPERTROPHY
s 0ROSTHESIS ATTACHMENT
IE DEFIBRILLATORS PACEMAKERS
DRUG DELIVERY MECHANISMS
.ONABSORBABLE SUTURES ARE COM
POSED OF SINGLE OR MULTIPLE FILAMENTS
OF METAL SYNTHETIC OR ORGANIC FIBERS
RENDERED INTO A STRAND BY SPINNING
TWISTING OR BRAIDING %ACH STRAND IS
SUBSTANTIALLY UNIFORM IN DIAMETER
THROUGHOUT ITS LENGTH CONFORMING
TO THE 5NITED 3TATES 0HARMACOPEIA
530 LIMITATIONS FOR EACH SIZE
.ONABSORBABLE SUTURES HAVE BEEN
CLASSIFIED BY THE 530 ACCORDING TO
THEIR COMPOSITION )N ADDITION
THESE SUTURES MAY BE UNCOATED
OR COATED UNCOLORED NATURALLY
COLORED OR DYED WITH AN &$!
APPROVED DYE TO ENHANCE VISIBILITY
35452%
2!7 -!4%2)!,
3URGICAL 3ILK
2AW SILK SPUN BY SILKWORM
3TAINLESS 3TEEL 7IRE
3PECIALLY FORMULATED
IRON
CHROMIUM
NICKEL
MOLYBDENUM ALLOY
.YLON %4(),/.
NYLON
SUTURE .52/,/.
NYLON
SUTURE
0OLYAMIDE POLYMER
0OLYESTER &IBER
5NCOATED -%23),%.%
POLYESTER FIBER SUTURE
0OLYMER OF POLYETHYLENE
TEREPHTHALATE MAY BE COATED
4!",%
./.
!"3/2"!",%
35452%3 2!7
-!4%2)!,3
#OATED %4()"/.$
%8#%,
POLYESTER SUTURE
0OLYPROPYLENE 02/,%.%
POLYPROPYLENE SUTURE
0OLYMER OF PROPYLENE
0OLYHEXAFLUOROPROPYLENE
6$&
02/./6!
POLYHEXAFLUORO
PROPYLENE
6$& SUTURE
0OLYMER BLEND OF POLYVINYLIDENE
FLUORIDE AND POLYVINYLIDENE FLUO
RIDE
COHEXAFLUOROPROPYLENE
!BSORBABLE 3UTURES
3URGICAL 'UT
!BSORBABLE SURGICAL GUT IS CLASSIFIED
AS EITHER PLAIN OR CHROMIC "OTH
TYPES CONSIST OF PROCESSED STRANDS OF
HIGHLY PURIFIED COLLAGEN 4HE
PERCENTAGE OF COLLAGEN IN THE SUTURE
DETERMINES ITS TENSILE STRENGTH AND
ITS ABILITY TO BE ABSORBED BY THE
BODY WITHOUT ADVERSE REACTION
.ONCOLLAGENOUS MATERIAL CAN CAUSE
A REACTION RANGING FROM IRRITATION TO
REJECTION OF THE SUTURE 4HE MORE
PURE COLLAGEN THROUGHOUT THE
LENGTH OF THE STRAND THE LESS FOREIGN
MATERIAL THERE IS INTRODUCED INTO
THE WOUND
30%#)&)# 35452).' %4()#/.
SURGICAL GUT SUTURES ARE
MANUFACTURED FROM BETWEEN
-!4%2)!,3
4HE MATERIALS AND PRODUCTS
DESCRIBED HERE EMBODY THE MOST
CURRENT ADVANCES IN THE MANUFACTURE
OF SURGICAL SUTURES 4HEY ARE
GROUPED AS EITHER ABSORBABLE OR
NONABSORBABLE FOR EASY REFERENCE
AND PURE RIBBONS OF COLLAGEN
4O MEET 530 SPECIFICATIONS
PROCESSED RIBBONS OF THE SUBMUCOSA
LAYER OF SHEEP INTESTINE OR THE
SEROSA LAYER OF BEEF INTESTINE ARE
ELECTRONICALLY SPUN AND POLISHED
INTO VIRTUALLY MONOFILAMENT STRANDS
OF VARIOUS SIZES WITH MINIMUM AND
MAXIMUM LIMITS ON DIAMETER FOR
EACH SIZE 4HE %4()#/. EXCLUSIVE
425
'!5').' PROCESS PRODUCES
A UNIFORM DIAMETER TO WITHIN AN
ACCURACY OF INCH
MM ALONG THE ENTIRE
LENGTH OF EVERY STRAND ELIMINATING
HIGH AND LOW SPOTS (IGH AND LOW
SPOTS CAN CAUSE THE SUTURE TO FRAY
OR CHATTER WHEN KNOTS ARE TIED
DOWN RESULTING IN A KNOT THAT IS
NOT POSITIONED PROPERLY OR TIED
SECURELY -OST PROTEIN
BASED
ABSORBABLE SUTURES HAVE A TENDENCY
TO FRAY WHEN TIED
425
'!5').' ENSURES THAT
%4()#/. SURGICAL GUT SUTURES
POSSESS UNIFORM HIGH TENSILE
STRENGTH VIRTUALLY ELIMINATING THE
POSSIBILITY OF FRAY OR BREAKING 4HEIR
UNEXCEEDED STRENGTH AND SURFACE
SMOOTHNESS ALLOW THE SURGEON TO
SNUG DOWN THE SUTURE KNOT TO
ACHIEVE OPTIMUM TENSION
4HE RATE OF ABSORPTION OF SURGICAL
GUT IS DETERMINED BY THE TYPE OF
4RADEMARK
4(% 35452%
GUT BEING USED THE TYPE AND
CONDITION OF THE TISSUE INVOLVED
AND THE GENERAL HEALTH STATUS OF THE
PATIENT 3URGICAL GUT MAY BE USED IN
THE PRESENCE OF INFECTION ALTHOUGH
IT MAY BE ABSORBED MORE RAPIDLY
UNDER THIS CONDITION
0LAIN SURGICAL GUT IS RAPIDLY
ABSORBED 4ENSILE STRENGTH IS
MAINTAINED FOR ONLY TO DAYS
POSTIMPLANTATION AND ABSORPTION
IS COMPLETE WITHIN DAYS 4HE
SURGEON MAY CHOOSE PLAIN GUT FOR
USE IN TISSUES WHICH HEAL RAPIDLY
AND REQUIRE MINIMAL SUPPORT FOR
EXAMPLE LIGATING SUPERFICIAL BLOOD
VESSELS AND SUTURING SUBCUTANEOUS
FATTY TISSUE 0LAIN SURGICAL GUT CAN
ALSO BE SPECIALLY HEAT
TREATED TO
ACCELERATE TENSILE STRENGTH LOSS AND
ABSORPTION 4HIS FAST ABSORBING
SURGICAL GUT IS USED PRIMARILY FOR
EPIDERMAL SUTURING WHERE SUTURES
ARE REQUIRED FOR ONLY TO DAYS
4HESE SUTURES HAVE LESS TENSILE
STRENGTH THAN PLAIN SURGICAL GUT
OF THE COMPARABLE 530 SIZE &AST
ABSORBING PLAIN GUT IS NOT TO BE
USED INTERNALLY
#HROMIC GUT IS TREATED WITH A
CHROMIUM SALT SOLUTION TO RESIST
BODY ENZYMES PROLONGING
ABSORPTION TIME OVER DAYS
4HE EXCLUSIVE #(2/-)#):).'
PROCESS USED BY %4()#/.
THOROUGHLY BATHES THE PURE COLLAGEN
RIBBONS IN A BUFFERED CHROME
TANNING SOLUTION BEFORE SPINNING
INTO STRANDS !FTER SPINNING THE
ENTIRE CROSS SECTION OF THE STRAND
IS EVENLY CHROMICIZED 4HE PROCESS
ALTERS THE COLORATION OF THE SURGICAL
GUT FROM YELLOWISH
TAN TO BROWN
#HROMIC GUT SUTURES MINIMIZE
TISSUE IRRITATION CAUSING LESS
REACTION THAN PLAIN SURGICAL GUT
DURING THE EARLY STAGES OF WOUND
HEALING 4ENSILE STRENGTH MAY BE
RETAINED FOR TO DAYS WITH
SOME MEASURABLE STRENGTH REMAINING
FOR UP TO DAYS
39.4(%4)#
!"3/2"!",% 35452%3
3YNTHETIC ABSORBABLE SUTURES OFFER THE
STRENGTH NEEDED FOR A WIDE RANGE OF
APPLICATIONS FROM ABDOMINAL AND
CHEST WOUND CLOSURE TO OPHTHALMIC
AND PLASTIC SURGERY
#/!4%$ 6)#29,
2!0)$%
0/,9',!#4). 35452%
4HIS BRAIDED SUTURE IS COMPOSED OF
THE SAME COPOLYMER AS COATED
6)#29, SUTURELACTIDE AND
GLYCOLIDEAND IS COATED WITH A
COMBINATION OF EQUAL PARTS OF
COPOLYMER OF LACTIDE AND GLYCOLIDE
POLYGLACTIN AND CALCIUM
STEARATE (OWEVER THE ABSORPTION
RATE AND TENSILE STRENGTH PROFILE ARE
SIGNIFICANTLY DIFFERENT FROM COATED
6)#29, SUTURE ACHIEVED BY THE USE
OF A POLYMER MATERIAL WITH A LOWER
MOLECULAR WEIGHT THAN COATED
6)#29, SUTURE #OATED 6)#29,
2!0)$% SUTURES ARE ONLY AVAILABLE
UNDYED
#OATED 6)#29, 2!0)$% SUTURE
IS THE FASTEST
ABSORBING SYNTHETIC
SUTURE AND EXHIBITS CHARACTERISTICS
THAT MODEL THE PERFORMANCE OF
SURGICAL GUT SUTURE (OWEVER
BEING A SYNTHETIC MATERIAL #OATED
6)#29, 2!0)$% SUTURE ELICITS
A LOWER TISSUE REACTION THAN CHROMIC
GUT SUTURE #OATED 6)#29,
2!0)$% SUTURE IS INDICATED ONLY
FOR USE IN SUPERFICIAL SOFT TISSUE
APPROXIMATION OF THE SKIN AND
MUCOSA WHERE ONLY SHORT
TERM
WOUND SUPPORT TO DAYS
IS REQUIRED )T IS NOT TO BE USED IN
LIGATION IN OPHTHALMIC CARDIOVASCU
LAR OR NEUROLOGICAL PROCEDURES
WHERE EXTENDED APPROXIMATION OF
TISSUES UNDER STRESS IS REQUIRED OR
WHERE WOUND SUPPORT BEYOND
DAYS IS REQUIRED
#OATED 6)#29, 2!0)$% SUTURES
RETAIN APPROXIMATELY OF THE
ORIGINAL TENSILE STRENGTH AT DAYS
POSTIMPLANTATION !LL OF THE ORIGINAL
TENSILE STRENGTH IS LOST BY APPROXI
MATELY TO DAYS !BSORPTION IS
ESSENTIALLY COMPLETE BY DAYS
#OATED 6)#29, 2!0)$% SUTURE
IS PARTICULARLY WELL SUITED FOR SKIN
CLOSURE EPISIOTOMY REPAIR AND
CLOSURE OF LACERATIONS UNDER CASTS
)N ADDITION SINCE THE SUTURE BEGINS
TO FALL OFF IN TO DAYS AS THE
WOUND HEALS THE NEED FOR SUTURE
REMOVAL IS ELIMINATED
-/./#29,
0/,)',%#!02/.% 35452%
4HIS MONOFILAMENT SUTURE
FEATURES SUPERIOR PLIABILITY FOR EASY
HANDLING AND TYING #OMPRISED
OF A COPOLYMER OF GLYCOLIDE AND
EPSILON
CAPROLACTONE IT IS VIRTUALLY
INERT IN TISSUE AND ABSORBS
PREDICTABLY 4HE SURGEON MAY
PREFER -/./#29, SUTURES FOR
PROCEDURES WHICH REQUIRE HIGH
INITIAL TENSILE STRENGTH DIMINISHING
OVER WEEKS POSTOPERATIVELY 4HESE
INCLUDE SUBCUTICULAR CLOSURE AND
SOFT TISSUE APPROXIMATIONS AND
LIGATIONS WITH THE EXCEPTION OF
NEURAL CARDIOVASCULAR OPHTHALMIC
AND MICROSURGICAL APPLICATIONS
-/./#29, SUTURE IS AVAILABLE
DYED VIOLET AND UNDYED NATURAL
$YED -/./#29, SUTURE RETAINS
TO OF ITS ORIGINAL STRENGTH
AT DAYS POSTIMPLANTATION REDUCED
TO TO AT DAYS WITH ALL
#(!04%2
ORIGINAL STRENGTH LOST BY DAYS
!T DAYS UNDYED -/./#29,
SUTURE RETAINS APPROXIMATELY
TO OF ITS ORIGINAL STRENGTH AND
APPROXIMATELY TO AT
DAYS POSTIMPLANTATION !LL OF
THE ORIGINAL TENSILE STRENGTH OF
UNDYED -/./#29, SUTURE IS
LOST BY DAYS POSTIMPLANTATION
!BSORPTION IS ESSENTIALLY COMPLETE
AT TO DAYS
#/!4%$ 6)#29,
0/,9',!#4). 35452%
4HIS MATERIAL FILLS THE NEED FOR A
SMOOTHER SYNTHETIC ABSORBABLE
SUTURE THAT WILL PASS THROUGH TISSUE
READILY WITH MINIMAL DRAG #OATED
6)#29, SUTURES FACILITATE EASE OF
HANDLING SMOOTH TIE DOWN AND
UNSURPASSED KNOT SECURITY
4HE COATING IS A COMBINATION OF
EQUAL PARTS OF COPOLYMER OF LACTIDE
AND GLYCOLIDE POLYGLACTIN
PLUS CALCIUM STEARATE WHICH IS
USED EXTENSIVELY IN PHARMACEUTICALS
AND FOOD #ALCIUM STEARATE IS A SALT
OF CALCIUM AND STEARIC ACID BOTH
OF WHICH ARE PRESENT IN THE BODY
AND CONSTANTLY METABOLIZED AND
EXCRETED 4HE RESULT OF THIS MIXTURE
IS AN OUTSTANDINGLY ABSORBABLE
ADHERENT NONFLAKING LUBRICANT
!T WEEKS POSTIMPLANTATION
APPROXIMATELY OF THE TENSILE
STRENGTH OF COATED 6)#29, SUTURE
REMAINS !PPROXIMATELY OF
TENSILE STRENGTH IS RETAINED AT
WEEKS FOR SIZES
AND LARGER !T
WEEKS OF TENSILE STRENGTH IS
RETAINED FOR SIZES
AND SMALLER !T
WEEKS OF THE ORIGINAL
STRENGTH IS RETAINED FOR SIZES
AND
LARGER !LL OF THE ORIGINAL TENSILE
STRENGTH IS LOST BY FIVE WEEKS POST
IMPLANTATION !BSORPTION OF COATED
6)#29, SUTURE IS ESSENTIALLY
COMPLETE BETWEEN AND DAYS
,ACTIDE AND GLYCOLIDE ACIDS ARE
READILY ELIMINATED FROM THE BODY
PRIMARILY IN URINE !S WITH
UNCOATED SUTURES COATED 6)#29,
SUTURES ELICIT ONLY A MILD TISSUE
REACTION DURING ABSORPTION 4HEIR
SAFETY AND EFFECTIVENESS IN NEURAL
AND CARDIOVASCULAR TISSUE HAVE NOT
BEEN ESTABLISHED 4RANSCUTANEOUS OR
CONJUNCTIVAL SUTURES REMAINING IN
PLACE LONGER THAN DAYS MAY CAUSE
LOCALIZED IRRITATION AND SHOULD BE
REMOVED AS INDICATED #OATED
6)#29, SUTURES ARE AVAILABLE AS
BRAIDED DYED VIOLET OR UNDYED
NATURAL STRANDS IN A VARIETY OF
LENGTHS WITH OR WITHOUT NEEDLES
#/!4%$ 6)#29,
0,53 !.4)"!#4%2)!,
0/,9',!#4). 35452%
4HIS SYNTHETIC ABSORBABLE STERILE SUR
GICAL SUTURE IS A COPOLYMER MADE FROM
GLYCOLIDE AND , LACTIDE
#OATED 6)#29, 0LUS !NTIBACTERIAL
3UTURE IS COATED WITH A MIXTURE COM
POSED OF EQUAL PARTS OF COPOLYMER OF
GLYCOLIDE AND LACTIDE POLYGLACTIN
AND CALCIUM STEARATE #OATED 6)#29,
0LUS !NTIBACTERIAL SUTURE CONTAINS
)2'!#!2% -0
ONE OF THE
PUREST FORMS OF THE BROAD SPECTRUM
ANTIBACTERIAL AGENT TRICLOSAN
#OATED 6)#29, 0LUS !NTIBACTERIAL
SUTURE OFFERS PROTECTION AGAINST
BACTERIAL COLONIZATION OF THE SUTURE
)N VIVO STUDIES DEMONSTRATE THAT
#OATED 6)#29, 0LUS !NTIBACTERIAL
SUTURE HAS A ZONE OF INHIBITION THAT
IS EFFECTIVE AGAINST THE PATHOGENS THAT
MOST OFTEN CAUSE SURGICAL SITE INFECTION
33) n 3TAPHYLOCOCCUS AUREUS
METHICILLIN RESISTANT 3TAPHYLOCOCCUS
AUREUS -23! 3TAPHYLOCOCCUS
EPIDERMIDIS METHICILLIN RESISTANT
3TAPHYLOCOCCUS EPIDERMIDIS -23%
)N VIVO STUDIES DEMONSTRATE THAT
6)#29, 0LUS !NTIBACTERIAL SUTURE
HAS NO ADVERSE EFFECT ON NORMAL
WOUND HEALING
#OATED 6)#29, 0LUS !NTIBACTERIAL
SUTURE PERFORMS AND HANDLES THE SAME
AS #OATED 6)#29, SUTURE #OATED
6)#29, 0LUS !NTIBACTERIAL SUTURE HAS
THE SAME DEPENDABLE CONSTRUCTION AS
#OATED 6)#29, SUTURE )N VIVO
TESTING BY SURGEONS DEMONSTRATES THE
SAME EXCELLENCE IN PERFORMANCE
AND HANDLING
4HE SUTURE IS AVAILABLE UNDYED
NATURAL OR DYED #OATED 6)#29,
0LUS SUTURE IS INDICATED FOR USE IN
GENERAL SOFT TISSUE APPROXIMATION
ANDOR LIGATION REQUIRING MEDIUM
SUPPORT EXCEPT FOR OPHTHALMIC
CARDIOVASCULAR AND NEUROLOGICAL TISSUES
&REQUENT USES INCLUDE GENERAL CLOSURE
BOWEL ORTHOPEDIC AND PLASTIC SURGERY
#OATED 6)#29, 0LUS !NTIBACTERIAL
SUTURE RETAINS APPROXIMATELY OF
THE ORIGINAL TENSILE STRENGTH AT TWO
WEEKS POST IMPLANTATION !T THREE
WEEKS APPROXIMATELY OF THE
ORIGINAL STRENGTH IS RETAINED !T FOUR
WEEKS APPROXIMATELY OF THE
ORIGINAL STRENGTH IS RETAINED
!LL OF THE ORIGINAL TENSILE STRENGTH IS
LOST BY FIVE WEEKS POST IMPLANTATION
!BSORPTION OF #OATED 6)#29, 0LUS
!NTIBACTERIAL 3UTURE IS ESSENTIALLY
COMPLETE BETWEEN AND DAYS
0$3
)) 0/,9$)/8!./.%
35452%
#OMPRISED OF THE POLYESTER POLY
P
DIOXANONE THIS MONOFILAMENT
REPRESENTS A SIGNIFICANT ADVANCE
IN SUTURING OPTIONS )T COMBINES
THE FEATURES OF SOFT PLIABLE
MONOFILAMENT CONSTRUCTION WITH
ABSORBABILITY AND EXTENDED WOUND
4RADEMARK
4(% 35452%
SUPPORT FOR UP TO WEEKS )T ELICITS
ONLY A SLIGHT TISSUE REACTION 4HIS
MATERIAL IS WELL
SUITED FOR MANY
TYPES OF SOFT TISSUE APPROXIMATION
INCLUDING PEDIATRIC CARDIOVASCULAR
ORTHOPAEDIC GYNECOLOGIC
OPHTHALMIC PLASTIC DIGESTIVE
AND COLONIC SURGERIES
,IKE OTHER SYNTHETIC ABSORBABLE
SUTURES 0$3 )) SUTURES ARE
ABSORBED IN VIVO THROUGH HYDROLYSIS
!PPROXIMATELY OF TENSILE
STRENGTH REMAINS WEEKS
POSTIMPLANTATION AT WEEKS
AND AT WEEKS !BSORPTION IS
MINIMAL UNTIL ABOUT THE TH DAY
POSTOPERATIVELY AND ESSENTIALLY
COMPLETE WITHIN MONTHS 4HE
SAFETY AND EFFECTIVENESS OF 0$3 ))
SUTURES IN MICROSURGERY NEURAL
TISSUE AND ADULT CARDIOVASCULAR
TISSUE HAVE NOT BEEN ESTABLISHED
0$3 )) SUTURES ARE AVAILABLE CLEAR
OR DYED VIOLET TO ENHANCE VISIBILITY
./.!"3/2"!",% 35452%3
4HE 530 CLASSIFIES NONABSORBABLE
SURGICAL SUTURES AS FOLLOWS
s #,!33 )3ILK OR SYNTHETIC FIBERS
OF MONOFILAMENT TWISTED OR
BRAIDED CONSTRUCTION
s #,!33 ))#OTTON OR LINEN
FIBERS OR COATED NATURAL OR
SYNTHETIC FIBERS WHERE THE COATING
CONTRIBUTES TO SUTURE THICKNESS
WITHOUT ADDING STRENGTH
s #,!33 )))-ETAL WIRE OF
MONOFILAMENT OR MULTIFILAMENT
CONSTRUCTION
352')#!, 3),+
&OR MANY SURGEONS SURGICAL SILK
REPRESENTS THE STANDARD HANDLING
PERFORMANCE BY WHICH NEWER
SYNTHETIC MATERIALS ARE JUDGED
ESPECIALLY DUE TO ITS SUPERIOR
HANDLING CHARACTERISTICS 3ILK
FILAMENTS CAN BE TWISTED OR BRAIDED
THE LATTER PROVIDING THE BEST
HANDLING QUALITIES
2AW SILK IS A CONTINUOUS FILAMENT
SPUN BY THE SILKWORM MOTH LARVA
TO MAKE ITS COCOON #REAM OR
ORANGE
COLORED IN ITS RAW STATE EACH
SILK FILAMENT IS PROCESSED TO REMOVE
NATURAL WAXES AND SERICIN GUM
WHICH IS EXUDED BY THE SILKWORM AS
IT SPINS ITS COCOON 4HE GUM HOLDS
THE COCOON TOGETHER BUT IS OF NO
BENEFIT TO THE QUALITY OF BRAIDED
SURGICAL SILK SUTURES
%4()#/. DEGUMS THE SILK FOR
MOST SUTURE SIZES BEFORE THE
BRAIDING PROCESS 4HIS ALLOWS FOR A
TIGHTER MORE COMPACT BRAID WHICH
SIGNIFICANTLY IMPROVES SUTURE QUALITY
!FTER BRAIDING THE STRANDS ARE DYED
SCOURED AND STRETCHED AND THEN
IMPREGNATED AND COATED WITH A
MIXTURE OF WAXES OR SILICONE %ACH
OF THESE STEPS IS CRITICAL TO THE
QUALITY OF THE FINISHED SUTURE AND
MUST BE CARRIED OUT IN PRECISE ORDER
3URGICAL SILK IS USUALLY DYED BLACK
FOR EASY VISIBILITY IN TISSUE
2AW SILK IS GRADED ACCORDING TO
STRENGTH UNIFORMITY OF FILAMENT
DIAMETER AND FREEDOM FROM DEFECTS
/NLY TOP GRADES OF SILK FILAMENTS ARE
USED TO PRODUCE 0%2-!
(!.$
SURGICAL SILK SUTURES
3URGICAL SILK LOSES TENSILE STRENGTH
WHEN EXPOSED TO MOISTURE AND
SHOULD BE USED DRY !LTHOUGH SILK
IS CLASSIFIED BY THE 530 AS A
NONABSORBABLE SUTURE LONG
TERM
IN VIVO STUDIES HAVE SHOWN THAT IT
LOSES MOST OR ALL OF ITS TENSILE
STRENGTH IN ABOUT YEAR AND USUALLY
CANNOT BE DETECTED IN TISSUE AFTER
YEARS 4HUS IT BEHAVES IN REALITY
AS A VERY SLOWLY ABSORBING SUTURE
352')#!, 34!).,%33 34%%,
4HE ESSENTIAL QUALITIES OF SURGICAL
STAINLESS STEEL SUTURES INCLUDE THE
ABSENCE OF TOXIC ELEMENTS FLEXIBILITY
AND FINE WIRE SIZE "OTH MONOFILA
MENT AND TWISTED MULTIFILAMENT
VARIETIES ARE HIGH IN TENSILE STRENGTH
LOW IN TISSUE REACTIVITY AND HOLD
A KNOT WELL 0ROVIDED THAT THE
SUTURES DO NOT FRAGMENT THERE IS
LITTLE LOSS OF TENSILE STRENGTH IN
TISSUES 4HE , LOW CARBON
STAINLESS STEEL ALLOY FORMULA USED
IN THE MANUFACTURE OF THESE
SUTURES OFFERS OPTIMUM METAL
STRENGTH FLEXIBILITY UNIFORMITY
AND COMPATIBILITY WITH STAINLESS
STEEL IMPLANTS AND PROSTHESES
3TAINLESS STEEL SUTURES MAY ALSO BE
USED IN ABDOMINAL WALL CLOSURE
STERNUM CLOSURE RETENTION SKIN
CLOSURE A VARIETY OF ORTHOPAEDIC
PROCEDURES AND NEUROSURGERY
$ISADVANTAGES ASSOCIATED WITH
ALLOY SUTURES INCLUDE DIFFICULTY IN
HANDLING POSSIBLE CUTTING PULLING
AND TEARING OF THE PATIENTgS TISSUE
FRAGMENTATION BARBING AND
KINKING WHICH RENDERS THE STAINLESS
STEEL SUTURE USELESS 7HEN USED FOR
BONE APPROXIMATION AND FIXATION
ASYMMETRICAL TWISTING OF THE WIRE
WILL LEAD TO POTENTIAL BUCKLING WIRE
FRACTURE OR SUBSEQUENT WIRE
FATIGUE )NCOMPLETE WIRE FIXATION
UNDER THESE CIRCUMSTANCES WILL
PERMIT MOVEMENT OF THE WIRE
RESULTING IN POSTOPERATIVE PAIN
AND POSSIBLE DEHISCENCE
3URGICAL STAINLESS STEEL SUTURES
SHOULD NOT BE USED WHEN A
PROSTHESIS OF ANOTHER ALLOY IS
#(!04%2
$)!-%4%2
530
INCH
IMPLANTED SINCE AN UNFAVORABLE
ELECTROLYTIC REACTION MAY OCCUR
!BOVE ALL STAINLESS STEEL SUTURES
POSE A SAFETY RISK 4HEY EASILY TEAR
SURGICAL GLOVES WHEN HANDLED
AND MAY PUNCTURE THE SURGEONgS
OWN SKINPUTTING BOTH
PHYSICIAN AND PATIENT AT RISK
OF TRANSMITTED IMMUNODEFICIENCY
VIRUS OR HEPATITIS -ANY SURGEONS
REFER TO WIRE SIZE BY THE "ROWN
3HARPE " 3 GAUGE OF
SMALLEST DIAMETER TO LARGEST
DIAMETER %4()#/. LABELS
SURGICAL STAINLESS STEEL WITH BOTH
THE " 3 AND 530 DIAMETER SIZE
CLASSIFICATIONS
%4()#/. PACKAGING OF SURGICAL
STAINLESS STEEL MAINTAINS THE INTEGRITY
OF THE PRODUCT BY ELIMINATING KINK
ING AND BENDING OF STRANDS *UST AS
IMPORTANT IT PRESENTS THE STRANDS IN
A SAFE MANNER FOR ALL MEMBERS OF
THE SURGICAL TEAM WHO HANDLE THEM
" 3
4!",%
352')#!,
34!).,%33
34%%, 7)2%
'!5'%
%15)6!,%.43
39.4(%4)#
./.!"3/2"!",% 35452%3
.YLON SUTURES ARE A POLYAMIDE POLY
MER DERIVED BY CHEMICAL SYNTHESIS
"ECAUSE OF THEIR ELASTICITY THEY ARE
PARTICULARLY WELL
SUITED FOR RETENTION
AND SKIN CLOSURE 4HEY MAY BE
CLEAR OR DYED GREEN OR BLACK FOR
BETTER VISIBILITY
%4(),/.
.9,/. 35452%
4HESE SUTURES ARE EXTRUDED INTO
NONCAPILLARY SINGLE OR MONOFILAMENT
STRANDS CHARACTERIZED BY HIGH TENSILE
STRENGTH AND EXTREMELY LOW TISSUE
REACTIVITY 4HEY DEGRADE IN VIVO AT A
RATE OF APPROXIMATELY TO
PER YEAR BY HYDROLYSIS %4(),/.
SUTURES IN SIZES
AND
AND
LARGER ARE PRODUCED FROM A SPECIAL
GRADE OF NYLON 4HE MEDICAL GRADE
POLYAMIDE NYLON
IS USED FOR
SIZES
AND FINER 7HILE BOTH
GRADES PERMIT GOOD HANDLING
MONOFILAMENT NYLON SUTURES HAVE A
TENDENCY TO RETURN TO THEIR ORIGINAL
STRAIGHT EXTRUDED STATE A PROPERTY
KNOWN AS MEMORY 4HEREFORE
MORE THROWS IN THE KNOT ARE
REQUIRED TO SECURELY HOLD MONOFILA
MENT THAN BRAIDED NYLON SUTURES
-ONOFILAMENT NYLON IN A WET OR
DAMP STATE IS MORE PLIABLE AND
EASIER TO HANDLE THAN DRY NYLON !
LIMITED LINE OF %4(),/. SUTURES
SIZES
THROUGH
ARE PRE
MOISTENED OR PLIABILIZED FOR USE
IN COSMETIC PLASTIC SURGERY 4HIS
PROCESS ENHANCES THE HANDLING
AND KNOT TYING CHARACTERISTICS TO
APPROXIMATE THAT OF BRAIDED SUTURES
%4(),/. SUTURES ARE FREQUENTLY
USED IN OPHTHALMOLOGY AND
MICRO
SURGERY PROCEDURES IN VERY
FINE SIZES &OR THIS REASON SIZES
AND
HAVE AN INTENSIFIED BLACK
DYE FOR HIGH VISIBILITY
.52/,/.
.9,/. 35452%
4HIS SUTURE IS COMPOSED OF FILAMENTS
OF NYLON THAT HAVE BEEN TIGHTLY
BRAIDED INTO A MULTIFILAMENT STRAND
!VAILABLE IN WHITE OR DYED BLACK
.52/,/. SUTURES LOOK FEEL AND
HANDLE LIKE SILK (OWEVER
.52/,/. SUTURES HAVE MORE
STRENGTH AND ELICIT LESS TISSUE
REACTION THAN SILK "RAIDED NYLON
MAY BE USED IN ALL TISSUES WHERE
MULTIFILAMENT NONABSORBABLE SUTURES
ARE ACCEPTABLE "RAIDED NYLON
SUTURES GENERALLY LOSE TO
OF THEIR TENSILE STRENGTH PER YEAR IN
TISSUE BY HYDROLYZATION
0OLYESTER FIBER SUTURE IS COMPRISED
OF UNTREATED FIBERS OF POLYESTER
POLYETHYLENE TEREPHTHALATE CLOSELY
BRAIDED INTO A MULTIFILAMENT STRAND
4HEY ARE STRONGER THAN NATURAL
FIBERS DO NOT WEAKEN WHEN WETTED
PRIOR TO USE AND CAUSE MINIMAL
TISSUE REACTION !VAILABLE WHITE OR
4RADEMARK
4(% 35452%
DYED GREEN POLYESTER FIBER SUTURES
ARE AMONG THE MOST ACCEPTABLE FOR
VASCULAR SYNTHETIC PROSTHESES
-%23),%.%
0/,9%34%2
&)"%2 35452%
4HE FIRST SYNTHETIC BRAIDED SUTURE
MATERIAL SHOWN TO LAST INDEFINITELY
IN THE BODY -%23),%.% SUTURES
PROVIDE PRECISE CONSISTENT SUTURE
TENSION 4HEY MINIMIZE BREAKAGE
AND VIRTUALLY ELIMINATE THE NEED TO
REMOVE IRRITATING SUTURE FRAGMENTS
POSTOPERATIVELY "ECAUSE IT IS
UNCOATED -%23),%.% SUTURE
HAS A HIGHER COEFFICIENT OF FRICTION
WHEN PASSED THROUGH TISSUE
%4()"/.$
%8#%,
0/,9%34%2 35452%
%4()"/.$ %8#%, SUTURES ARE
UNIFORMLY COATED WITH POLYBUTILATE
A BIOLOGICALLY INERT NONABSORBABLE
COMPOUND WHICH ADHERES ITSELF TO
THE BRAIDED POLYESTER FIBER STRAND
0OLYBUTILATE WAS THE FIRST SYNTHETIC
COATING DEVELOPED SPECIFICALLY AS A
SURGICAL SUTURE LUBRICANT 4HE COAT
ING EASES THE PASSAGE OF THE BRAIDED
STRANDS THROUGH TISSUE AND PROVIDES
EXCELLENT PLIABILITY HANDLING QUALI
TIES AND SMOOTH TIE
DOWN WITH EACH
THROW OF THE KNOT "OTH THE SUTURE
MATERIAL AND THE COATING ARE
PHARMACOLOGICALLY INACTIVE 4HE
SUTURES ELICIT MINIMAL TISSUE REACTION
AND RETAIN THEIR STRENGTH IN VIVO FOR
EXTENDED PERIODS %4()"/.$
%8#%, SUTURES ARE USED PRIMARILY IN
CARDIOVASCULAR SURGERY FOR VESSEL
ANASTOMOSIS AND PLACEMENT OF
PROSTHETIC MATERIALS
%4()"/.$ %8#%, SUTURES
ARE ALSO AVAILABLE ATTACHED
TO 4&% POLYMER FELT PLEDGETS
0LEDGETS SERVE TO PREVENT POSSIBLE
TEARING OF ADJACENT FRIABLE TISSUE
0LEDGETS ARE USED ROUTINELY IN VALVE
REPLACEMENT PROCEDURES TO PREVENT
THE ANNULUS FROM TEARING WHEN THE
PROSTHETIC VALVE IS SEATED AND THE
SUTURES ARE TIED AND IN SITUATIONS
WHERE EXTREME DEFORMITY DISTORTION
OR TISSUE DESTRUCTION AT THE ANNULUS
HAS OCCURRED
0OLYPROPYLENE IS AN ISOSTATIC
CRYSTALLINE STEREOISOMER OF A
LINEAR HYDROCARBON POLYMER
PERMITTING LITTLE OR NO SATURATION
-ANUFACTURED BY A PATENTED
PROCESS WHICH ENHANCES PLIABILITY
AND HANDLING POLYPROPYLENE
MONOFILAMENT SUTURES ARE NOT
SUBJECT TO DEGRADATION OR WEAKENING
BY TISSUE ENZYMES 4HEY CAUSE
MINIMAL TISSUE REACTION AND HOLD
KNOTS BETTER THAN MOST OTHER
SYNTHETIC MONOFILAMENT MATERIALS
02/,%.%
0/,902/09,%.%
35452%
7IDELY USED IN GENERAL CARDIOVASCU
LAR PLASTIC AND ORTHOPAEDIC SURGERY
02/,%.% SUTURES DO NOT ADHERE TO
TISSUE AND ARE THEREFORE EFFICACIOUS
AS A PULL
OUT SUTURE 02/,%.%
SUTURES ARE RELATIVELY BIOLOGICALLY
INERT OFFERING PROVEN STRENGTH
RELIABILITY AND VERSATILITY
02/,%.% SUTURES ARE
RECOMMENDED FOR USE WHERE
MINIMAL SUTURE REACTION IS DESIRED
SUCH AS IN CONTAMINATED AND
INFECTED WOUNDS TO MINIMIZE
LATER SINUS FORMATION AND SUTURE
EXTRUSION 4HEY ARE AVAILABLE CLEAR
OR DYED BLUE
02/./6!
0/,9
(%8!&,5/2/02/09,%.%
6$&
35452%
4HIS MONOFILAMENT NONABSORBABLE
SUTURE IS A POLYMER BLEND OF POLY
VINYLIDENE FLUORIDE AND POLY
VINYLIDENE FLUORIDE
COHEXAFLUORO
PROPYLENE 4HIS SUTURE RESISTS
INVOLVEMENT IN INFECTION AND HAS
BEEN SUCCESSFULLY EMPLOYED IN
CONTAMINATED AND INFECTED WOUNDS
TO ELIMINATE OR MINIMIZE LATER SINUS
FORMATION AND SUTURE EXTRUSION
&URTHERMORE THE LACK OF ADHERENCE
TO TISSUES HAS FACILITATED THE USE
OF 02/./6! SUTURE AS A
PULL
OUT SUTURE
4HIS MATERIAL IS WELL
SUITED FOR
MANY TYPES OF SOFT TISSUE APPROXI
MATION AND LIGATION INCLUDING USE
IN CARDIOVASCULAR OPHTHALMIC AND
NEUROLOGICAL PROCEDURES
4ABLE GIVES AN OVERVIEW OF THE
MANY SUTURING OPTIONS THAT HAVE
BEEN DISCUSSED IN THIS SECTION
3EE ATTACHED CHART
#/--/.
35452).'
4%#(.)15%3
,)'!452%3
! SUTURE TIED AROUND A VESSEL TO
OCCLUDE THE LUMEN IS CALLED A LIGATURE
OR TIE )T MAY BE USED TO EFFECT
HEMOSTASIS OR TO CLOSE OFF A STRUCTURE
TO PREVENT LEAKAGE 4HERE ARE TWO
PRIMARY TYPES OF LIGATURES
&REE TIE OR FREEHAND LIGATURES ARE
SINGLE STRANDS OF SUTURE MATERIAL
USED TO LIGATE A VESSEL DUCT OR OTHER
STRUCTURE !FTER A HEMOSTAT OR OTHER
SIMILAR TYPE OF SURGICAL CLAMP HAS
BEEN PLACED ON THE END OF THE
STRUCTURE THE SUTURE STRAND IS TIED
AROUND THE VESSEL UNDER THE TIP OF
THE HEMOSTAT 4HE HEMOSTAT IS
REMOVED AFTER THE FIRST THROW AND
THE SURGEON TIGHTENS THE KNOT USING
HIS OR HER FINGERTIPS TAKING CARE TO
AVOID INSTRUMENT DAMAGE TO THE
#(!04%2
&)'52%
,)'!452%3
&REE TIE
3TICK TIE
&)'52%
,OOPED SUTURE KNOTTED
AT ONE END
4WO STRANDS KNOTTED AT
EACH END AND KNOTTED IN
THE MIDDLE
#/.4).5/53
35452).'
4%#(.)15%3
#/.4).5/53 35452%3
!LSO REFERRED TO AS RUNNING STITCHES
CONTINUOUS SUTURES ARE A SERIES OF
STITCHES TAKEN WITH ONE STRAND OF
MATERIAL 4HE STRAND MAY BE TIED TO
ITSELF AT EACH END OR LOOPED WITH
BOTH CUT ENDS OF THE STRAND TIED
TOGETHER ! CONTINUOUS SUTURE LINE
CAN BE PLACED RAPIDLY )T DERIVES ITS
STRENGTH FROM TENSION DISTRIBUTED
EVENLY ALONG THE FULL LENGTH OF THE
SUTURE STRAND (OWEVER CARE MUST
BE TAKEN TO APPLY FIRM TENSION
RATHER THAN TIGHT TENSION TO AVOID
).4%22504%$
35452).'
4%#(.)15%3
&)'52%
3IMPLE INTERRUPTED
2UNNING LOCKED SUTURE
/VER AND OVER RUNNING
STITCH
SUTURE !DDITIONAL THROWS ARE ADDED
AS NEEDED TO SQUARE AND SECURE THE
KNOT 3TICK TIE SUTURE LIGATURE OR
TRANSFIXION SUTURE IS A STRAND OF
SUTURE MATERIAL ATTACHED TO A NEEDLE
TO LIGATE A VESSEL DUCT OR OTHER
STRUCTURE 4HIS TECHNIQUE IS USED ON
DEEP STRUCTURES WHERE PLACEMENT OF
A HEMOSTAT IS DIFFICULT OR ON VESSELS
OF LARGE DIAMETER 4HE NEEDLE IS
PASSED THROUGH THE STRUCTURE OR
ADJACENT TISSUE FIRST TO ANCHOR THE
SUTURE THEN TIED AROUND THE
STRUCTURE !DDITIONAL THROWS ARE
USED AS NEEDED TO SECURE THE KNOT
4(% 02)-!29 35452% ,).%
4HE PRIMARY SUTURE LINE IS THE LINE
OF SUTURES THAT HOLDS THE WOUND
EDGES IN APPROXIMATION DURING
HEALING BY FIRST INTENTION )T MAY
CONSIST OF A CONTINUOUS STRAND OF
MATERIAL OR A SERIES OF INTERRUPTED
SUTURE STRANDS /THER TYPES OF
PRIMARY SUTURES SUCH AS DEEP
SUTURES BURIED SUTURES PURSE
STRING
SUTURES AND SUBCUTICULAR SUTURES
ARE USED FOR SPECIFIC INDICATIONS
2EGARDLESS OF TECHNIQUE A SURGICAL
NEEDLE IS ATTACHED TO THE SUTURE
STRAND TO PERMIT REPEATED PASSES
THROUGH TISSUE
)NTERRUPTED VERTICAL
MATTRESS
)NTERRUPTED HORIZONTAL
MATTRESS
4RADEMARK
!"3/2"!",% 35452%3
35452%
490%3
3URGICAL 'UT
3UTURE
0LAIN
#/,/2 /&
-!4%2)!,
9ELLOWISH
TAN
2!7 -!4%2)!,
!"3/204)/. 2!4%
4)335% 2%!#4)/.
#OLLAGEN DERIVED FROM
HEALTHY BEEF AND SHEEP
4%.3),% 342%.'4(
2%4%.4)/. IN VIVO
)NDIVIDUAL PATIRENT CHARACTERISTICS CAN
AFFECT RATE OF TENSILE STRENGTH LOSS
!BSORBED BY PROLEOLYTIC
ENZYMATIC DIGESTIVE
PROCESS
-ODERATE REACTION
#OLLAGEN DERIVED FROM
HEALTHY BEEF AND SHEEP
)NDIVIDUAL PATIRENT CHARACTERISTICS CAN
AFFECT RATE OF TENSILE STRENGTH LOSS
!BSORBED BY PROLEOLYTIC
ENZYMATIC DIGESTIVE
PROCESS
-ODERATE REACTION
#OPOLYMER OF LACTIDE
AND GLYCOLIDE COATED
WITH AND CALCIUM
STEARATE
!PPROXIMATELY REMAINS AT
DAYS !LL TENSILE STRENGTH IS LOST AT
APPROXIMATELY DAYS
%SSENTIALLY COMPLETE
BETWEEN DAYS
!BSORBED BY HYDROLYSIS
-INIMAL TO MODERATE
ACUTE INFLAMMATORY
REACTION
#OPOLYMER OF
GLYCOLIDE AND
EPSILON
CAPROLACTONE
!PPROXIMATELY VIOLET #OMPLETE AT
REMAINS AT WEEK !PPROXIMATELY
DAYS !BSORBED BY
VIOLET REMAINS AT WEEKS HYDROLYSIS
,OST WITHIN WEEKS VIOLET WEEKS
#OPOLYMER OF LACTIDE
AND GLYCOLIDE COATED
WITH AND CALCIUM
STEARATE
!PPROXIMATELY REMAINS AT TWO
WEEKS !PPROXIMATELY REMAINS
AT THREE WEEKS AT FOUR WEEKS
%SSENTIALLY COMPLETE
BETWEEN
DAYS
!BSORBED BY HYDROLYSIS
-INIMAL ACUTE
INFLAMMATORY REACTION
!PPROXIMATELY REMAINS AT TWO
WEEKS !PPROXIMATELY REMAINS
AT THREE WEEKS AT FOUR WEEKS
%SSENTIALLY COMPLETE
BETWEEN
DAYS
!BSORBED BY HYDROLYSIS
-INIMAL ACUTE
INFLAMMATORY REACTION
!PPROXIMATELY REMAINS AT WEEKS -INIMAL UNTIL ABOUT TH
!PPROXIMATELY REMAINS AT WEEKS DAY %SSENTIALLY COMPLETE
!PPROXIMATELY REMAINS AT WEEKS WITHIN MONTHS !BSORBED
3LIGHT REACTION
/RGANIC PROTEIN CALLED
FIBRIN
0ROGRESSIVE DEGRADATION OF FIBER MAY
RESULT IN GRADUAL LOSS OF TENSILE
STRENGTH OVER TIME
'RADUAL ENCAPSULATION
BY FIBROUS CONNECTIVE
TISSUE
!CUTE INFLAMMATORY
REACTION
, STAINLESS STEEL
)NDEFINATE
.ONABSORBABLE
-INIMAL ACUTE
INFLAMMATORY REACTION
,ONG
CHAIN ALIPHATIC
POLYMERS .YLON OR
.YLON
0ROGRESSIVE HYDROLYSIS MAY RESULT IN
GRADUAL LOSS OF TENSILE STRENGTH OVER
TIME
'RADUAL ENCAPSULATION
BY FIBROUS CONNECTIVE
TISSUE
-INIMAL ACUTE
INFLAMMATORY REACTION
,ONG
CHAIN ALIPHATIC
POLYMERS .YLON OR
.YLON
0ROGRESSIVE HYDROLYSIS MAY RESULT IN
GRADUAL LOSS OF TENSILE STRENGTH OVER
TIME
'RADUAL ENCAPSULATION
BY FIBROUS CONNECTIVE
TISSUE
-INIMAL ACUTE
INFLAMMATORY REACTION
0OLY ETHYLENE
TEREPHTHALATE
.O SIGNIFICANT CHANGE KNOWN TO
OCCUR IN VIVO
'RADUAL ENCAPSULATION
BY FIBROUS CONNECTIVE
TISSUE
-INIMAL ACUTE
INFLAMMATORY REACTION
.O SIGNIFICANT CHANGE KNOWN TO
OCCUR IN VIVO
'RADUAL ENCAPSULATION
BY FIBROUS CONNECTIVE
TISSUE
-INIMAL ACUTE
INFLAMMATORY REACTION
)SOTACTIC CRYSTALLINE
STEREOISOMER OF
POLYPROPYLENE
.O SUBJECT TO DEGRADATION OR
WEAKENING BY ACTION OF TISSUE
ENZYMES
.ONABSORBABLE
-INIMAL ACUTE
INFLAMMATORY REACTION
0OLYMER BLEND OF POLY
VINYLIDENE FLUORIDE
AND POLY VINYLIDENE
FLUORIDE
COHEXAFLUORO
PROPYLENE
.O SUBJECT TO DEGRADATION OR
WEAKENING BY ACTION OF TISSUE
ENZYMES
.ONABSORBABLE
-INIMAL ACUTE
INFLAMMATORY REACTION
"LUE $YED
3URGICAL 'UT
3UTURE
#HROMIC
"ROWN
"LUE $YED
#OATED
"RAIDED
6)#29,
2!0)$%
POLYGLACTIN
3UTURE
5NDYED
.ATURAL
-ONOFILAMENT 5NDYED
-/./#29,
.ATURAL
POLIGLECAPRONE
3UTURE
6IOLET
5NDYED
.ATURAL
#OATED 6)#29,
0LUS !NTIBACTERIAL
POLYGLACTIN
3UTURE
"RAIDED
#OATED 6)#29,
POLYGLACTIN
3UTURE
"RAIDED
-ONOFILAMENT 5NDYED
.ATURAL
#OPOLYMER OF LACTIDE
AND GLYCOLIDE COATED
WITH AND CALCIUM
STEARATE
0$3
))
POLYDIOXANONE
3UTURE
-ONOFILAMENT 6IOLET
0OLYESTER POLYMER
-ONOFILAMENT
6IOLET
6IOLET
"LUE
-INIMAL ACUTE
INFLAMMATORY REACTION
BY SLOW HYDROLYSIS
#LEAR
./.!"3/2"!",% 35452%3
0%2-!
(!.$
3ILK 3UTURE
"RAIDED
6IOLET
7HITE
3URGICAL 3TAINLESS
3TEEL 3UTURE
-ONOFILAMENT 3ILVER METALLIC
-ULIFILAMENT
%4(),/.
.YLON 3UTURE
-ONOFILAMENT 6IOLET
.52/,/.
.YLON 3UTURE
"RAIDED
-%23),%.%
0OLYESTER &IBER
3UTURE
"RAIDED
%4()"/.$
%8#%, 0OLYESTER
&IBER 3UTURE
"RAIDED
02/,%.%
0OLYPROPYLENE
3UTURE
-ONOFILAMENT #LEAR
'REEN
5NDYED #LEAR
6IOLET
'REEN
5NDYED #LEAR
'REEN
-ONOFILAMENT 5NDYED 7HITE
'REEN
0OLY ETHYLENE
TEREPHTHALATE COATED
5NDYED 7HITE WITH POLYBUTILATE
"LUE
02/./6!
-ONOFILAMENT "LUE
0/,9 HEXAFLUORO
PROPYLENE
6$&
3UTURE
#/.42!).$)#!4)/.3
&2%15%.4 53%3
(/7 3500,)%$
#/,/2 #/$%
/& 0!#+%43
9ELLOW
"EING ABSORBABLE SHOULD NOT BE USED
WHERE EXTENDED APPROXIMATION OF TISSUES
UNDER STRESS IS REQUIRED 3HOULD NOT BE
USED IN PATIENTS WITH KNOWN SENSITIVITIES
OR ALLERGIES TO COLLAGEN OR CHROMIUM
'ENERAL SOFT TISSUE APPROXIMATION
ANDOR LIGATION INCLUDING USE IN
OPHTHALMIC PROCEDURES .OT FOR USE
IN CARDIOVASCULAR AND NEUROLOGICAL
TISSUES
THRU WITH AND WITHOUT NEEDLES
AND ON ,)'!0!+ DISPENSING REELS
THRU WITH #/.42/,
2%,%!3% NEEDLES
"EING ABSORBABLE SHOULD NOT BE USED
WHERE EXTENDED APPROXIMATION OF TISSUES
UNDER STRESS IS REQUIRED 3HOULD NOT BE
USED IN PATIENTS WITH KNOWN SENSITIVITIES
OR ALLERGIES TO COLLAGEN OR CHROMIUM
'ENERAL SOFT TISSUE APPROXIMATION
ANDOR LIGATION INCLUDING USE IN
OPHTHALMIC PROCEDURES .OT FOR USE
IN CARDIOVASCULAR AND NEUROLOGICAL
TISSUES
THRU WITH AND WITHOUT NEEDLES
AND ON ,)'!0!+ DISPENSING REELS
THRU WITH #/.42/,
2%,%!3% NEEDLES
"EIGE
3HOULD NOT BE USED WHERE EXTENDED
APPROXIMATION OF TISSUE UNDER STRESS IS
REQUIRED OR WHERE WOUND SUPPORT BEYOND
DAYS IS REQUIRED
3UPERFICIAL SOFT TISSUE APPROXIMATION
OF SKIN AND MUCOSA ONLY .OT FOR USE
IN LIGATION OPHTHALMIC CARDIOVASCU
LAR OR NEUROLOGICAL PROCEDURES
THRU WITH NEEDLES
2ED
"EING ABSORBABLE SHOULD NOT BE USED
WHERE EXTENDED APPROXIMATION OF TISSUE
UNDER STRESS IS REQUIRED 5NDYED NOT
INDICATED FOR USE IN FASCIA
'ENERAL SOFT TISSUE APPROXIMATION
ANDOR LIGATION .OT FOR USE IN CAR
DIOVASCULAR AND NEUROLOGICAL TISSUES
MICROSURGERY OR OPHTHALMIC SURGERY
THRU WITH AND WITHOUT NEEDLES
THRU WITH #/.42/,
2%,%!3% NEEDLES
#ORAL
"EING ABSORBABLE SHOULD NOT BE USED
WHERE EXTENDED APPROXIMATION OF TISSUE
IS REQUIRED
'ENERAL SOFT TISSUE APPROXIMATION
ANDOR LIGATION .OT FOR USE IN CARDIO
VASCULAR AND NEUROLOGICAL TISSUES
THRU WITH AND WITHOUT NEEDLES
6IOLET
"EING ABSORBABLE SHOULD NOT BE USED
WHERE EXTENDED APPROXIMATION OF TISSUE
IS REQUIRED
'ENERAL SOFT TISSUE APPROXIMATION
ANDOR LIGATION INCLUDING USE IN
OPHTHALMIC PROCEDURES .OT FOR USE IN
CARDIOVASCULAR AND NEUROLOGICAL TISSUES
THRU WITH AND WITHOUT NEEDLES
6IOLET
AND ON ,)'!0!+ DISPENSING REELS
THRU WITH #/.42/, 2%,%!3%
NEEDLES
WITH ATTACHED BEADS FOR
OPHTHALMIC USE
"EING ABSORBABLE SHOULD NOT BE USED WHERE
PROLONGED APPROXIMATION OF TISSUES UNDER
STRESS IS REQUIRED 3HOULD NOT BE USED WITH
PROSTHETIC DEVICES SUCH AS HEART VALVES OR
SYNTHETIC GRAFTS
!LL TYPES OF SOFT TISSUE APPROXIMA
TION INCLUDING PEDIATRIC CARDIOVASCU
LAR AND OPHTHALMIC PROCEDURES .OT
FOR USE IN ADULT CARDIOVASCULAR TISSUE
MICROSURGERY AND NEURAL TISSUE
THRU WITH NEEDLES
THRU WITH #/.42/,
2%,%!3% NEEDLES
THRU
WITH NEEDLES
THRU WITH NEEDLES
3ILVER
3HOULD NOT BE USED IN PATIENTS WITH
KNOWN SENSITIVITIES OR ALLERGIES TO SILK
'ENERAL SOFT TISSUE APPROXIMATION
ANDOR LIGATION INCLUDING
CARDIOVASCULAR OPHTHALMIC AND
NEUROLOGICAL PROCEDURES
THRU WITH AND WITHOUT NEEDLES
AND ON ,)'!0!+ DISPENSING REELS
THRU WITH #/.42/,
2%,%!3% NEEDLES
,IGHT "LUE
3HOULD NOT BE USED IN PATIENTS WITH
KNOWN SENSITIVITIES OR ALLERGIES TO ,
STAINLESS STEEL OR CONSTITUENT METALS SUCH
AS CHROMIUM AND NICKEL
!BDOMINAL WOUND CLOSURE HERNIA
REPAIR STERNAL CLOSURE AND ORTHOAEDIC
PROCEDURES INCLUDING CERCLAGE AND
TENDON REPAIR
THRU WITH AND WITHOUT NEEDLES 9ELLOW /CHRE
3HOULD NOT BE USED WHERE PERMANENT
RETENTION OF TENSILE STRENGTH IS REQUIRED
'ENERAL SOFT TISSUE APPROXIMATION
ANDOR LIGATION INCLUDING
CARDIOVASCULAR OPHTHALMIC AND
NEUROLOGICAL PROCEDURES
THRU WITH AND WITHOUT NEEDLES -INT 'REEN
3HOULD NOT BE USED WHERE PERMANENT
RETENTION OF TENSILE STRENGTH IS REQUIRED
'ENERAL SOFT TISSUE APPROXIMATION
ANDOR LIGATION INCLUDING
CARDIOVASCULAR OPHTHALMIC AND
NEUROLOGICAL PROCEDURES
THRU WITH AND WITHOUT NEEDLES
THRU WITH #/.42/,
2%,%!3% NEEDLES
-INT 'REEN
.ONE KNOWN
'ENERAL SOFT TISSUE APPROXIMATION
ANDOR LIGATION INCLUDING
CARDIOVASCULAR OPHTHALMIC AND
NEUROLOGICAL PROCEDURES
THRU WITH AND WITHOUT NEEDLES
AND
FOR OPHTHALMIC GREEN
MONOFILAMENT WITH #/.42/,
2%,%!3% NEEDLES
4URQUOISE
.ONE KNOWN
'ENERAL SOFT TISSUE APPROXIMATION
ANDOR LIGATION INCLUDING
CARDIOVASCULAR OPHTHALMIC AND
NEUROLOGICAL PROCEDURES
THRU WITH AND WITHOUT NEEDLES
THRU WITH #/.42/,
2%,%!3% NEEDLES VARIOUS SIZES
ATTACHED TO 4&% POLYMER PLEDGETS
/RANGE
.ONE KNOWN
'ENERAL SOFT TISSUE APPROXIMATION
ANDOR LIGATION INCLUDING
CARDIOVASCULAR OPHTHALMIC AND
NEUROLOGICAL PROCEDURES
THRU CLEAR WITH AND WITHOUT
NEEDLES
THRU
AND
THRU
WITH AND WITHOUT NEEDLES THRU WITH
#/.42/, 2%,%!3% NEEDLES VARIOUS
SIZES ATTACHED TO 4&% POLYMER PLEDGETS
$EEP "LUE
.ONE KNOWN
'ENERAL SOFT TISSUE APPROXIMATION
ANDOR LIGATION INCLUDING
CARDIOVASCULAR OPHTHALMIC AND
NEUROLOGICAL PROCEDURES
THROUGH WITH 4!0%2#54
SURGICAL NEEDLE
THROUGH
WITH TAPER POINT
NEEDLE
2OYAL "LUE
4!",%
35452).'
/04)/.3
-!4%2)!,3
#(!2!#4%2)34)#3
!.$ !00,)#!4)/.3
4RADEMARK
4(% 35452%
TISSUE STRANGULATION %XCESSIVE
TENSION AND INSTRUMENT DAMAGE
SHOULD BE AVOIDED TO PREVENT SUTURE
BREAKAGE WHICH COULD DISRUPT THE
ENTIRE LINE OF A CONTINUOUS SUTURE
&)'52%
$%%0
35452%3
#ONTINUOUS SUTURING LEAVES LESS
FOREIGN BODY MASS IN THE WOUND
)N THE PRESENCE OF INFECTION IT MAY
BE DESIRABLE TO USE A MONOFILAMENT
SUTURE MATERIAL BECAUSE IT HAS NO
INTERSTICES WHICH CAN HARBOR
MICROORGANISMS 4HIS IS ESPECIALLY
CRITICAL AS A CONTINUOUS SUTURE
LINE CAN TRANSMIT INFECTION ALONG
THE ENTIRE LENGTH OF THE STRAND !
CONTINUOUS ONE LAYER MASS CLOSURE
MAY BE USED ON PERITONEUM ANDOR
FASCIAL LAYERS OF THE ABDOMINAL WALL
TO PROVIDE A TEMPORARY SEAL DURING
THE HEALING PROCESS
&)'52%
0523%
342).'
35452%3
).4%22504%$ 35452%3
)NTERRUPTED SUTURES USE A NUMBER
OF STRANDS TO CLOSE THE WOUND
%ACH STRAND IS TIED AND CUT AFTER
INSERTION 4HIS PROVIDES A MORE SECURE
CLOSURE BECAUSE IF ONE SUTURE BREAKS
THE REMAINING SUTURES WILL HOLD THE
WOUND EDGES IN APPROXIMATION
)NTERRUPTED SUTURES MAY BE USED
IF A WOUND IS INFECTED BECAUSE
MICROORGANISMS MAY BE LESS
LIKELY TO TRAVEL ALONG A SERIES OF
INTERRUPTED STITCHES
$%%0 35452%3
$EEP SUTURES ARE PLACED COMPLETELY
UNDER THE EPIDERMAL SKIN LAYER
4HEY MAY BE PLACED AS CONTINUOUS
OR INTERRUPTED SUTURES AND ARE NOT
REMOVED POSTOPERATIVELY
"52)%$ 35452%3
"URIED SUTURES ARE PLACED SO THAT THE
KNOT PROTRUDES TO THE INSIDE UNDER
THE LAYER TO BE CLOSED 4HIS TECH
NIQUE IS USEFUL WHEN USING LARGE
DIAMETER PERMANENT SUTURES ON
DEEPER LAYERS IN THIN PATIENTS WHO
MAY BE ABLE TO FEEL LARGE KNOTS THAT
ARE NOT BURIED
0523%
342).' 35452%3
0URSE
STRING SUTURES ARE CONTINUOUS
SUTURES PLACED AROUND A LUMEN AND
TIGHTENED LIKE A DRAWSTRING TO
INVERT THE OPENING 4HEY MAY BE
PLACED AROUND THE STUMP OF THE
APPENDIX IN THE BOWEL TO SECURE AN
INTESTINAL STAPLING DEVICE OR IN AN
ORGAN PRIOR TO INSERTION OF A TUBE
SUCH AS THE AORTA TO HOLD THE
CANNULATION TUBE IN PLACE DURING
AN OPEN HEART PROCEDURE
35"#54)#5,!2 35452%3
3UBCUTICULAR SUTURES ARE CONTINUOUS
OR INTERRUPTED SUTURES PLACED IN THE
DERMIS BENEATH THE EPITHELIAL LAYER
#ONTINUOUS SUBCUTICULAR SUTURES ARE
PLACED IN A LINE PARALLEL TO THE
WOUND 4HIS TECHNIQUE INVOLVES
TAKING SHORT LATERAL STITCHES THE FULL
LENGTH OF THE WOUND !FTER THE
#(!04%2
&)'52%
35"#54!.%/53
35452%3
&)'52%
2%4%.4)/.
35452%
"/,34%2
SUTURE HAS BEEN DRAWN TAUT THE
DISTAL END IS ANCHORED IN THE SAME
MANNER AS THE PROXIMAL END 4HIS
MAY INVOLVE TYING OR ANY OF A
VARIETY OF ANCHORING DEVICES
3UBCUTICULAR SUTURING MAY BE
PERFORMED WITH ABSORBABLE SUTURE
WHICH DOES NOT REQUIRE REMOVAL OR
WITH MONOFILAMENT NONABSORBABLE
SUTURE THAT IS LATER REMOVED BY
SIMPLY REMOVING THE ANCHORING
DEVICE AT ONE END AND PULLING THE
OPPOSITE END
4(% 3%#/.$!29
35452% ,).%
! SECONDARY LINE OF SUTURES MAY
BE USED
s 4O REINFORCE AND SUPPORT THE
PRIMARY SUTURE LINE ELIMINATE
DEAD SPACE AND PREVENT FLUID
ACCUMULATION IN AN ABDOMINAL
WOUND DURING HEALING BY FIRST
INTENTION 7HEN USED FOR THIS
PURPOSE THEY MAY ALSO BE CALLED
RETENTION STAY OR TENSION SUTURES
s 4O SUPPORT WOUNDS FOR HEALING
BY SECOND INTENTION
s &OR SECONDARY CLOSURE FOLLOWING
WOUND DISRUPTION WHEN HEALING
BY THIRD INTENTION
./4% )F SECONDARY SUTURES ARE
USED IN CASES OF NONHEALING THEY
SHOULD BE PLACED IN OPPOSITE FASHION
FROM THE PRIMARY SUTURES
IE INTERRUPTED IF THE PRIMARY
SUTURES WERE CONTINUOUS
CONTINUOUS IF THE PRIMARY SUTURES
WERE INTERRUPTED
2ETENTION SUTURES ARE PLACED APPROXI
MATELY INCHES FROM EACH EDGE OF
THE WOUND 4HE TENSION EXERTED
LATERAL TO THE PRIMARY SUTURE LINE
CONTRIBUTES TO THE TENSILE STRENGTH OF
THE WOUND 4HROUGH
AND
THROUGH
SUTURES ARE PLACED FROM INSIDE THE
PERITONEAL CAVITY THROUGH ALL LAYERS
OF THE ABDOMINAL WALL INCLUDING THE
PERITONEUM 4HEY SHOULD BE INSERT
ED BEFORE THE PERITONEUM IS CLOSED
USING A SIMPLE INTERRUPTED STITCH
4HE WOUND MAY BE CLOSED IN LAYERS
FOR A DISTANCE OF APPROXIMATELY
THREE
FOURTHS ITS LENGTH 4HEN THE
RETENTION SUTURES IN THIS AREA MAY BE
DRAWN TOGETHER AND TIED )T IS
IMPORTANT THAT A FINGER BE PLACED
WITHIN THE ABDOMINAL CAVITY TO
PREVENT STRANGULATION OF THE VISCERA
IN THE CLOSURE 4HE REMAINDER OF THE
WOUND MAY THEN BE CLOSED 0RIOR
TO TIGHTENING AND TYING THE FINAL
RETENTION SUTURES IT IS IMPORTANT
TO EXPLORE THE ABDOMEN AGAIN WITH
A FINGER TO PREVENT STRANGULATION
OF VISCERA IN THE CLOSURE 4HE
REMAINDER OF THE WOUND MAY THEN
BE CLOSED
2ETENTION SUTURES UTILIZE
NONABSORBABLE SUTURE MATERIAL
4HEY SHOULD THEREFORE BE REMOVED
AS SOON AS THE DANGER OF SUDDEN
4RADEMARK
4(% 35452%
INCREASES IN INTRA
ABDOMINAL
PRESSURE IS OVER USUALLY TO
WEEKS WITH AN AVERAGE OF WEEKS
34)4#( 0,!#%-%.4
-ANY TYPES OF STITCHES ARE USED
FOR BOTH CONTINUOUS AND INTERRUPTED
SUTURING )N EVERY CASE EQUAL
BITES OF TISSUE SHOULD BE TAKEN
ON EACH SIDE OF THE WOUND 4HE
NEEDLE SHOULD BE INSERTED FROM
TO CENTIMETERS FROM THE EDGE
OF THE WOUND DEPENDING UPON THE
TYPE AND CONDITION OF THE TISSUE
BEING SUTURED
+./4 49).'
/F THE MORE THAN DIFFERENT
TYPES OF KNOTS DESCRIBED IN 4(%
%.#9,#/0%$)! /& +./43
ONLY A FEW ARE USED IN MODERN
SURGERY )T IS OF PARAMOUNT
IMPORTANCE THAT EACH KNOT PLACED
FOR APPROXIMATION OF TISSUES OR
LIGATION OF VESSELS BE TIED WITH
PRECISION AND EACH MUST HOLD WITH
PROPER TENSION
+./4 3%#52)49
4HE CONSTRUCTION OF %4()#/.
SUTURES HAS BEEN CAREFULLY
DESIGNED TO PRODUCE THE OPTIMUM
COMBINATION OF STRENGTH
UNIFORMITY AND HAND FOR EACH
MATERIAL 4HE TERM HAND IS THE
MOST SUBTLE OF ALL SUTURE QUALITY
ASPECTS )T RELATES TO THE FEEL OF THE
SUTURE IN THE SURGEONS HANDS THE
SMOOTHNESS WITH WHICH IT PASSES
THROUGH TISSUE AND TIES DOWN THE
WAY IN WHICH KNOTS CAN BE SET AND
SNUGGED DOWN AND MOST OF ALL TO
THE FIRMNESS OR BODY OF THE SUTURE
%XTENSIBILITY RELATES TO THE WAY IN
WHICH THE SUTURE WILL STRETCH SLIGHTLY
DURING KNOT TYING AND THEN RECOVER
4HE STRETCHING CHARACTERISTICS
PROVIDE THE SIGNAL THAT ALERTS THE
SURGEON TO THE PRECISE MOMENT
WHEN THE SUTURE KNOT IS SNUG
4HE TYPE OF KNOT TIED WILL DEPEND
UPON THE MATERIAL USED THE DEPTH
AND LOCATION OF THE INCISION AND THE
AMOUNT OF STRESS THAT WILL BE PLACED
UPON THE WOUND POSTOPERATIVELY
-ULTIFILAMENT SUTURES ARE GENERALLY
EASIER TO HANDLE AND TIE THAN
MONOFILAMENT SUTURES HOWEVER ALL
THE SYNTHETIC MATERIALS REQUIRE A
SPECIFIC KNOTTING TECHNIQUE 7ITH
MULTIFILAMENT SUTURES THE NATURE OF
THE MATERIAL AND THE BRAIDED OR
TWISTED CONSTRUCTION PROVIDE A HIGH
COEFFICIENT OF FRICTION AND THE KNOTS
REMAIN AS THEY ARE LAID DOWN )N
MONOFILAMENT SUTURES ON THE OTHER
HAND THE COEFFICIENT OF FRICTION IS
RELATIVELY LOW RESULTING IN A GREATER
TENDENCY FOR THE KNOT TO LOOSEN
AFTER IT HAS BEEN TIED )N ADDITION
MONOFILAMENT SYNTHETIC POLYMERIC
MATERIALS POSSESS THE PROPERTY OF
MEMORY -EMORY IS THE TENDENCY
NOT TO LIE FLAT BUT TO RETURN TO A
GIVEN SHAPE SET BY THE MATERIALS
EXTRUSION PROCESS OR THE SUTURES
PACKAGING 4HE 2%,!9
SUTURE
DELIVERY SYSTEM DELIVERS SUTURES WITH
MINIMAL PACKAGE MEMORY DUE TO ITS
UNIQUE PACKAGE DESIGN
3UTURE KNOTS MUST BE PROPERLY
PLACED TO BE SECURE 3PEED IN KNOT
TYING FREQUENTLY RESULTS IN LESS THAN
PERFECT PLACEMENT OF THE STRANDS
)N ADDITION TO VARIABLES INHERENT IN
THE SUTURE MATERIALS CONSIDERABLE
VARIATION CAN BE FOUND BETWEEN
KNOTS TIED BY DIFFERENT SURGEONS
AND EVEN BETWEEN KNOTS TIED BY
THE SAME INDIVIDUAL ON DIFFERENT
OCCASIONS
4HE GENERAL PRINCIPLES OF KNOT
TYING WHICH APPLY TO ALL SUTURE
MATERIALS ARE
4HE COMPLETED KNOT MUST BE
FIRM AND SO TIED THAT SLIPPING IS
VIRTUALLY IMPOSSIBLE 4HE
SIMPLEST KNOT FOR THE MATERIAL IS
THE MOST DESIRABLE
4HE KNOT MUST BE AS SMALL AS
POSSIBLE TO PREVENT AN EXCESSIVE
AMOUNT OF TISSUE REACTION WHEN
ABSORBABLE SUTURES ARE USED OR TO
MINIMIZE FOREIGN BODY REACTION
TO NONABSORBABLE SUTURES %NDS
SHOULD BE CUT AS SHORT AS POSSIBLE
)N TYING ANY KNOT FRICTION
BETWEEN STRANDS SAWING MUST
BE AVOIDED AS THIS CAN WEAKEN THE
INTEGRITY OF THE SUTURE
#/.4).5/53 35452% ).4%22504%$ 35452%3
4O APPOSE SKIN AND OTHER TISSUE
/VER
AND
OVER
3UBCUTICULAR
/VER AND OVER
6ERTICAL MATTRESS
(ORIZONTAL MATTRESS
4O INVERT TISSUE
,EMBERT
#USHING
#ONNELL
,EMBERT
(ALSTED
0URSE
STRING
4O EVERT TISSUE
(ORIZONTAL MATTRESS
(ORIZONTAL MATTRESS
4!",%
#/--/.,9
53%$ 490%3
/& 34)4#(%3
#(!04%2
&)'52%
&).)3(%$
35452%
4)%3
3QUARE KNOT
#ARE SHOULD BE TAKEN TO AVOID
DAMAGE TO THE SUTURE MATERIAL
WHEN HANDLING !VOID THE
CRUSHING OR CRIMPING APPLICATION
OF SURGICAL INSTRUMENTS SUCH AS
NEEDLEHOLDERS AND FORCEPS TO THE
STRAND EXCEPT WHEN GRASPING THE
FREE END OF THE SUTURE DURING AN
INSTRUMENT TIE
%XCESSIVE TENSION APPLIED BY THE
SURGEON WILL CAUSE BREAKING OF
THE SUTURE AND MAY CUT TISSUE
0RACTICE IN AVOIDING EXCESSIVE
TENSION LEADS TO SUCCESSFUL USE OF
FINER GAUGE MATERIALS
3URGEONS KNOTnFIRST
THROW
3UTURES USED FOR APPROXIMATION
SHOULD NOT BE TIED TOO TIGHTLY
BECAUSE THIS MAY CONTRIBUTE TO
TISSUE STRANGULATION
!FTER THE FIRST LOOP IS TIED IT IS
NECESSARY TO MAINTAIN TRACTION
ON ONE END OF THE STRAND TO
AVOID LOOSENING OF THE THROW IF
BEING TIED UNDER ANY TENSION
3URGEONS KNOTnSECOND
THROW
&INAL TENSION ON FINAL THROW
SHOULD BE AS NEARLY HORIZONTAL
AS POSSIBLE
4HE SURGEON SHOULD NOT HESITATE
TO CHANGE STANCE OR POSITION IN
RELATION TO THE PATIENT IN ORDER
TO PLACE A KNOT SECURELY AND FLAT
$EEP TIE
)NSTRUMENT TIE
%XTRA TIES DO NOT ADD TO THE
STRENGTH OF A PROPERLY TIED AND
SQUARED KNOT 4HEY ONLY
CONTRIBUTE TO ITS BULK 7ITH
SOME SYNTHETIC MATERIALS KNOT
SECURITY REQUIRES THE STANDARD
SURGICAL TECHNIQUE TO FLAT AND
SQUARE TIES WITH ADDITIONAL
THROWS IF INDICATED BY SURGICAL
CIRCUMSTANCE AND THE EXPERIENCE
OF THE SURGEON
+./4 49).' 4%#(.)15%3
-/34 /&4%. 53%$
!N IMPORTANT PART OF GOOD SUTURING
TECHNIQUE IS CORRECT METHOD IN
KNOT TYING ! SEESAW MOTION OR
THE SAWING OF ONE STRAND DOWN OVER
ANOTHER UNTIL THE KNOT IS FORMED
MAY MATERIALLY WEAKEN SUTURES TO
THE POINT THAT THEY MAY BREAK WHEN
THE SECOND THROW IS MADE OR EVEN
WORSE IN THE POSTOPERATIVE PERIOD
WHEN THE SUTURE IS FURTHER WEAKENED
BY INCREASED TENSION OR MOTION )F
THE TWO ENDS OF THE SUTURE ARE
PULLED IN OPPOSITE DIRECTIONS WITH
UNIFORM RATE AND TENSION THE KNOT
MAY BE TIED MORE SECURELY
3OME PROCEDURES INVOLVE TYING
KNOTS WITH THE FINGERS USING ONE OR
TWO HANDS OTHERS INVOLVE TYING WITH
THE HELP OF INSTRUMENTS 0ERHAPS
THE MOST COMPLEX METHOD OF KNOT
TYING IS DONE DURING ENDOSCOPIC
PROCEDURES WHEN THE SURGEON MUST
MANIPULATE INSTRUMENTS FROM WELL
OUTSIDE THE BODY CAVITY
&OLLOWING ARE THE MOST FREQUENTLY
USED KNOT TYING TECHNIQUES WITH
ACCOMPANYING ILLUSTRATIONS OF
FINISHED KNOTS
315!2% +./4
4HE TWO
HAND SQUARE KNOT IS THE
EASIEST AND MOST RELIABLE FOR TYING
MOST SUTURE MATERIALS )T MAY BE
USED TO TIE SURGICAL GUT VIRGIN SILK
SURGICAL COTTON AND SURGICAL STAIN
LESS STEEL 3TANDARD TECHNIQUE OF FLAT
AND SQUARE TIES WITH ADDITIONAL
THROWS IF INDICATED BY THE SURGICAL
CIRCUMSTANCE AND THE EXPERIENCE OF
THE OPERATOR SHOULD BE USED TO TIE
-/./#29,
POLIGLECAPRONE
SUTURE 6)#29,
SUTURE #OATED
6)#29,
SUTURE #OATED 6)#29,
2!0)$% POLYGLACTIN SUTURE
4RADEMARK
4(% 35452%
0$3
)) POLYDIOXANONE SUTURE
%4(),/.
NYLON SUTURE
%4()"/.$
%8#%, POLYESTER
SUTURE 0%2-!
(!.$
SILK
SUTURE 02/./6!
POLY HEXAFLUO
ROPROPYLENE
6$& SUTURE AND
02/,%.%
POLYPROPYLENE SUTURE
7HEREVER POSSIBLE THE SQUARE
KNOT IS TIED USING THE TWO
HAND
TECHNIQUE /N SOME OCCASIONS IT
WILL BE NECESSARY TO USE ONE HAND
EITHER THE LEFT OR THE RIGHT TO TIE A
SQUARE KNOT
#!54)/. )F THE STRANDS OF A
SQUARE KNOT ARE INADVERTENTLY
INCORRECTLY CROSSED A GRANNY KNOT
WILL RESULT 'RANNY KNOTS ARE NOT
RECOMMENDED BECAUSE THEY HAVE A
TENDENCY TO SLIP WHEN SUBJECTED TO
INCREASED STRESS
352'%/.3 /2
&2)#4)/. +./4
4HE SURGEONgS OR FRICTION KNOT IS
RECOMMENDED FOR TYING 6)#29,
SUTURE #OATED 6)#29,
SUTURE
%4()"/.$
%8#%, POLYESTER
SUTURE %4(),/.
NYLON SUTURE
-%23),%.%
POLYESTER FIBER
SUTURE .52/,/.
NYLON SUTURE
02/./6!
POLY HEXAFLUORO
PROPYLENE
6$& SUTURE AND
02/,%.%
POLYPROPYLENE
SUTURE 4HE SURGEONS KNOT ALSO
MAY BE PERFORMED USING A
ONE
HAND TECHNIQUE
$%%0 4)%
4YING DEEP IN A BODY CAVITY CAN BE
DIFFICULT 4HE SQUARE KNOT MUST BE
FIRMLY SNUGGED DOWN AS IN ALL
SITUATIONS (OWEVER THE OPERATOR
MUST AVOID UPWARD TENSION WHICH
MAY TEAR OR AVULSE THE TISSUE
,)'!4)/. 53).' !
(%-/34!4)# #,!-0
&REQUENTLY IT IS NECESSARY TO LIGATE
A BLOOD VESSEL OR TISSUE GRASPED IN
A HEMOSTATIC CLAMP TO ACHIEVE
HEMOSTASIS IN THE OPERATIVE FIELD
).3425-%.4 4)%
4HE INSTRUMENT TIE IS USEFUL WHEN
ONE OR BOTH ENDS OF THE SUTURE
MATERIAL ARE SHORT &OR BEST RESULTS
EXERCISE CAUTION WHEN USING A
NEEDLEHOLDER WITH ANY MONOFILA
MENT SUTURE AS REPEATED BENDING
MAY CAUSE THESE SUTURES TO BREAK
%.$/3#/0)# +./4
49).' 4%#(.)15%3
$URING AN ENDOSCOPIC PROCEDURE
A SQUARE KNOT OR SURGEONgS KNOT MAY
BE TIED EITHER OUTSIDE THE ABDOMEN
AND PUSHED DOWN INTO THE BODY
THROUGH A TROCAR EXTRACORPOREAL
OR DIRECTLY WITHIN THE ABDOMINAL
CAVITY INTRACORPOREAL
)N EXTRACORPOREAL KNOT TYING THE
SUTURE APPROPRIATELY PENETRATES THE
TISSUE AND BOTH NEEDLE AND SUTURE
ARE REMOVED FROM THE BODY CAVITY
BRINGING BOTH SUTURE ENDS OUTSIDE
OF THE TROCAR 4HEN A SERIES OF
HALF
HITCHES ARE TIED EACH ONE
BEING PUSHED DOWN INTO THE CAVITY
AND TIGHTENED WITH AN ENDOSCOPIC
KNOT PUSHER
)NTRACORPOREAL KNOT TYING IS
PERFORMED TOTALLY WITHIN THE
ABDOMINAL CAVITY !FTER THE SUTURE
HAS PENETRATED THE TISSUE THE NEEDLE
35452% ,/#!4)/.
IS CUT FROM THE SUTURE AND REMOVED
3EVERAL LOOPS ARE MADE WITH THE
SUTURE AROUND THE NEEDLEHOLDER
AND THE END OF THE SUTURE IS PULLED
THROUGH THE LOOPS 4HIS TECHNIQUE
IS THEN REPEATED TO FORM A SURGEONgS
KNOT WHICH IS TIGHTENED BY THE
KNOT PUSHER
)N BOTH EXTRACORPOREAL AND INTRACOR
POREAL KNOT TYING THE FOLLOWING
PRINCIPLES OF SUTURE MANIPULATION
ON TISSUE SHOULD BE OBSERVED
(ANDLE TISSUE AS GENTLY AS
POSSIBLE TO AVOID TISSUE TRAUMA
'RASP AS LITTLE TISSUE AS POSSIBLE
5SE THE SMALLEST SUTURE POSSIBLE
FOR THE TASK
%XERCISE CARE IN APPROXIMATING
THE KNOT SO THAT THE TISSUE BEING
APPROXIMATED IS NOT STRANGULATED
3UTURE MUST BE HANDLED WITH CARE
TO AVOID DAMAGE
#544).' 4(%
3%#52%$ 35452%3
/NCE THE KNOT HAS BEEN SECURELY
TIED THE ENDS MUST BE CUT "EFORE
CUTTING MAKE SURE BOTH TIPS OF
THE SCISSORS ARE VISIBLE TO AVOID
INADVERTENTLY CUTTING TISSUE BEYOND
THE SUTURE
#UTTING SUTURES ENTAILS RUNNING
THE TIP OF THE SCISSORS LIGHTLY DOWN
THE SUTURE STRAND TO THE KNOT
4HE ENDS OF SURGICAL GUT ARE LEFT
RELATIVELY LONG APPROXIMATELY
MM FROM THE KNOT
4)-% &/2 35452% 2%-/6!,
3KIN ON THE FACE AND NECK
TO DAYS
/THER SKIN SUTURES
TO DAYS
2ETENTION SUTURES
TO WEEKS
4!",%
35452%
2%-/6!,
#(!04%2
/THER MATERIALS ARE CUT CLOSER TO THE
KNOT APPROXIMATELY MM
TO DECREASE TISSUE REACTION AND
MINIMIZE THE AMOUNT OF FOREIGN
MATERIAL LEFT IN THE WOUND 4O
ENSURE THAT THE ACTUAL KNOT IS NOT
CUT TWIST OR ANGLE THE BLADES OF THE
SCISSORS PRIOR TO CUTTING
-AKE CERTAIN TO REMOVE THE
CUT ENDS OF THE SUTURE FROM THE
OPERATIVE SITE
35452% 2%-/6!,
7HEN THE EXTERNAL WOUND HAS
HEALED SO THAT IT NO LONGER NEEDS THE
SUPPORT OF NONABSORBABLE SUTURE
MATERIAL SKIN SUTURES MUST BE
REMOVED 4HE LENGTH OF TIME THE
SUTURES REMAIN IN PLACE DEPENDS
UPON THE RATE OF HEALING AND THE
NATURE OF THE WOUND 'ENERAL RULES
ARE AS FOLLOWS
3UTURES SHOULD BE REMOVED USING
ASEPTIC AND STERILE TECHNIQUE 4HE
SURGEON USES A STERILE SUTURE REMOVAL
TRAY PREPARED FOR THE PROCEDURE
4HE FOLLOWING STEPS ARE TAKEN
s 34%0 #LEANSE THE AREA WITH
AN ANTISEPTIC (YDROGEN PEROXIDE
CAN BE USED TO REMOVE DRIED SERUM
ENCRUSTED AROUND THE SUTURES
s 34%0 0ICK UP ONE END OF THE
SUTURE WITH THUMB FORCEPS AND
CUT AS CLOSE TO THE SKIN AS POSSIBLE
WHERE THE SUTURE ENTERS THE SKIN
s 34%0 'ENTLY PULL THE SUTURE
STRAND OUT THROUGH THE SIDE OPPO
SITE THE KNOT WITH THE FORCEPS 4O
PREVENT RISK OF INFECTION THE SUTURE
SHOULD BE REMOVED WITHOUT PULLING
ANY PORTION THAT HAS BEEN OUTSIDE
THE SKIN BACK THROUGH THE SKIN
./4% &AST ABSORBING SYNTHETIC OR
GUT SUTURE MATERIAL TEND TO LOSE ALL
TENSILE STRENGTH IN TO DAYS AND CAN
BE REMOVED EASILY WITHOUT CUTTING
! COMMON PRACTICE IS TO COVER THE
SKIN SUTURES WITH 02/8)
342)0
SKIN CLOSURES DURING THE REQUIRED
HEALING PERIOD !FTER THE WOUND
EDGES HAVE REGAINED SUFFICIENT TENSILE
STRENGTH THE SUTURES MAY BE
REMOVED BY SIMPLY REMOVING THE
02/8)
342)0 SKIN CLOSURES
35452%
(!.$,).' 4)03
4HESE GUIDELINES WILL HELP THE SURGICAL
TEAM KEEP THEIR SUTURE INVENTORY UP
TO DATE AND THEIR SUTURES IN THE BEST
POSSIBLE CONDITION
2EAD LABELS
(EED EXPIRATION DATES AND
ROTATE STOCK
/PEN ONLY THOSE SUTURES NEEDED
FOR THE PROCEDURE AT HAND
3TRAIGHTEN SUTURES WITH A GENTLE
PULL .EVER CRUSH OR RUB THEM
$ONgT PULL ON NEEDLES
!VOID CRUSHING OR CRIMPING
SUTURE STRANDS WITH SURGICAL
INSTRUMENTS
$ONgT STORE SURGICAL GUT
NEAR HEAT
-OISTENBUT NEVER SOAK
SURGICAL GUT
$O NOT WET RAPIDLY ABSORBING
SUTURES
+EEP SILK DRY
7ET LINEN AND COTTON TO INCREASE
THEIR STRENGTH
$ONgT BEND STAINLESS STEEL WIRE
$RAW NYLON BETWEEN GLOVED
FINGERS TO REMOVE THE PACKAGING
MEMORY
!RM A NEEDLEHOLDER PROPERLY
35452% 3%,%#4)/.
02/#%$52%
02).#)0,%3 /&
35452% 3%,%#4)/.
4HE SURGEON HAS A CHOICE OF SUTURE
MATERIALS FROM WHICH TO SELECT FOR
USE IN BODY TISSUES !DEQUATE
STRENGTH OF THE SUTURE MATERIAL WILL
PREVENT SUTURE BREAKAGE 3ECURE
KNOTS WILL PREVENT KNOT SLIPPAGE
"UT THE SURGEON MUST UNDERSTAND
THE NATURE OF THE SUTURE MATERIAL
&)'52%
!2-).'
! .%%$,%
(/,$%2
02/0%2,9
'RASP THE NEEDLE ONE THIRD TO ONE HALF OF THE DISTANCE FROM
THE SWAGED END TO THE POINT
4RADEMARK
4(% 35452%
THE BIOLOGIC FORCES IN THE HEALING
WOUND AND THE INTERACTION OF
THE SUTURE AND THE TISSUES 4HE
FOLLOWING PRINCIPLES SHOULD GUIDE
THE SURGEON IN SUTURE SELECTION
4HEREFORE
A )N THE URINARY AND BILIARY
TRACTS USE RAPIDLY ABSORBED
SUTURES
2EGARDING SUTURE SIZE
A 5SE THE FINEST SIZE SUTURE
7HEN A WOUND HAS REACHED
COMMENSURATE WITH THE
MAXIMAL STRENGTH SUTURES ARE NO
NATURAL STRENGTH OF THE TISSUE
LONGER NEEDED 4HEREFORE
B )F THE POSTOPERATIVE COURSE OF
A 4ISSUES THAT ORDINARILY HEAL
THE PATIENT MAY PRODUCE
SLOWLY SUCH AS SKIN FASCIA
SUDDEN STRAINS ON THE SUTURE
AND TENDONS SHOULD USUALLY
LINE REINFORCE IT WITH
BE CLOSED WITH NONABSORBABLE
RETENTION SUTURES 2EMOVE
SUTURES !N ABSORBABLE SUTURE
THEM AS SOON AS THE PATIENTS
WITH EXTENDED UP TO
CONDITION IS STABILIZED
MONTHS WOUND SUPPORT MAY
ALSO BE USED
352'%29 7)4(). 4(%
B 4ISSUES THAT HEAL RAPIDLY
!"$/-).!, 7!,, #!6)49
SUCH AS STOMACH COLON AND
%NTERING THE ABDOMEN THE SURGEON
BLADDER MAY BE CLOSED WITH
WILL NEED TO SEAL OR TIE OFF
ABSORBABLE SUTURES
SUBCUTANEOUS BLOOD VESSELS
&OREIGN BODIES IN POTENTIALLY
CONTAMINATED TISSUES MAY CONVERT IMMEDIATELY AFTER THE INCISION IS
MADE USING EITHER AN ELECTROSURGICAL
CONTAMINATION INTO INFECTION
UNIT DESIGNED FOR THIS PURPOSE OR
7HERE COSMETIC RESULTS ARE
FREE TIES LIGATURES )F LIGATURES ARE
IMPORTANT CLOSE AND PROLONGED
USED AN ABSORBABLE SUTURE MATERIAL
APPOSITION OF WOUNDS AND
IS GENERALLY PREFERRED 7HEN
AVOIDANCE OF IRRITANTS WILL
PREPARING THE TIES THE SCRUB PERSON
PRODUCE THE BEST RESULTS
OFTEN PREPARES ONE STRAND ON A
4HEREFORE
NEEDLE FOR USE AS A SUTURE LIGATURE
A 5SE THE SMALLEST INERT
SHOULD THE SURGEON WISH TO
MONOFILAMENT SUTURE
TRANSFIX A LARGE BLOOD VESSEL
MATERIALS SUCH AS NYLON
/NCE INSIDE THE TYPE OF SUTURE
OR POLYPROPYLENE
B !VOID SKIN SUTURES AND CLOSE
SELECTED WILL DEPEND UPON THE
SUBCUTICULARLY WHENEVER
NATURE OF THE OPERATION AND THE
POSSIBLE
C 5NDER CERTAIN CIRCUMSTANCES SURGEONgS TECHNIQUE
TO SECURE CLOSE APPOSITION OF
4(% '!342/).4%34).!, 42!#4
SKIN EDGES A TOPICAL SKIN
,EAKAGE FROM AN ANASTOMOSIS
ADHESIVE OR SKIN CLOSURE
OR SUTURE SITE IS THE PRINCIPAL
TAPE MAY BE USED
PROBLEM ENCOUNTERED PERFORMING
&OREIGN BODIES IN THE PRESENCE
OF FLUIDS CONTAINING HIGH CONCEN
A PROCEDURE INVOLVING THE
GASTROINTESTINAL TRACT 4HIS PROBLEM
TRATIONS OF CRYSTALLOIDS MAY ACT
CAN LEAD TO LOCALIZED OR GENERALIZED
AS A NIDUS FOR PRECIPITATION AND
PERITONITIS 3UTURES SHOULD NOT BE
STONE FORMATION
TIED TOO TIGHTLY IN AN ANASTOMOTIC
CLOSURE 7OUNDS OF THE STOMACH AND
INTESTINE ARE RICH IN BLOOD SUPPLY
AND MAY BECOME EDEMATOUS AND
HARDENED 4IGHT SUTURES MAY CUT
THROUGH THE TISSUE AND CAUSE
LEAKAGE ! LEAK
PROOF ANASTOMOSIS
CAN BE ACHIEVED WITH EITHER A
SINGLE OR DOUBLE
LAYER CLOSURE
&OR A SINGLE
LAYER CLOSURE INTERRUPT
ED SUTURES SHOULD BE PLACED
APPROXIMATELY MM APART
3UTURE IS PLACED THROUGH THE
SUBMUCOSA INTO THE MUSCULARIS AND
THROUGH THE SEROSA "ECAUSE THE
SUBMUCOSA PROVIDES STRENGTH IN
THE GASTROINTESTINAL TRACT EFFECTIVE
CLOSURE INVOLVES SUTURING THE
SUBMUCOSAL LAYERS IN APPOSITION
WITHOUT PENETRATING THE MUCOSA
! CONTINUOUS SUTURE LINE PROVIDES A
TIGHTER SEAL THAN INTERRUPTED SUTURES
(OWEVER IF A CONTINUOUS SUTURE
BREAKS THE ENTIRE LINE MAY SEPARATE
-ANY SURGEONS PREFER TO USE A
DOUBLE
LAYER CLOSURE PLACING A
SECOND LAYER OF INTERRUPTED SUTURES
THROUGH THE SEROSA FOR INSURANCE
!BSORBABLE 6)#29,
SUTURES OR
CHROMIC GUT SUTURES MAY BE USED
IN EITHER A SINGLE OR DOUBLE
LAYER
CLOSURE 3URGICAL SILK MAY ALSO BE
USED FOR THE SECOND LAYER OF A
DOUBLE
LAYER CLOSURE
)NVERTED EVERTED OR END
TO
END
CLOSURE TECHNIQUES HAVE ALL BEEN
USED SUCCESSFULLY IN THIS AREA BUT
THEY ALL HAVE DRAWBACKS 4HE
SURGEON MUST TAKE METICULOUS CARE
IN PLACING THE SUTURES IN THE SUBMU
COSA %VEN WITH THE BEST TECHNIQUE
SOME LEAKAGE MAY OCCUR
&ORTUNATELY THE OMENTUM USUALLY
CONFINES THE AREA AND NATURAL BODY
DEFENSES HANDLE THE PROBLEM
#(!04%2
&)'52%
3INGLE LAYER
$OUBLE LAYER
!.!34/-/4)#
#,/352%
4%#(.)15%
&)'52%
).6%24%$
#,/352%
4%#(.)15%
4(% 34/-!#(
4(% 3-!,, ).4%34).%
&OR AN ORGAN THAT CONTAINS FREE
HYDROCHLORIC ACID AND POTENT
PROTEOLYTIC ENZYMES THE STOMACH
HEALS SURPRISINGLY QUICKLY
3TOMACH WOUNDS ATTAIN MAXIMUM
STRENGTH WITHIN TO DAYS
#LOSURE OF THE SMALL INTESTINE
PRESENTS THE SAME CONSIDERATIONS
AS THE STOMACH 0ROXIMAL INTESTINAL
CONTENTS PRIMARILY BILE OR
PANCREATIC JUICES MAY CAUSE A
SEVERE CHEMICAL RATHER THAN
BACTERIAL PERITONITIS
)F USING AN INVERTED CLOSURE
TECHNIQUE CARE MUST BE TAKEN TO
MINIMIZE THE CUFF OF TISSUE WHICH
PROTRUDES INTO THE SMALL SIZED
INTESTINAL LUMEN IN ORDER TO AVOID
PARTIAL OR COMPLETE OBSTRUCTION
!BSORBABLE SUTURES ARE USUALLY
PREFERRED PARTICULARLY BECAUSE THEY
WILL NOT PERMANENTLY LIMIT THE
LUMEN DIAMETER ! NONABSORBABLE
SUTURE MAY BE USED IN THE SEROSAL
POSTOPERATIVELY AND HAVE A PEAK
RATE OF COLLAGEN SYNTHESIS AT DAYS
!BSORBABLE SUTURES ARE USUALLY
ACCEPTABLE IN THE STOMACH ALTHOUGH
THEY MAY PRODUCE A MODERATE
REACTION IN BOTH THE WOUND AND
NORMAL TISSUE #OATED 6)#29,
SUTURES ARE MOST COMMONLY USED
02/,%.%
SUTURES MAY ALSO BE
USED FOR STOMACH CLOSURE
LAYER FOR ADDED ASSURANCE
4HE SMALL INTESTINE HEALS VERY
RAPIDLY REACHING MAXIMAL STRENGTH
IN APPROXIMATELY DAYS
4(% #/,/.
4HE HIGH MICROBIAL CONTENT OF
THE COLON ONCE MADE CONTAMINATION
A MAJOR CONCERN "UT ABSORBABLE
SUTURES ONCE ABSORBED LEAVE NO
CHANNEL FOR MICROBIAL MIGRATION
3TILL LEAKAGE OF LARGE BOWEL
CONTENTS IS OF GREAT CONCERN AS IT
IS POTENTIALLY MORE SERIOUS THAN
LEAKAGE IN OTHER AREAS OF THE
GASTROINTESTINAL TRACT
4HE COLON IS A STRONG ORGAN
APPROXIMATELY TWICE AS STRONG IN THE
SIGMOID REGION AS IN THE CECUM 9ET
WOUNDS OF THE COLON GAIN STRENGTH
AT THE SAME RATE REGARDLESS OF THEIR
LOCATION 4HIS PERMITS THE SAME
SUTURE SIZE TO BE USED AT EITHER END
OF THE COLON 4HE COLON HEALS AT A
RATE SIMILAR TO THAT OF THE STOMACH
AND SMALL INTESTINE ! HIGH RATE OF
COLLAGEN SYNTHESIS IS MAINTAINED FOR
A PROLONGED PERIOD OVER DAYS
4HE ENTIRE GASTROINTESTINAL TRACT
EXHIBITS A LOSS OF COLLAGEN AND
INCREASED COLLAGENOUS ACTIVITY
IMMEDIATELY FOLLOWING COLON
ANASTOMOSIS "OTH ABSORBABLE AND
NONABSORBABLE SUTURES MAY BE USED
FOR CLOSURE OF THE COLON 0LACEMENT
OF SUTURES IN THE SUBMUCOSA
AVOIDING PENETRATION OF THE MUCOSA
WILL HELP PREVENT COMPLICATIONS
4(% 2%#45-
4HE RECTUM HEALS VERY SLOWLY
"ECAUSE THE LOWER PORTION IS BELOW
THE PELVIC PERITONEUM IT HAS NO
SEROSA ! LARGE BITE OF MUSCLE SHOULD
BE INCLUDED IN AN ANASTOMOSIS AND
THE SUTURES SHOULD BE TIED CAREFULLY
TO AVOID CUTTING THROUGH THE TISSUES
4RADEMARK
4(% 35452%
-ONOFILAMENT SUTURES REDUCE THE
RISK OF BACTERIAL PROLIFERATION IN
THE RECTUM
&)'52%
4(% "),)!29 42!#4
4(% '!,,",!$$%2
7ITHIN THE GALLBLADDER THE CYSTIC
AND COMMON BILE DUCTS HEAL RAPIDLY
4HEIR CONTENTS PRESENT SPECIAL
CONSIDERATIONS FOR SUTURE SELECTION
4HE PRESENCE OF A FOREIGN BODY SUCH
AS A SUTURE IN AN ORGAN THAT IS PRONE
TO CRYSTAL FORMATION MAY PRECIPITATE
THE FORMATION OF STONES
-ULTIFILAMENT SUTURES SHOULD
PROBABLY NOT BE USED BECAUSE IT
IS NOT ALWAYS POSSIBLE TO PREVENT
EXPOSURE OF A SUTURE IN THE DUCTS
4HE SURGEON SHOULD CHOOSE AN
ABSORBABLE SUTURE IN THE FINEST SIZE
POSSIBLE THAT LEAVES THE LEAST SURFACE
AREA EXPOSED
,)6%2
2%3%#4)/.
3KIN
3UBCUTANEOUS FAT
&)'52%
4(%
!"$/-).!,
7!,,
0!2%.#(9-!4/53 /2'!.3
4(% 30,%%. ,)6%2 !.$ +)$.%9
/N OCCASION A SURGEON MAY BE
CALLED UPON TO REPAIR A LACERATION
OF ONE OF THESE VITAL ORGANS )F
LARGE VESSELS PARTICULARLY ARTERIES
WITHIN THESE ORGANS HAVE BEEN
SEVERED THEY MUST BE LOCATED
AND LIGATED BEFORE ATTEMPTING
TO CLOSE THE DEFECT /THERWISE
HEMATOMAS OR SECONDARY HEMOR
RHAGE MAY OCCUR
"ECAUSE THESE ORGANS ARE COMPOSED
CHIEFLY OF CELLS WITH LITTLE CONNECTIVE
TISSUE FOR SUPPORT ATTEMPTS MUST
BE MADE TO COAPT THE OUTER FIBROUS
CAPSULE OF THE TORN TISSUE )N THE
ABSENCE OF HEMORRHAGE LITTLE TENSION
IS PLACED ON THE SUTURE LINE AND ONLY
SMALL SIZE SUTURES NEED TO BE USED )F
THE TISSUE CANNOT BE APPROXIMATED
TACKING A PIECE OF OMENTUM OVER
THE DEFECT WILL USUALLY SUFFICE TO
0ERITONEUM
-USCLE TISSUE
PROVIDE CLOSURE 3UTURES DO NOT NEED
TO BE PLACED CLOSE TOGETHER OR DEEPLY
INTO THE ORGAN
,ACERATIONS IN THIS AREA TEND TO
HEAL RAPIDLY .EW FIBROUS TISSUE WILL
USUALLY FORM OVER THE WOUND WITH
TO DAYS
)N A LIVER RESECTION SUTURING OF THE
WEDGES IN A HORIZONTAL THROUGH
AND
THROUGH FASHION SHOULD HOLD
THE TISSUE SECURELY ,ARGE VESSELS
SHOULD BE TIED USING 6)#29,
SUTURES OR SILK 2AW SURFACES CAN BE
CLOSED OR REPAIRED USING 6)#29,
POLYGLACTIN MESH
4RANSVERSALIS FASCIA
#,/3).' 4(% !"$/-%.
7HEN CLOSING THE ABDOMEN THE
CLOSURE TECHNIQUE MAY BE MORE
IMPORTANT THAN THE TYPE OF SUTURE
MATERIAL USED
4(% 0%2)4/.%5-
4HE PERITONEUM THE THIN MEMBRA
NOUS LINING OF THE ABDOMINAL CAVITY
LIES BENEATH THE POSTERIOR FASCIA )T
HEALS QUICKLY 3OME BELIEVE THAT THE
PERITONEUM DOES NOT REQUIRE SUTUR
ING WHILE OTHERS DISAGREE )F THE
POSTERIOR FASCIA IS SECURELY CLOSED
SUTURING THE PERITONEUM MAY NOT
CONTRIBUTE TO THE PREVENTION OF AN
INCISIONAL HERNIA !MONG SURGEONS
WHO CHOOSE TO CLOSE THE PERI
TONEUM A CONTINUOUS SUTURE LINE
#(!04%2
WITH ABSORBABLE SUTURE MATERIAL
IS USUALLY PREFERRED )NTERRUPTED
SUTURES CAN ALSO BE USED FOR
THIS PROCEDURE
&!3#)!
4HIS LAYER OF FIRM STRONG CONNECTIVE
TISSUE COVERING THE MUSCLES IS THE
MAIN SUPPORTIVE STRUCTURE OF THE
BODY )N CLOSING AN ABDOMINAL
INCISION THE FASCIAL SUTURES MUST
HOLD THE WOUND CLOSED AND
ALSO HELP TO RESIST CHANGES IN INTRA
ABDOMINAL PRESSURE /CCASIONALLY
SYNTHETIC GRAFT MATERIAL MAY BE
USED WHEN FASCIA IS ABSENT OR WEAK
02/,%.%
POLYPROPYLENE MESH MAY
BE USED TO REPLACE ABDOMINAL WALL
OR REPAIR HERNIAS WHEN A GREAT DEAL
OF STRESS WILL BE PLACED ON THE SUTURE
LINE DURING HEALING .ONABSORBABLE
SUTURES SUCH AS 02/,%.% SUTURE
MAY BE USED TO SUTURE THE GRAFT TO
THE TISSUE
&ASCIA REGAINS APPROXIMATELY
OF ITS ORIGINAL STRENGTH IN MONTHS
)T MAY TAKE UP TO A YEAR OR LONGER TO
REGAIN MAXIMUM STRENGTH &ULL
ORIGINAL STRENGTH IS NEVER REGAINED
4HE ANATOMIC LOCATION AND TYPE OF
ABDOMINAL INCISION WILL INFLUENCE
HOW MAY LAYERS OF FASCIA WILL BE
SUTURED 4HE POSTERIOR FASCIAL LAYER
IS ALWAYS CLOSED 4HE ANTERIOR LAYER
MAY BE CUT AND MAY ALSO REQUIRE
SUTURING -ASS CLOSURE TECHNIQUES
ARE BECOMING THE MOST POPULAR
-OST SUTURE MATERIALS HAVE SOME
INHERENT DEGREE OF ELASTICITY )F NOT
TIED TOO TIGHTLY THE SUTURE WILL
GIVE TO ACCOMMODATE POSTOPERA
TIVE SWELLING THAT OCCURS 3TAINLESS
STEEL SUTURES IF TIED TOO TIGHTLY WILL
CUT LIKE A KNIFE AS THE TISSUE SWELLS
OR AS TENSION IS PLACED UPON THE
SUTURE LINE "ECAUSE OF THE SLOW
HEALING TIME AND BECAUSE THE FASCIAL
SUTURE MUST BEAR THE MAXIMUM
STRESS OF THE WOUND A MODERATE SIZE
NONABSORBABLE SUTURE MAY BE USED
!N ABSORBABLE SUTURE WITH LONGER
LASTING TENSILE STRENGTH SUCH AS
0$3
)) SUTURES MAY ALSO PROVIDE
ADEQUATE SUPPORT 0$3 )) SUTURES
ARE ESPECIALLY WELL
SUITED FOR USE IN
YOUNGER HEALTHY PATIENTS
-ANY SURGEONS PREFER THE USE OF
INTERRUPTED SIMPLE OR FIGURE
OF EIGHT
SUTURES TO CLOSE FASCIA WHILE OTHERS
EMPLOY RUNNING SUTURE OR A
COMBINATION OF THESE TECHNIQUES
)N THE ABSENCE OF INFECTION OR GROSS
CONTAMINATION THE SURGEON MAY
CHOOSE EITHER MONOFILAMENT OR
MULTIFILAMENT SUTURES )N THE
PRESENCE OF INFECTION A
MONOFILAMENT ABSORBABLE MATERIAL
LIKE 0$3 )) SUTURES OR INERT NONAB
SORBABLE SUTURES LIKE STAINLESS STEEL OR
02/,%.%
SUTURES MAY BE USED
-53#,%
-USCLE DOES NOT TOLERATE SUTURING
WELL (OWEVER THERE ARE SEVERAL
OPTIONS IN THIS AREA
!BDOMINAL MUSCLES MAY BE EITHER
CUT SPLIT SEPARATED OR RETRACTED
DEPENDING UPON THE LOCATION AND
TYPE OF THE INCISION CHOSEN 7HERE
POSSIBLE THE SURGEON PREFERS TO
AVOID INTERFERING WITH THE BLOOD
SUPPLY AND NERVE FUNCTION BY
MAKING A MUSCLE
SPLITTING INCISION
OR RETRACTING THE ENTIRE MUSCLE
TOWARD ITS NERVE SUPPLY $URING
CLOSURE MUSCLES HANDLED IN THIS
MANNER DO NOT NEED TO BE SUTURED
4HE FASCIA IS SUTURED RATHER THAN
THE MUSCLE
4HE 3MEAD
*ONES FAR
AND
NEAR
TECHNIQUE FOR ABDOMINAL WOUND
CLOSURE IS STRONG AND RAPID PROVIDES
GOOD SUPPORT DURING EARLY HEALING
WITH A LOW INCIDENCE OF WOUND
DISRUPTION AND HAS A LOW INCIDENCE
OF LATE INCISIONAL PROBLEMS 4HIS IS
A SINGLE
LAYER CLOSURE THROUGH BOTH
LAYERS OF THE ABDOMINAL WALL FASCIA
ABDOMINAL MUSCLES PERITONEUM
&)'52%
352')#!,
/04)/.3 ).
-53#,%
#UTTING
3PLITTING
2ETRACTING
4RADEMARK
4(% 35452%
AND THE ANTERIOR FASCIAL LAYER
4HE INTERRUPTED SUTURES RESEMBLE A
FIGURE OF EIGHT WHEN PLACED
!BSORBABLE 0$3 )) SUTURES OR
6)#29,
SUTURES ARE USUALLY USED
3TAINLESS STEEL SUTURES MAY ALSO BE
USED -ONOFILAMENT 02/,%.%
SUTURES ALSO PROVIDE ALL THE
ADVANTAGES OF STEEL SUTURES STRENGTH
MINIMAL TISSUE REACTIVITY AND
RESISTANCE TO BACTERIAL CONTAMINATION
4HEY ARE BETTER TOLERATED THAN STEEL
SUTURES BY PATIENTS IN THE LATE
POSTOPERATIVE MONTHS AND ARE EASIER
FOR THE SURGEON TO HANDLE AND TIE
(OWEVER BOTH STAINLESS STEEL AND
02/,%.% SUTURES MAY BE
DETECTABLE UNDER THE SKIN OF THIN
PATIENTS 4O AVOID THIS PROBLEM
KNOTS SHOULD BE BURIED IN FASCIA
INSTEAD OF IN THE SUBCUTANEOUS SPACE
35"#54!.%/53 &!4
.EITHER FAT NOR MUSCLE TOLERATE
SUTURING WELL 3OME SURGEONS
QUESTION THE ADVISABILITY OF PLACING
SUTURES IN FATTY TISSUE BECAUSE IT
HAS LITTLE TENSILE STRENGTH DUE TO
ITS COMPOSITION WHICH IS MOSTLY
WATER (OWEVER OTHERS BELIEVE IT
IS NECESSARY TO PLACE AT LEAST A
FEW SUTURES IN A THICK LAYER OF
SUBCUTANEOUS FAT TO PREVENT DEAD
SPACE ESPECIALLY IN OBESE PATIENTS
$EAD SPACES ARE MOST LIKELY TO
OCCUR IN THIS TYPE OF TISSUE SO
THE EDGES OF THE WOUND MUST BE
CAREFULLY APPROXIMATED 4ISSUE
FLUIDS CAN ACCUMULATE IN THESE
POCKET
LIKE SPACES DELAYING HEALING
AND PREDISPOSING INFECTION
!BSORBABLE SUTURES ARE USUALLY
SELECTED FOR THE SUBCUTANEOUS LAYER
6)#29,
SUTURE IS ESPECIALLY SUITED
FOR USE IN FATTY AVASCULAR TISSUE SINCE
IT IS ABSORBED BY HYDROLYSIS 4HE
SURGEON MAY USE THE SAME TYPE AND
SIZE OF MATERIAL USED EARLIER TO LIGATE
BLOOD VESSELS IN THIS LAYER
35"#54)#5,!2 4)335%
4O MINIMIZE SCARRING SUTURING
THE SUBCUTICULAR LAYER OF TOUGH
CONNECTIVE TISSUE WILL HOLD THE SKIN
EDGES IN CLOSE APPROXIMATION )N A
SINGLE
LAYER SUBCUTICULAR CLOSURE LESS
EVIDENCE OF SCAR GAPING OR EXPANSION
MAY BE SEEN AFTER A PERIOD OF TO
MONTHS THAN IS EVIDENT WITH SIMPLE
SKIN CLOSURE 4HE SURGEON TAKES
CONTINUOUS SHORT LATERAL STITCHES
BENEATH THE EPITHELIAL LAYER OF SKIN
%ITHER ABSORBABLE OR NONABSORBABLE
SUTURES MAY BE USED )F NONAB
SORBABLE MATERIAL IS CHOSEN ONE END
OF THE SUTURE STRAND WILL PROTRUDE
FROM EACH END OF THE INCISION AND
THE SURGEON MAY TIE THEM TOGETHER
TO FORM A LOOP OR KNOT THE ENDS
OUTSIDE OF THE INCISION
4O PRODUCE ONLY A HAIR
LINE SCAR
ON THE FACE FOR EXAMPLE THE
SKIN CAN BE HELD IN VERY CLOSE
APPROXIMATION WITH SKIN CLOSURE
TAPES IN ADDITION TO SUBCUTICULAR
SUTURES 4APES MAY BE LEFT ON THE
WOUND FOR AN EXTENDED PERIOD OF
TIME DEPENDING UPON THEIR LOCATION
ON THE BODY
7HEN GREAT TENSION IS NOT PLACED
UPON THE WOUND AS IN FACIAL OR
NECK SURGERY VERY FINE SIZES OF
SUBCUTICULAR SUTURES MAY BE USED
!BDOMINAL WOUNDS THAT MUST
WITHSTAND MORE STRESS CALL FOR LARGER
SUTURE SIZES
3OME SURGEONS CHOOSE TO CLOSE
BOTH THE SUBCUTICULAR AND EPIDERMAL
LAYERS TO ACHIEVE MINIMAL SCARRING
#HROMIC SURGICAL GUT AND POLYMERIC
MATERIALS SUCH AS -/./#29,
SUTURE ARE ACCEPTABLE FOR PLACEMENT
WITHIN THE DERMIS 4HEY ARE CAPABLE
OF MAINTAINING SUFFICIENT TENSILE
STRENGTH THROUGH THE COLLAGEN
SYNTHESIS STAGE OF HEALING WHICH
LASTS APPROXIMATELY WEEKS 4HE
SUTURES MUST NOT BE PLACED TOO
CLOSE TO THE EPIDERMAL SURFACE TO
REDUCE EXTRUSION )F THE SKIN IS
NONPIGMENTED AND THIN A CLEAR OR
WHITE MONOFILAMENT SUTURE SUCH
AS -/./#29, SUTURE WILL BE
INVISIBLE TO THE EYE -/./#29,
SUTURE IS PARTICULARLY WELL
SUITED FOR
THIS CLOSURE BECAUSE AS A MONOFILA
MENT IT DOES NOT HARBOR INFECTION
AND AS A SYNTHETIC ABSORBABLE
SUTURE TISSUE REACTION IS MINIMIZED
!FTER THIS LAYER IS CLOSED THE SKIN
EDGES MAY THEN BE APPROXIMATED
3+).
3KIN IS COMPOSED OF THE EPITHELIUM
AND THE UNDERLYING DERMIS )T IS SO
TOUGH THAT A VERY SHARP NEEDLE IS
ESSENTIAL FOR EVERY STITCH TO MINIMIZE
TISSUE TRAUMA 3EE #HAPTER 4HE
3URGICAL .EEDLE
3KIN WOUNDS REGAIN TENSILE STRENGTH
SLOWLY )F A NONABSORBABLE SUTURE
MATERIAL IS USED IT IS TYPICALLY
REMOVED BETWEEN AND DAYS
POSTOPERATIVELY WHEN THE WOUND
HAS ONLY REGAINED APPROXIMATELY
TO OF ITS STRENGTH 4HIS IS
POSSIBLE BECAUSE MOST OF THE STRESS
PLACED UPON THE HEALING WOUND IS
ABSORBED BY THE FASCIA WHICH THE
SURGEON RELIES UPON TO HOLD THE
WOUND CLOSED 4HE SKIN OR
SUBCUTICULAR SUTURES NEED ONLY BE
STRONG ENOUGH TO WITHSTAND NATURAL
SKIN TENSION AND HOLD THE WOUND
EDGES IN APPOSITION
4HE USE OF COATED 6)#29,
2!0)$% SUTURE A RAPIDLY ABSORBED
SYNTHETIC SUTURE ELIMINATES THE
NEED FOR SUTURE REMOVAL #OATED
#(!04%2
6)#29, 2!0)$% SUTURE WHICH
IS INDICATED FOR SUPERFICIAL CLOSURE
OF SKIN AND MUCOSA PROVIDES
SHORT
TERM WOUND SUPPORT
CONSISTENT WITH THE RAPID HEALING
CHARACTERISTICS OF SKIN 4HE SUTURES
BEGIN TO FALL OFF IN TO DAYS
WITH ABSORPTION ESSENTIALLY
COMPLETE AT DAYS
3UTURING TECHNIQUE FOR SKIN
CLOSURE MAY BE EITHER CONTINUOUS
OR INTERRUPTED 3KIN EDGES SHOULD
BE EVERTED 0REFERABLY EACH SUTURE
STRAND IS PASSED THROUGH THE SKIN
ONLY ONCE REDUCING THE CHANCE
OF CROSS
CONTAMINATION ACROSS THE
ENTIRE SUTURE LINE )NTERRUPTED
TECHNIQUE IS USUALLY PREFERRED
)F SURGEON PREFERENCE INDICATES
THE USE OF A NONABSORBABLE SUTURE
MATERIAL SEVERAL ISSUES MUST BE
CONSIDERED 3KIN SUTURES ARE EXPOSED
TO THE EXTERNAL ENVIRONMENT
MAKING THEM A SERIOUS THREAT
TO WOUND CONTAMINATION AND
STITCH ABSCESS 4HE INTERSTICES OF
MULTIFILAMENT SUTURES MAY PROVIDE
A HAVEN FOR MICROORGANISMS
4HEREFORE MONOFILAMENT NONAB
SORBABLE SUTURES MAY BE PREFERRED FOR
SKIN CLOSURE -ONOFILAMENT SUTURES
ALSO INDUCE SIGNIFICANTLY LESS TISSUE
REACTION THAN MULTIFILAMENT SUTURES
&OR COSMETIC REASONS NYLON OR
POLYPROPYLENE MONOFILAMENT SUTURES
MAY BE PREFERRED -ANY SKIN
WOUNDS ARE SUCCESSFULLY CLOSED WITH
SILK AND POLYESTER MULTIFILAMENTS
AS WELL 4ISSUE REACTION TO NONAB
SORBABLE SUTURES SUBSIDES AND
REMAINS RELATIVELY ACELLULAR AS
FIBROUS TISSUE MATURES AND FORMS A
DENSE CAPSULE AROUND THE SUTURE
.OTE SURGICAL GUT HAS BEEN KNOWN
TO PRODUCE TISSUE REACTION #OATED
6)#29,
2!0)$% SUTURE ELICITS
A LOWER TISSUE REACTION THAN CHROMIC
GUT SUTURE DUE TO ITS ACCELERATED
ABSORPTION PROFILE 4HE KEY TO
SUCCESS IS EARLY SUTURE REMOVAL
BEFORE EPITHELIALIZATION OF THE SUTURE
TRACT OCCURS AND BEFORE CONTAMINA
TION IS CONVERTED INTO INFECTION
! 7/2$ !"/54 3#!22).'
%0)4(%,)!,):!4)/.
7HEN A WOUND IS SUSTAINED IN
THE SKINWHETHER ACCIDENTALLY OR
DURING A SURGICAL PROCEDURETHE
EPITHELIAL CELLS IN THE BASAL LAYER AT
THE MARGINS OF THE WOUND FLATTEN
AND MOVE INTO THE WOUND AREA
4HEY MOVE DOWN THE WOUND EDGE
UNTIL THEY FIND LIVING UNDAMAGED
TISSUE AT THE BASE OF THE WOUND
4HEN THEY MOVE ACROSS THE WOUND
BED TO MAKE CONTACT WITH SIMILAR
CELLS MIGRATING FROM THE OPPOSITE
SIDE OF THE WOUND 4HEY MOVE
DOWN THE SUTURE TRACT AFTER IF HAS
BEEN EMBEDDED IN THE SKIN 7HEN
THE SUTURE IS REMOVED THE TRACT OF
THE EPITHELIAL CELLS REMAINS
%VENTUALLY IT MAY DISAPPEAR BUT
SOME MAY REMAIN AND FORM KERATIN
! PUNCTATE SCAR IS USUALLY SEEN ON
THE SKIN SURFACE AND A RAILROAD
TRACK OR CROSSHATCH APPEARANCE
ON THE WOUND MAY RESULT 4HIS IS
RELATIVELY RARE IF THE SKIN SUTURES ARE
NOT PLACED WITH EXCESSIVE TENSION
AND ARE REMOVED BY THE SEVENTH
POSTOPERATIVE DAY
4HE FORCES THAT CREATE THE DISTANCE
BETWEEN THE EDGES OF THE WOUND
WILL REMAIN LONG AFTER THE SUTURES
HAVE BEEN REMOVED 3IGNIFICANT
COLLAGEN SYNTHESIS WILL OCCUR FROM
TO DAYS POSTOPERATIVELY !FTER
THIS TIME ANY ADDITIONAL GAIN IN
TENSILE WILL BE DUE TO REMODELING
OR CROSSLINKING OF COLLAGEN FIBERS
RATHER THAN TO COLLAGEN SYNTHESIS
)NCREASES IN TENSILE STRENGTH WILL
CONTINUE FOR AS LONG AS YEARS BUT
THE TISSUE WILL NEVER QUITE REGAIN ITS
ORIGINAL STRENGTH
#,/352% 7)4(
2%4%.4)/. 35452%3
7E HAVE ALREADY DISCUSSED THE
TECHNIQUES INVOLVED WITH PLACING
RETENTION SUTURES AND USING THEM
IN A SECONDARY SUTURE LINE 3EE THE
SECTION ON 3UTURING 4ECHNIQUES
(EAVY SIZES TO OF NONABSORBABLE
MATERIALS ARE USUALLY USED FOR
RETENTION SUTURES NOT FOR STRENGTH
BUT BECAUSE LARGER SIZES ARE LESS LIKELY
TO CUT THROUGH TISSUE WHEN A SUDDEN
RISE IN INTRA
ABDOMINAL PRESSURE
OCCURS FROM VOMITING COUGHING
&)'52%
4(% 2!),2/!$
42!#+ 3#!2
#/.&)'52!4)/.
4RADEMARK
4(% 35452%
STRAINING OR DISTENTION 4O PREVENT
THE HEAVY SUTURE MATERIAL FROM
CUTTING INTO THE SKIN UNDER STRESS
ONE END OF THE RETENTION SUTURE MAY
BE THREADED THROUGH A SHORT LENGTH
OF PLASTIC OR RUBBER TUBING CALLED A
BOLSTER OR BUMPER BEFORE IT IS TIED !
PLASTIC BRIDGE WITH ADJUSTABLE
FEATURES MAY ALSO BE USED TO PROTECT
THE SKIN AND PRIMARY SUTURE LINE
AND PERMIT POSTOPERATIVE WOUND
MANAGEMENT FOR PATIENT COMFORT
0ROPERLY PLACED RETENTION SUTURES
PROVIDE STRONG REINFORCEMENT FOR
ABDOMINAL WOUNDS BUT ALSO CAUSE
THE PATIENT MORE POSTOPERATIVE PAIN
THAN DOES A LAYERED CLOSURE 4HE
BEST TECHNIQUE IS TO USE A MATERIAL
WITH NEEDLES SWAGED ON EACH END
DOUBLE
ARMED 4HEY SHOULD BE
PLACED FROM THE INSIDE OF THE WOUND
TOWARD THE OUTSIDE SKIN TO AVOID
PULLING POTENTIALLY CONTAMINATED
EPITHELIAL CELLS THROUGH THE ENTIRE
ABDOMINAL WALL
4HE %4()#/. RETENTION
SUTURE LINE INCLUDES %4(),/.
SUTURES -%23),%.%
SUTURES
%4()"/.$
%8#%, SUTURES AND
0%2-!
(!.$
SUTURES 3URGICAL
STEEL SUTURES MAY ALSO BE USED
2ETENTION SUTURES MAY BE LEFT IN
PLACE FOR TO DAYS POSTOPERA
TIVELY 4HREE WEEKS IS AN AVERAGE
LENGTH OF TIME !SSESSMENT OF THE
PATIENTgS CONDITION IS THE CONTROLLING
FACTOR IN DECIDING WHEN TO REMOVE
RETENTION SUTURES
! DRAINAGE TUBE INSERTED INTO THE
PERITONEAL CAVITY THROUGH A STAB
WOUND IN THE ABDOMINAL WALL
USUALLY IS ANCHORED TO THE SKIN WITH
ONE OR TWO NONABSORBABLE SUTURES
4HIS PREVENTS THE DRAIN FROM
SLIPPING INTO OR OUT OF THE WOUND
35452% &/2 $2!).3
35452% .%%$3 ). /4(%2
"/$9 4)335%3 .%52/352'%29
)F A DRAINAGE TUBE IS PLACED IN A
HOLLOW ORGAN OR A BLADDER DRAIN IS
INSERTED IT MAY BE SECURED TO THE
WALL OF THE ORGAN BEING DRAINED
WITH ABSORBABLE SUTURES 4HE SURGEON
MAY ALSO CHOOSE TO MINIMIZE THE
DISTANCE BETWEEN THE ORGAN AND THE
ABDOMINAL WALL BY USING SUTURES TO
TACK THE ORGAN BEING DRAINED TO THE
PERITONEUM AND FASCIA
3UTURES MAY BE PLACED AROUND THE
CIRCUMFERENCE OF THE DRAIN EITHER
TWO SUTURES AT AND OgCLOCK
POSITIONS OR FOUR SUTURES AT
AND OgCLOCK POSITIONS AND
SECURED TO THE SKIN WITH TEMPORARY
LOOPS 7HEN THE DRAIN IS NO LONGER
NEEDED THE SKIN SUTURES MAY BE
EASILY REMOVED TO REMOVE THE DRAIN
4HE OPENING CAN BE LEFT OPEN TO
PERMIT ADDITIONAL DRAINAGE UNTIL IT
CLOSES NATURALLY
&)'52%
0,!#%-%.4
/& 35452%3
!2/5.$
! $2!).
3URGEONS HAVE TRADITIONALLY USED AN
INTERRUPTED TECHNIQUE TO CLOSE THE
GALEA AND DURA MATER
4HE TISSUE OF THE GALEA SIMILAR TO
THE FASCIA OF THE ABDOMINAL CAVITY
IS VERY VASCULAR AND HEMOSTATIC
4HEREFORE SCALP HEMATOMA IS A
POTENTIAL PROBLEM AND THE SURGEON
MUST BE CERTAIN TO CLOSE WELL
4HE DURA MATER IS THE OUTERMOST OF
THE THREE MENINGES THAT PROTECTS THE
BRAIN AND SPINAL CORD )T TEARS WITH
EASE AND CANNOT WITHSTAND TOO
MUCH TENSION 4HE SURGEON MAY
DRAIN SOME OF THE CEREBROSPINAL
FLUID TO DECREASE VOLUME EASING THE
TENSION ON THE DURA BEFORE CLOSING
)F IT IS TOO DAMAGED TO CLOSE A
PATCH MUST BE INSERTED AND SUTURED
IN PLACE
3URGICAL SILK IS APPROPRIATE IN THIS
AREA FOR ITS PLIABILITY AND EASY KNOT
TYING PROPERTIES 5NFORTUNATELY
IT ELICITS A SIGNIFICANT FOREIGN BODY
TISSUE REACTION -OST SURGEONS HAVE
SWITCHED TO .52/,/.
SUTURES
OR COATED 6)#29,
SUTURES BECAUSE
THEY TIE EASILY OFFER GREATER STRENGTH
THAN SURGICAL SILK AND CAUSE LESS
TISSUE REACTION 02/,%.%
SUTURES
HAVE ALSO BEEN ACCEPTED BY SURGEONS
WHO PREFER A CONTINUOUS CLOSURE
TECHNIQUE WHO MUST REPAIR
POTENTIALLY INFECTED WOUNDS OR
WHO MUST REPAIR DURAL TEARS
#(!04%2
)N PERIPHERAL NERVE REPAIR PRECISE
SUTURING OFTEN REQUIRES THE AID OF
AN OPERATING MICROSCOPE 3UTURE
GAUGE AND NEEDLE FINENESS MUST BE
CONSISTENT WITH NERVE SIZE !FTER
THE MOTOR AND SENSORY FIBERS ARE
PROPERLY REALIGNED THE EPINEURIUM
THE OUTER SHEATH OF THE NERVE IS
SUTURED 4HE STRENGTH OF SUTURES IN
THIS AREA IS LESS OF A CONSIDERATION
THAN THE DEGREE OF INFLAMMATORY
AND FIBROPLASTIC TISSUE REACTION
&INE SIZES OF NYLON POLYESTER AND
POLY
PROPYLENE ARE PREFERRED
-)#2/352'%29
4HE INTRODUCTION OF FINE SIZES OF
SUTURES AND NEEDLES HAS INCREASED
THE USE OF THE OPERATING MICROSCOPE
%4()#/. INTRODUCED THE FIRST
MICROSURGERY SUTURES%4(),/.
SUTURESIN SIZES
THROUGH
3INCE THEN THE MICROSURGERY
LINE HAS EXPANDED TO INCLUDE
02/,%.%
SUTURES AND COATED
6)#29,
SUTURES ,ITERALLY ALL
SURGICAL SPECIALTIES PERFORM SOME
PROCEDURES UNDER THE OPERATING
MICROSCOPE ESPECIALLY VASCULAR AND
NERVE ANASTOMOSIS
3KIN
/0(4(!,-)# 352'%29
4HE EYE PRESENTS SPECIAL HEALING
CHALLENGES 4HE OCULAR MUSCLES THE
CONJUNCTIVA AND THE SCLERA HAVE GOOD
BLOOD SUPPLIES BUT THE CORNEA IS AN
AVASCULAR STRUCTURE 7HILE EPITHELIAL
IZATION OF THE CORNEA OCCURS RAPIDLY
IN THE ABSENCE OF INFECTION FULL
THICKNESS CORNEA WOUNDS HEAL SLOWLY
4HEREFORE IN CLOSING WOUNDS SUCH AS
CATARACT INCISIONS SUTURES SHOULD
REMAIN IN PLACE FOR APPROXIMATELY
DAYS -USCLE RECESSION WHICH
INVOLVES SUTURING MUSCLE TO
SCLERA ONLY REQUIRES SUTURES FOR
APPROXIMATELY DAYS
.YLON WAS THE PREFERRED SUTURE
MATERIAL FOR OPHTHALMIC SURGERY
7HILE NYLON IS NOT ABSORBED
PROGRESSIVE HYDROLYSIS OF NYLON
IN VIVO MAY RESULT IN GRADUAL LOSS OF
TENSILE STRENGTH OVER TIME &INE SIZES
OF ABSORBABLE SUTURES ARE CURRENTLY
USED FOR MANY OCULAR PROCEDURES
/CCASIONALLY THE SUTURES ARE
ABSORBED TOO SLOWLY IN MUSCLE
RECESSIONS AND PRODUCE GRANULOMAS
TO THE SCLERA 4OO RAPID ABSORPTION
HAS AT TIMES BEEN A PROBLEM IN
CATARACT SURGERY "ECAUSE THEY
INDUCE LESS CELLULAR REACTION THAN
'ALEA
3KULL
&)'52%
,!9%23
/& 35452%3
3522/5.$).'
! $2!).
"RAIN
$URA MATER
SURGICAL GUT AND BEHAVE DEPENDABLY
6)#29, SUTURES HAVE PROVEN USEFUL
IN MUSCLE AND CATARACT SURGERY
7HILE SOME OPHTHALMIC SURGEONS
PROMOTE THE USE OF A NO
STITCH
SURGICAL TECHNIQUE
COATED
6)#29, POLYGLACTIN VIOLET
MONOFILAMENT SUTURES OFFER DISTINCT
ADVANTAGES 4HEY PROVIDE THE SECURI
TY OF SUTURING IMMEDIATELY FOLLOW
ING SURGERY BUT ELIMINATE THE RISKS
OF SUTURE REMOVAL AND RELATED
ENDOPHTHALMITIS
4HE OPHTHALMOLOGIST HAS MANY
FINE SIZE SUTURE MATERIALS TO CHOOSE
FROM FOR KERATOPLASTY CATARACT
AND VITREOUS RETINAL MICROSURGICAL
PROCEDURES )N ADDITION TO
6)#29,
SUTURES OTHER MONOFILA
MENT SUTURE MATERIALS INCLUDING
%4(),/. SUTURES 02/,%.%
SUTURES AND 0$3
)) SUTURES MAY
BE USED "RAIDED MATERIAL SUCH AS
VIRGIN SILK BLACK BRAIDED SILK
-%23),%.%
SUTURES AND COATED
6)#29, SUTURES ARE ALSO AVAILABLE
FOR OPHTHALMIC PROCEDURES
500%2 !,)-%.4!29
42!#4 02/#%$52%3
4HE SURGEON MUST CONSIDER THE
UPPER ALIMENTARY TRACT FROM THE
MOUTH DOWN TO THE LOWER
ESOPHAGEAL SPHINCTER TO BE A
POTENTIALLY CONTAMINATED AREA
4HE GUT IS A MUSCULOMEMBRANOUS
CANAL LINED WITH MUCUS MEMBRANES
&INAL HEALING OF MUCOSAL WOUNDS
APPEARS TO BE LESS DEPENDENT UPON
SUTURE MATERIAL THAN ON THE WOUND
CLOSURE TECHNIQUE
4HE ORAL CAVITY AND PHARYNX
GENERALLY HEAL QUICKLY IF NOT INFECTED
&INE SIZE SUTURES ARE ADEQUATE IN THIS
AREA AS THE WOUND IS UNDER LITTLE
TENSION !BSORBABLE SUTURES MAY BE
4RADEMARK
4(% 35452%
PREFERRED 0ATIENTS ESPECIALLY
CHILDREN USUALLY FIND THEM MORE
COMFORTABLE (OWEVER THE SURGEON
MAY PREFER A MONOFILAMENT
NONABSORBABLE SUTURE UNDER CERTAIN
CIRCUMSTANCES 4HIS OPTION CAUSES
LESS SEVERE TISSUE REACTION THAN
MULTIFILAMENT MATERIALS IN BUCCAL
MUCOSA BUT ALSO REQUIRES SUTURE
REMOVAL FOLLOWING HEALING
/CULAR MUSCLES
2%30)2!4/29
42!#4 352'%29
2ELATIVELY FEW STUDIES HAVE BEEN
DONE ON HEALING IN THE RESPIRATORY
TRACT "RONCHIAL STUMP CLOSURE
FOLLOWING LOBECTOMY OR PNEUMONEC
TOMY PRESENTS A PARTICULAR CHALLENGE
)NFECTION LONG STUMPS POOR
APPROXIMATION OF THE TRANSECTED
4(% %9%
#ONJUNCTIVA
#ORNEA
3CLERA
)N CASES INVOLVING SEVERE
PERIODONTITIS 6)#29, PERIODONTAL
MESH MAY BE USED TO PROMOTE TISSUE
REGENERATION A TECHNIQUE THAT
ENHANCES THE REGENERATION AND
ATTACHMENT OF TISSUE LOST DUE TO
PERIODONTITIS 6)#29, PERIODONTAL
MESH AVAILABLE IN SEVERAL SHAPES AND
SIZES WITH A PREATTACHED 6)#29,
LIGATURE IS WOVEN FROM THE SAME
COPOLYMER USED TO PRODUCE
ABSORBABLE 6)#29,
SUTURE !S A
SYNTHETIC ABSORBABLE 6)#29,
PERIODONTAL MESH ELIMINATES THE
TRAUMA ASSOCIATED WITH A SECOND
SURGICAL PROCEDURE AND REDUCES THE
RISK OF INFECTION OR INFLAMMATION
ASSOCIATED WITH THIS PROCEDURE
4HE ESOPHAGUS IS A DIFFICULT ORGAN
TO SUTURE )T LACKS A SEROSAL LAYER
4HE MUCOSA HEALS SLOWLY 4HE THICK
MUSCULAR LAYER DOES NOT HOLD SUTURES
WELL )F MULTIFILAMENT SUTURES ARE
USED PENETRATION THROUGH THE
MUCOSA INTO THE LUMEN SHOULD BE
AVOIDED TO PREVENT INFECTION
&)'52%
/RAL CAVITY
&)'52%
4(% 500%2
!,)-%.4!29
#!.!,
%SOPHAGUS
&)'52%
"2/.#()!,
345-0
#,/352%
#(!04%2
&)'52%
#/.4).5/53
342!.$
35452).'
). 6!3#5,!2
352'%29
&)'52%
3%!4).' !
(%!24 6!,6%
7)4( %4()"/.$
%8#%, 35452%
BRONCHUS AND INCOMPLETE CLOSURE
IE AIR LEAKS MAY LEAD TO
BRONCHOPLEURAL FISTULA !VOIDANCE
OF TISSUE TRAUMA AND MAINTENANCE
OF THE BLOOD SUPPLY TO THE AREA OF
CLOSURE ARE CRITICAL TO HEALING 4HE
BRONCHIAL STUMP HEALS SLOWLY AND
SOMETIMES NOT AT ALL 5NLESS IT IS
CLOSED TIGHTLY WITH STRONG CLOSELY
SPACED SUTURES AIR MAY LEAK INTO
THE THORACIC CAVITY
#LOSURE IS USUALLY ACHIEVED WITH
MECHANICAL DEVICES PARTICULARLY
STAPLES 7HEN SUTURES ARE USED
POLYPROPYLENE MONOFILAMENT NONAB
SORBABLE SUTURES ARE LESS LIKELY TO
CAUSE TISSUE REACTION OR HARBOR
INFECTION 3ILK SUTURE IS ALSO
COMMONLY USED 3URGEONS USUALLY
AVOID ABSORBABLE SUTURES BECAUSE
THEY MAY PERMIT SECONDARY LEAKAGE
AS THEY LOSE STRENGTH
-ONOFILAMENT NYLON SUTURE SHOULD
ALSO BE AVOIDED BECAUSE OF ITS
POTENTIAL FOR KNOT LOOSENING
#!2$)/6!3#5,!2 352'%29
&)'52%
4(% "5..%,,
4%#(.)15%
!LTHOUGH DEFINITIVE STUDIES ARE FEW
BLOOD VESSELS APPEAR TO HEAL RAPIDLY
-OST CARDIOVASCULAR SURGEONS PREFER
TO USE SYNTHETIC NONABSORBABLE
SUTURES FOR CARDIAC AND PERIPHERAL
VASCULAR PROCEDURES ,ASTING STRENGTH
AND LEAKPROOF ANASTOMOSES ARE ESSEN
TIAL 7IRE SUTURES ARE USED ON THE
STERNUM UNLESS IT IS FRAGILE IN WHICH
CASE ABSORBABLE SUTURES CAN BE USED
6%33%,3
%XCESSIVE TISSUE REACTION TO SUTURE
MATERIAL MAY LEAD TO DECREASED
LUMINAL DIAMETER OR TO THROMBUS
FORMATION IN A VESSEL 4HEREFORE
THE MORE INERT SYNTHETICS INCLUDING
NYLON AND POLYPROPYLENE ARE
THE MATERIALS OF CHOICE FOR VESSEL
4RADEMARK
4(% 35452%
ANASTOMOSES -ULTIFILAMENT
POLYESTER SUTURES ALLOW CLOTTING TO
OCCUR WITHIN THE INTERSTICES WHICH
HELPS TO PREVENT LEAKAGE AT THE
SUTURE LINE 4HE ADVANTAGES OF A
MATERIAL SUCH AS %4()"/.$
%8#%, SUTURES ARE ITS STRENGTH
DURABILITY AND SLIPPERY SURFACE
WHICH CAUSES LESS FRICTION WHEN
DRAWN THROUGH A VESSEL -ANY
SURGEONS FIND THAT 02/,%.%
SUTURES 02/./6!
SUTURES OR
SILK ARE IDEAL FOR CORONARY ARTERY
PROCEDURES BECAUSE THEY DO NOT
SAW THROUGH VESSELS
#ONTINUOUS SUTURES PROVIDE A MORE
LEAKPROOF CLOSURE THAN INTERRUPTED
SUTURES IN LARGE VESSEL ANASTOMOSES
BECAUSE THE TENSION ALONG THE
SUTURE STRAND IS DISTRIBUTED EVENLY
AROUND THE VESSELgS CIRCUMFERENCE
)NTERRUPTED MONOFILAMENT SUTURES
SUCH AS %4(),/.
SUTURES
02/,%.%
SUTURES OR
02/./6!
SUTURES ARE USED FOR
MICROVASCULAR ANASTOMOSES
7HEN ANASTOMOSING MAJOR VESSELS
IN YOUNG CHILDREN SPECIAL CARE
MUST BE TAKEN TO ANTICIPATE THE
FUTURE GROWTH OF THE PATIENT
(ERE THE SURGEON MAY USE SILK TO
ITS BEST ADVANTAGE BECAUSE IT LOSES
MUCH OF ITS TENSILE STRENGTH AFTER
APPROXIMATELY YEAR AND IS USUALLY
COMPLETELY ABSORBED AFTER OR MORE
YEARS #ONTINUOUS POLYPROPYLENE
SUTURES HAVE BEEN USED IN CHILDREN
WITHOUT ADVERSE EFFECTS 4HE
CONTINUOUS SUTURE WHEN PLACED
IS A COIL WHICH STRETCHES AS THE
CHILD GROWS TO ACCOMMODATE THE
CHANGING DIMENSIONS OF THE BLOOD
VESSEL (OWEVER REPORTS OF STRICTURE
FOLLOWING VESSEL GROWTH HAVE
STIMULATED INTEREST IN USE OF A
SUTURE LINE WHICH IS ONE
HALF
CONTINUOUS ONE
HALF INTERRUPTED
#LINICAL STUDIES SUGGEST THAT A
PROLONGED ABSORBABLE SUTURE SUCH AS
0$3
)) SUTURE MAY BE IDEAL GIVING
ADEQUATE SHORT
TERM SUPPORT WHILE
PERMITTING FUTURE GROWTH
&OLLOWING VASCULAR TRAUMA MYCOTIC
ANEURYSMS FROM INFECTION ARE
EXTREMELY SERIOUS COMPLICATIONS
! SUTURE MAY ACT AS A NIDUS FOR
AN INFECTION )N THE PRESENCE OF
INFECTION THE CHEMICAL PROPERTIES
OF SUTURE MATERIAL CAN CAUSE
EXTENSIVE TISSUE DAMAGE WHICH MAY
REDUCE THE TISSUEgS NATURAL ABILITY
TO COMBAT INFECTION ,OCALIZED
SEPSIS CAN ALSO SPREAD TO ADJACENT
VASCULAR STRUCTURES CAUSING NECROSIS
OF THE ARTERIAL WALL 4HEREFORE THE
SURGEON MAY CHOOSE A MONOFILAMENT
SUTURE MATERIAL THAT CAUSES ONLY A
MILD TISSUE REACTION AND RESISTS
BACTERIAL GROWTH
6!3#5,!2 02/34(%3%3
4HE FIXATION OF VASCULAR PROSTHESES
AND ARTIFICIAL HEART VALVES PRESENTS AN
ENTIRELY DIFFERENT SUTURING CHALLENGE
THAN VESSEL ANASTOMOSIS 4HE SUTURES
MUST RETAIN THEIR ORIGINAL PHYSICAL
PROPERTIES AND STRENGTH THROUGHOUT
THE LIFE OF THE PATIENT ! PROSTHESIS
NEVER BECOMES COMPLETELY INCORPO
RATED INTO THE TISSUE AND CONSTANT
MOVEMENT OF THE SUTURE LINE OCCURS
#OATED POLYESTER SUTURES ARE THE
CHOICE FOR FIXATION OF VASCULAR
PROSTHESES AND HEART VALVES BECAUSE
THEY RETAIN THEIR STRENGTH AND
INTEGRITY INDEFINITELY
%ITHER A CONTINUOUS OR INTERRUPTED
TECHNIQUE MAY BE USED FOR VESSEL TO
GRAFT ANASTOMOSES
4O ASSIST IN PROPER STRAND IDENTIFICA
TION MANY SURGEONS ALTERNATE GREEN
AND WHITE STRANDS OF %4()"/.$
%8#%, SUTURE AROUND THE CUFF OF
THE VALVE BEFORE TYING THE KNOTS
3OME SURGEONS ROUTINELY USE
PLEDGETS TO BUTTRESS SUTURES IN VALVE
SURGERY 4HEY ARE USED MOST
COMMONLY IN VALVE REPLACEMENT
PROCEDURES TO PREVENT THE ANNULUS
FROM TEARING WHEN THE PROSTHETIC
VALVE IS SEATED AND THE SUTURES ARE
TIED 4HEY MAY ALSO BE USED IN HEART
WALL CLOSURE OF PENETRATING INJURIES
EXCISING ANEURYSMS VASCULAR GRAFT
SURGERY AND TO ADD SUPPORT WHEN
THE SURGEON ENCOUNTERS EXTREME
DEFORMITY DISTORTION OR TISSUE
DESTRUCTION AT THE ANNULUS
52).!29 42!#4 352'%29
#LOSURE OF TISSUES IN THE URINARY
TRACT MUST BE LEAKPROOF TO PREVENT
ESCAPE OF URINE INTO SURROUNDING
TISSUES 4HE SAME CONSIDERATIONS
THAT AFFECT THE CHOICE OF SUTURES FOR
THE BILIARY TRACT AFFECT THE CHOICE OF
SUTURES FOR THIS AREA .ONABSORBABLE
SUTURES INCITE THE FORMATION OF CAL
CULI AND THEREFORE CANNOT BE USED
3URGEONS USE ABSORBABLE SUTURES AS A
RULE ESPECIALLY -/./#29,
SUTURES 0$3 )) SUTURES 6)#29,
SUTURES #OATED 6)#29,
SUTURES
AND CHROMIC GUT SUTURES
4HE URINARY TRACT HEALS RAPIDLY 4HE
TRANSITIONAL CELL EPITHELIUM MIGRATES
OVER THE DENUDED SURFACES QUICKLY
5NLIKE OTHER EPITHELIUM THE
MIGRATING CELLS IN THE URINARY TRACT
UNDERGO MITOSIS AND CELL DIVISION
%PITHELIAL MIGRATION MAY BE FOUND
ALONG SUTURE TRACTS IN THE BODY OF
THE BLADDER 4HE BLADDER WALL
REGAINS OF ITS ORIGINAL TENSILE
STRENGTH WITHIN DAYS 4HE RATE OF
COLLAGEN SYNTHESIS PEAKS AT DAYS
AND DECLINES RAPIDLY THEREAFTER
#(!04%2
4HUS SUTURES ARE NEEDED FOR ONLY
TO DAYS
4(% &%-!,% '%.)4!, 42!#4
3URGERY WITHIN THIS AREA PRESENTS
CERTAIN CHALLENGES &IRST IT IS USUALLY
REGARDED AS A POTENTIALLY CONTAMINAT
ED AREA 3ECOND THE SURGEON MUST
FREQUENTLY WORK WITHIN A VERY
RESTRICTED FIELD %NDOSCOPIC TECHNIQUE
IS FREQUENTLY USED IN THIS AREA #OATED
6)#9,
SUTURE IS AN EXCELLENT CHOICE
TO PREVENT BACTERIAL COLONIZATION
-OST GYNECOLOGICAL SURGEONS PREFER
TO USE ABSORBABLE SUTURES FOR REPAIR OF
INCISIONS AND DEFECTS 3OME PREFER
USING HEAVY SIZE SURGICAL GUT
SUTURES -/./#29, SUTURES OR
6)#29, SUTURES (OWEVER THE
STRESSES ON THE REPRODUCTIVE ORGANS
AND THE RATE OF HEALING INDICATE THAT
THESE LARGER
SIZED SUTURES MAY ONLY BE
REQUIRED FOR ABDOMINAL CLOSURE
(ANDLING PROPERTIES ESPECIALLY
PLIABILITY OF THE SUTURES USED FOR
INTERNAL USE ARE EXTREMELY
IMPORTANT 3YNTHETIC ABSORBABLE
SUTURES SUCH AS 6)#29,
SUTURES IN
SIZE MAY BE USED FOR THE TOUGH
MUSCULAR HIGHLY VASCULAR TISSUES
IN THE PELVIS AND VAGINA 4HESE
TISSUES DEMAND STRENGTH DURING
APPROXIMATION AND HEALING #OATED
6)#29,
2!0)$% SUTURE FOR
EXAMPLE IS AN EXCELLENT CHOICE FOR
EPISIOTOMY REPAIR
4%.$/. 352'%29
4ENDON SURGERY PRESENTS SEVERAL
CHALLENGES -OST TENDON INJURIES ARE
DUE TO TRAUMA AND THE WOUND MAY
BE DIRTY 4ENDONS HEAL SLOWLY 4HE
STRIATED NATURE OF THE TISSUE MAKES
SUTURING DIFFICULT
4ENDON REPAIR FIBROBLASTS ARE
DERIVED FROM THE PERITENDONOUS
TISSUE AND MIGRATE INTO THE WOUND
4HE JUNCTION HEALS FIRST WITH SCAR
TISSUE THEN BY REPLACEMENT WITH
NEW TENDON FIBERS #LOSE APPOSITION
OF THE CUT ENDS OF THE TENDON
ESPECIALLY EXTENSOR TENDONS
MUST BE MAINTAINED TO ACHIEVE
GOOD FUNCTIONAL RESULTS "OTH THE
SUTURE MATERIAL AND THE CLOSURE
TECHNIQUE ARE CRITICAL FOR SUCCESSFUL
TENDON REPAIR
4HE SUTURE MATERIAL THE SURGEON
CHOOSES MUST BE INERT AND STRONG
"ECAUSE TENDON ENDS CAN SEPARATE
DUE TO MUSCLE PULL SUTURES WITH A
GREAT DEGREE OF ELASTICITY SHOULD BE
AVOIDED 3URGICAL STEEL IS WIDELY USED
BECAUSE OF ITS DURABILITY AND LACK OF
ELASTICITY 3YNTHETIC NONABSORBABLE
MATERIALS INCLUDING POLYESTER FIBERS
POLYPROPYLENE AND NYLON MAY BE
USED )N THE PRESENCE OF POTENTIAL
INFECTION THE MOST INERT MONOFILA
MENT SUTURE MATERIALS ARE PREFERRED
4HE SUTURE SHOULD BE PLACED TO
CAUSE THE LEAST POSSIBLE INTERFERENCE
WITH THE SURFACE OF THE TENDON AS
THIS IS THE GLIDING MECHANISM )T
SHOULD ALSO NOT INTERFERE WITH THE
BLOOD SUPPLY REACHING THE WOUND
-AINTENANCE OF CLOSED APPOSITION
OF THE CUT ENDS OF THE TENDONS
PARTICULARLY EXTENSOR TENDONS IS
CRITICAL FOR GOOD FUNCTIONAL RESULTS
4HE PARALLEL ARRANGEMENT OF TENDON
FIBERS IN A LONGITUDINAL DIRECTION
MAKES PERMANENT AND SECURE PLACE
MENT OF SUTURES DIFFICULT 6ARIOUS
FIGURE
OF
EIGHT AND OTHER TYPES OF
SUTURING HAVE BEEN USED SUCCESSFULLY
TO PREVENT SUTURE SLIPPAGE AND THE
FORMATION OF GAPS BETWEEN THE CUT
ENDS OF THE TENDON
-ANY SURGEONS USE THE "UNNELL
4ECHNIQUE 4HE SUTURE IS PLACED TO
BE WITHDRAWN WHEN ITS FUNCTION AS A
HOLDING STRUCTURE IS NO LONGER NECES
SARY 2EFERRED TO AS A PULL
OUT SUTURE
IT IS BROUGHT OUT THROUGH THE SKIN
AND FASTENED OVER A POLYPROPYLENE
BUTTON 4HE "UNNELL 4ECHNIQUE
SUTURE CAN ALSO BE LEFT IN PLACE
.52/,/.
SUTURES 02/,%.%
SUTURES 02/./6!
SUTURES AND
%4()"/.$
%8#%, SUTURES MAY
BE USED FOR CONNECTING TENDON TO
BONE 0ERMANENT WIRE SUTURES ALSO
YIELD GOOD RESULTS BECAUSE HEALING IS
SLOW )N PERIOSTEUM WHICH HEALS
FAIRLY RAPIDLY SURGICAL GUT OR COATED
6)#29, SUTURES MAY BE USED )N
FACT VIRTUALLY ANY SUTURE MAY BE
USED SATISFACTORILY IN THE PERIOSTEUM
35452%3 &/2 "/.%
)N REPAIRING FACIAL FRACTURES
MONOFILAMENT SURGICAL STEEL HAS PROVEN
IDEAL FOR ITS LACK OF ELASTICITY &ACIAL
BONES DO NOT HEAL BY CALLUS FORMATION
BUT MORE COMMONLY BY FIBROUS UNION
4HE SUTURE MATERIAL MUST REMAIN IN
PLACE FOR A LONG PERIOD OF TIME
PERHAPS MONTHSUNTIL THE FIBROUS
TISSUE IS LAID DOWN AND REMODELED
3TEEL SUTURES IMMOBILIZE THE
FRACTURE LINE AND KEEP THE TISSUES IN
GOOD APPOSITION
&OLLOWING MEDIAN STEMOTOMY
SURGEONS PREFER INTERRUPTED STEEL
SUTURES TO CLOSE 3TERNUM CLOSURE MAY
BE DIFFICULT !PPROPRIATE TENSION MUST
BE MAINTAINED AND THE SURGEON MUST
GUARD AGAINST WEAKENING THE WIRE
!SYMMETRICAL TWISTING OF THE WIRE MAY
CAUSE IT TO BUCKLE FATIGUING THE METAL
AND ULTIMATELY CAUSING THE WIRE TO
BREAK -OTION BETWEEN THE SIDES OF
THE STERNUM WILL RESULT CAUSING
POSTOPERATIVE PAIN AND POSSIBLY
DEHISCENCE 0AINFUL NONUNION IS
ANOTHER POSSIBLE COMPLICATION )N
OSTEOPOROTIC PATIENTS VERY HEAVY
4RADEMARK
4(% 35452%
&)'52%
4!#+).' !
02/34(%4)#
$%6)#% ).
0/3)4)/. 4/
02%6%.4
-)'2!4)/.
CLOSURES STERILE TAPE 4HE WOUND
SHOULD BE PACKED TO MAINTAIN A MOIST
ENVIRONMENT 7HEN THE INFECTION
HAS SUBSIDED THE SURGEON CAN EASILY
REOPEN THE WOUND REMOVE THE
PACKING AND ANY TISSUE DEBRIS AND
THEN CLOSE USING THE PREVIOUSLY
INSERTED MONOFILAMENT NYLON SUTURE
). 4(%
.%84 3%#4)/.
6)#29, SUTURES MAY BE USED TO CLOSE
THE STERNUM SECURELY
4HE SURGEON MAY USE A BONE ANCHOR
TO HOLD ONE END OF A SUTURE IN PLACE
WHEN NEEDED EG SHOULDER REPAIR
SURGERY 4HIS INVOLVES DRILLING A HOLE
IN THE BONE AND INSERTING THE ANCHOR
WHICH EXPANDS ONCE COMPLETELY
INSIDE THE BONE TO KEEP IT FROM BEING
PULLED OUT
/4(%2 02/34(%4)# $%6)#%3
/FTEN IT IS NECESSARY FOR THE SUR
GEON TO IMPLANT A PROSTHETIC DEVICE
SUCH AS AN AUTOMATIC DEFIBRILLATOR OR
DRUG DELIVERY SYSTEM INTO A PATIENT
4O PREVENT SUCH A DEVICE FROM
MIGRATING OUT OF POSITION IT MAY BE
TACKED TO THE FASCIA OR CHEST WALL
WITH NONABSORBABLE SUTURES
#,/3).' #/.4!-).!4%$
/2 ).&%#4%$ 7/5.$3
#ONTAMINATION EXISTS WHEN
MICROORGANISMS ARE PRESENT BUT IN
INSUFFICIENT NUMBERS TO OVERCOME THE
BODYgS NATURAL DEFENSES )NFECTION
EXISTS WHEN THE LEVEL OF CONTAMINA
TION EXCEEDS THE TISSUEgS ABILITY TO
DEFEND AGAINST THE INVADING
MICROORGANISMS 'ENERALLY
CONTAMINATION BECOMES INFECTION
WHEN IT REACHES APPROXIMATELY
BACTERIA PER GRAM OF TISSUE IN AN
IMMUNOLOGICALLY NORMAL HOST
)NFLAMMATION WITHOUT DISCHARGE
ANDOR THE PRESENCE OF CULTURE
POSITIVE SEROUS FLUID INDICATE POSSIBLE
INFECTION 0RESENCE OF PURULENT
DISCHARGE INDICATES POSITIVE INFECTION
#ONTAMINATED WOUNDS CAN BECOME
INFECTED WHEN HEMATOMAS NECROTIC
TISSUE DEVASCULARIZED TISSUE OR LARGE
AMOUNTS OF DEVITALIZED TISSUE
ESPECIALLY IN FASCIA MUSCLE AND BONE
ARE PRESENT -ICROORGANISMS MULTIPLY
RAPIDLY UNDER THESE CONDITIONS WHERE
THEY ARE SAFE FROM CELLS THAT PROVIDE
LOCAL TISSUE DEFENSES
)N GENERAL CONTAMINATED WOUNDS
SHOULD NOT BE CLOSED BUT SHOULD BE LEFT
OPEN TO HEAL BY SECONDARY INTENTION
BECAUSE OF THE RISK OF INFECTION
&OREIGN BODIES INCLUDING SUTURES
PERPETUATE LOCALIZED INFECTION
4HEREFORE THE SURGEONgS TECHNIQUE
AND CHOICE OF SUTURE IS CRITICAL
.ONABSORBABLE MONOFILAMENT NYLON
SUTURES ARE COMMONLY USED IN
ANTICIPATION OF DELAYED CLOSURE OF
DIRTY AND INFECTED WOUNDS 4HE
SUTURES ARE LAID IN BUT NOT TIED
)NSTEAD THE LOOSE SUTURE ENDS ARE HELD
IN PLACE WITH 02/8)
342)0
SKIN
4HE SURGEON DEPENDS AS MUCH UPON
THE QUALITY AND CONFIGURATION OF THE
NEEDLE USED AS ON THE SUTURING
MATERIAL ITSELF TO ACHIEVE A SUCCESSFUL
CLOSURE 4HE RELATIONSHIP BETWEEN
NEEDLES AND SUTURES WILL BE EXPLORED
ON THE PAGES THAT FOLLOW
2%&%2%.#%3
-ANGRAM !* (ORAN 4# 0EARSON
-, 3ILVER ,# *ARVIS 72 'UIDELINE
FOR PREVENTION OF SURGICAL SITE
INFECTION )NFECTION #ONTROL
AND (OSPITAL %PIDEMIOLOGY
'ILBERT 0 -C"AIN !* 3TORCH -,
2OTHENBURGER 3* "ARBOLT 4!
,ITERATURE
BASED EVALUATION OF THE
POTENTIAL RISKS ASSOCIATED WITH
IMPREGNATION OF MEDICAL DEVICES AND
IMPLANTS WITH TRICLOSAN 3URG
)NFECTION * SUPPL 3
3
2OTHENBURGER 3 3PANGLER $
"HENDE 3 "URKLEY $ )N VITRO
ANTIBACTERIAL EVALUATION OF #OATED
6)#29,
0LUS !NTIBACTERIAL SUTURE
COATED POLYGLACTIN WITH
TRICLOSAN USING ZONE OF INHIBITION
ASSAYS 3 )NFECTION *
SUPPL 3
3
#(!04%2
4(% 352')#!, .%%$,%
4(% 352')#!, .%%$,%
.ECESSARY FOR THE PLACEMENT OF
SUTURES IN TISSUE SURGICAL NEEDLES
MUST BE DESIGNED TO CARRY SUTURE
MATERIAL THROUGH TISSUE WITH
MINIMAL TRAUMA 4HEY MUST BE
SHARP ENOUGH TO PENETRATE TISSUE
WITH MINIMAL RESISTANCE 4HEY
SHOULD BE RIGID ENOUGH TO RESIST
BENDING YET FLEXIBLE ENOUGH TO
BEND BEFORE BREAKING 4HEY MUST
BE STERILE AND CORROSION
RESISTANT
TO PREVENT INTRODUCTION OF
MICROORGANISMS OR FOREIGN BODIES
INTO THE WOUND
#OMFORT WITH NEEDLE SECURITY IN THE
NEEDLEHOLDER THE EASE OF PASSAGE
THROUGH TISSUE AND THE DEGREE OF
TRAUMA THAT IT CAUSES ALL HAVE AN
IMPACT UPON THE OVERALL RESULTS OF
SURGICAL NEEDLE PERFORMANCE 4HIS IS
ESPECIALLY TRUE WHEN PRECISE COSMET
IC RESULTS ARE DESIRED
4HE BEST SURGICAL NEEDLES ARE
s -ADE OF HIGH QUALITY STAINLESS
STEEL
s !S SLIM AS POSSIBLE WITHOUT
COMPROMISING STRENGTH
6ARIATIONS IN NEEDLE GEOMETRIES ARE
JUST AS IMPORTANT AS VARIATIONS IN
SUTURE SIZES .EEDLE DIMENSIONS
MUST BE COMPATIBLE WITH SUTURE
SIZES ALLOWING THE TWO TO WORK
IN TANDEM
%,%-%.43 /&
.%%$,% $%3)'.
.EEDLE DESIGN INVOLVES ANALYZING A
SURGICAL PROCEDURE AND THE DENSITY
OF THE TISSUE INVOLVED IN GREAT
DETAIL %4()#/. ENGINEERS WORK
CONTINUOUSLY TO IMPROVE UPON THEIR
NEEDLE LINE SOMETIMES MAKING SUB
TLE ALTERATIONS RESULTING IN A POSITIVE
IMPACT UPON THE PROCEDURE ITSELF
4HE ANATOMY OF THE IDEAL SURGICAL
NEEDLE HAS THREE KEY FACTORS THAT
MAKE UP THE IDEAL NEEDLE
n !LLOY
n 'EOMETRY n TIP AND BODY
n #OATING
4HE COMBINATION OF THESE ATTRIBUTES
IS %4()#/. -ULTI0ASS .EEDLE
4ECHNOLOGY
%4()#/.
s 3TABLE IN THE GRASP OF A
NEEDLEHOLDER
s !BLE TO CARRY SUTURE MATERIAL
THROUGH TISSUE WITH MINIMAL
TRAUMA
%4(!,,/9
.EEDLE !LLOY
s 3HARP ENOUGH TO PENETRATE TISSUE
WITH MINIMAL RESISTANCE
s 2IGID ENOUGH TO RESIST BENDING
YET DUCTILE ENOUGH TO RESIST
BREAKING DURING SURGERY
s 3TERILE AND CORROSION
RESISTANT
TO PREVENT INTRODUCTION OF
MICROORGANISMS OR FOREIGN
MATERIALS INTO THE WOUND
-5,4)0!33
02)-%
'EOMETRY
!DVANCED
.EEDLE
#OATING
-ULTI0ASS NEEDLES ARE THE HIGHEST
PERFORMING NEEDLES THAT %4()#/.
0RODUCTS OFFERS COMPRISED OF THREE
PROPRIETARY TECHNOLOGIES WHICH
ENSURE SUPERIOR STRENGTH TISSUE PEN
ETRATION AND CONTROL PASS AFTER PASS
.%7 !DVANCED .EEDLE
#OATINGNEW SILICONE COATING
HELPS TO MAINTAIN NEEDLE SHARP
NESS PASS AFTER PASS AND CONSISTEN
CY FROM NEEDLE TO NEEDLE
02)-% .EEDLE 'EOMETRY
NEEDLES HAVE LESS MASS AND
REQUIRE LESS PENETRATION FORCE TO
MINIMIZE TISSUE TRAUMA
%4(!,,/9 .EEDLE !LLOY
PROVIDES SUPERIOR STRENGTH AND
DUCTILITY BENDING WITHOUT BREAKING
4HE VARIOUS METAL ALLOYS USED IN THE
MANUFACTURE OF SURGICAL NEEDLES
DETERMINE THEIR BASIC CHARACTERISTICS
TO A GREAT DEGREE %4()#/.
STAINLESS STEEL ALLOY NEEDLES ARE HEAT
TREATED TO GIVE THEM THE MAXIMUM
POSSIBLE STRENGTH AND DUCTILITY
%4(!,,/9
NEEDLE ALLOY 0ATENT
.O WAS DEVELOPED FOR
UNSURPASSED STRENGTH IN PRECISION
NEEDLES USED IN CARDIOVASCULAR
OPHTHALMIC PLASTIC AND MICROSURGI
CAL PROCEDURES )T IS PRODUCED
ECONOMICALLY WITHOUT SACRIFICING
DUCTILITY OR CORROSION RESISTANCE
! NEEDLEgS STRENGTH IS DETERMINED
BY HOW IT RESISTS DEFORMATION
DURING REPEATED PASSES THROUGH
TISSUE 4ISSUE TRAUMA CAN BE
INDUCED IF A NEEDLE BENDS DURING
PENETRATION AND COMPROMISES TISSUE
APPOSITION 4HEREFORE GREATER NEEDLE
STRENGTH EQUALS LESS TISSUE TRAUMA
! WEAK NEEDLE THAT BENDS TOO EASILY
CAN COMPROMISE THE SURGEONgS
CONTROL AND DAMAGE SURROUNDING
TISSUE DURING THE PROCEDURE )N
ADDITION LOSS OF CONTROL IN NEEDLE
PLACEMENT COULD RESULT IN AN
INADVERTENT NEEDLESTICK
#(!04%2
-ANUFACTURERS MEASURE NEEDLE
STRENGTH IN THE LABORATORY BY
BENDING THEM TO DETERMINE THE
NEEDLEgS MAXIMUM STRENGTH 4HIS IS
REFERRED TO AS THE NEEDLEgS ULTIMATE
MOMENT AND IS MORE IMPORTANT TO
THE NEEDLE MANUFACTURER THAN TO THE
SURGEON 4HE MOST CRITICAL ASPECT OF
NEEDLE STRENGTH TO THE SURGEON IS
THE SURGICAL YIELD POINT 3URGICAL
YIELD INDICATES THE AMOUNT OF
ANGULAR DEFORMATION THE NEEDLE
CAN WITHSTAND BEFORE BECOMING
PERMANENTLY DEFORMED 4HIS POINT
IS USUALLY TO DEPENDING
UPON THE MATERIAL AND THE MANUFAC
TURING PROCESS !NY ANGLE BEYOND
THAT POINT RENDERS THE NEEDLE
USELESS 2ESHAPING A BENT NEEDLE
MAY CAUSE IT TO LOSE STRENGTH
AND BE LESS RESISTANT TO BENDING
AND BREAKING
!T %4()#/. THE COMBINATION
OF ALLOY SELECTION AND THE NEEDLE
MANUFACTURING PROCESS ARE CAREFULLY
RATIO
SELECTED TO ACHIEVE THE HIGHEST
POSSIBLE SURGICAL YIELD WHICH ALSO
OPTIMIZES NEEDLE STRENGTH
$UCTILITY REFERS TO THE NEEDLEgS
RESISTANCE TO BREAKING UNDER A GIVEN
AMOUNT OF BENDING )F TOO GREAT A
FORCE IS APPLIED TO A NEEDLE IT MAY
BREAK BUT A DUCTILE NEEDLE WILL
BEND BEFORE BREAKING .EEDLE
BREAKAGE DURING SURGERY CAN PREVENT
APPOSITION OF THE WOUND EDGES AS
THE BROKEN PORTION PASSES THROUGH
TISSUE )N ADDITION SEARCHING FOR
PART OF A BROKEN NEEDLE CAN CAUSE
ADDED TISSUE TRAUMA AND ADD TO THE
TIME THE PATIENT IS ANESTHETIZED !
PIECE THAT CANNOT BE RETRIEVED WILL
REMAIN AS A CONSTANT REMINDER TO
BOTH THE PATIENT AND SURGEON
.EEDLE BENDING AND BREAKAGE CAN
BE MINIMIZED BY CAREFULLY PASSING
NEEDLES THROUGH TISSUE IN THE
DIRECTION OF THE NEEDLE BODY
.EEDLES ARE NOT DESIGNED TO BE
USED AS RETRACTORS TO LIFT TISSUE
&)'52%
4!0%2
2!4)/
&)'52%
%4()#/.
2)""%$
.%%$,%
.EEDLE SHARPNESS IS ESPECIALLY
IMPORTANT IN DELICATE OR COSMETIC
SURGERY 4HE SHARPER THE NEEDLE
THE LESS SCARRING THAT WILL RESULT
(OWEVER THE RIGHT BALANCE MUST BE
FOUND )F A NEEDLE IS TOO SHARP A
SURGEON MAY NOT FEEL HE OR SHE HAS
ADEQUATE CONTROL OF NEEDLE PASSAGE
THROUGH TISSUE
3HARPNESS IS RELATED TO THE ANGLE OF
THE POINT AS WELL AS THE TAPER RATIO
OF THE NEEDLE 4HE %4()#/.
SHARPNESS TESTER INCORPORATES A THIN
LAMINATED SYNTHETIC MEMBRANE
THAT SIMULATES THE DENSITY OF HUMAN
TISSUE ALLOWING ENGINEERS TO GAUGE
EXACTLY HOW MUCH FORCE IS REQUIRED
FOR PENETRATION
-ULTI0ASS NEEDLES HAVE A MICRO
THIN
COATING COMPRISED OF A PATENTED
SILICONE FORMULATION THAT IMPROVES
PENETRATION PERFORMANCE OVER MULTIPLE
PASSES !CCORDING TO LABORATORY
TESTS THIS COATING SERVES SEVERAL
IMPORTANT FUNCTIONS
)T REDUCES THE FORCE NEEDED TO
MAKE INITIAL PENETRATION THROUGH
TISSUE THUS IT IS SHARPER
THAN OTHER SURGICAL NEEDLES ON
MULTIPLE PASSES IN HUMAN TISSUE
3IGNIFICANTLY IMPROVES THE CONSIS
TENCY OF THE NEEDLE PENETRATION
PASS TO PASS NEEDLE TO NEEDLE
-AINTAINS SHARPNESS FOR BETTER
PENETRATION AND CONTROL OVER
MULTIPLE PASSES WHILE DELIVERING
ONGOING STRENGTH SHARPNESS AND
CONTROL
.EEDLE PERFORMANCE IS ALSO
INFLUENCED BY THE STABILITY OF THE
NEEDLE IN THE GRASP OF A NEEDLEHOLD
ER -OST CURVED NEEDLES ARE
FLATTENED IN THE GRASPING AREA TO
ENHANCE CONTROL !LL %4()#/.
4RADEMARK
4(% 352')#!, .%%$,%
CURVED NEEDLES OF MIL WIRE
OR HEAVIER ARE RIBBED AS WELL AS
FLATTENED ,ONGITUDINAL RIBBING
OR GROOVES ON THE INSIDE OR OUTSIDE
CURVATURES OF CURVED NEEDLES
PROVIDES A CROSSLOCKING ACTION IN
THE NEEDLEHOLDER FOR ADDED NEEDLE
CONTROL 4HIS REDUCES UNDESIRABLE
ROCKING TWISTING AND TURNING IN
THE NEEDLEHOLDER
02).#)0,%3 /&
#(//3).' !
352')#!, .%%$,%
7HILE THERE ARE NO HARD AND FAST
RULES GOVERNING NEEDLE SELECTION THE
FOLLOWING PRINCIPLES SHOULD BE KEPT
IN MIND 3PECIFIC TYPES OF NEEDLES
MENTIONED HERE WILL BE DESCRIBED IN
FULL DETAIL LATER ON IN THIS SECTION
&)'52%
0OINT
.%%$,%
#/-0/.%.43
%YE
3WAGED END
"ODY
.EEDLE
POINT
#HORD LENGTH
3WAGE
&)'52%
!.!4/-9
/& ! .%%$,%
.EEDLE
RADIUS
.EEDLE
DIAMETER
.EEDLE LENGTH
.EEDLE BODY
#ONSIDER THE TISSUE IN WHICH THE
SURGEON WILL INTRODUCE THE
NEEDLE 'ENERALLY SPEAKING TAPER
POINT NEEDLES ARE MOST OFTEN USED
TO SUTURE TISSUES THAT ARE EASY
TO PENETRATE #UTTING OR
4!0%2#54
NEEDLES ARE
MORE OFTEN USED IN TOUGH HARD
TO
PENETRATE TISSUES 7HEN IN
DOUBT ABOUT WHETHER TO CHOOSE
A TAPER POINT OR CUTTING NEEDLE
CHOOSE THE TAPER POINT FOR
EVERYTHING EXCEPT SKIN SUTURES
7ATCH THE SURGEONgS TECHNIQUE
CLOSELY 3ELECT THE LENGTH
DIAMETER AND CURVATURE OF THE
NEEDLE ACCORDING TO THE DESIRED
PLACEMENT OF THE SUTURE AND THE
SPACE IN WHICH THE SURGEON
IS WORKING
#ONSULT FREQUENTLY WITH THE
SURGEON 7ORKING WITH THE SAME
SURGEON REPEATEDLY LEADS TO
FAMILIARITY WITH HIS OR HER
INDIVIDUAL ROUTINE (OWEVER
EVEN THE SAME SURGEON MAY NEED
TO CHANGE NEEDLE TYPE OR SIZE TO
MEET SPECIFIC REQUIREMENTS
EVEN DURING A SINGLE OPERATIVE
PROCEDURE
7HEN USING EYED NEEDLES TRY TO
MATCH NEEDLE DIAMETER TO SUTURE
SIZE 3WAGED NEEDLES WHERE THE
NEEDLE IS ALREADY ATTACHED TO THE
SUTURE STRAND ELIMINATE THIS
CONCERN
4HE BEST GENERAL RULE OF THUMB
FOR THE SCRUB PERSON TO FOLLOW IS
PAY ATTENTION AND REMAIN ALERT TO
THE PROGRESS OF THE OPERATION
/BSERVATION IS THE BEST GUIDE TO
NEEDLE SELECTION IF THE SURGEON
HAS NO PREFERENCE
#(!04%2
4(% !.!4/-9
/& ! .%%$,%
2EGARDLESS OF ITS INTENDED USE
EVERY SURGICAL NEEDLE HAS THREE BASIC
COMPONENTS
4HE EYE
4HE BODY
4HE POINT
4HE MEASUREMENTS OF THESE
SPECIFIC COMPONENTS DETERMINE
IN PART HOW THEY WILL BE USED
MOST EFFICIENTLY
.EEDLE SIZE MAY BE MEASURED IN
INCHES OR IN METRIC UNITS 4HE
FOLLOWING MEASUREMENTS DETERMINE
THE SIZE OF A NEEDLE
#(/2$ ,%.'4(4HE
STRAIGHT LINE DISTANCE FROM THE
POINT OF A CURVED NEEDLE TO
THE SWAGE
.%%$,% ,%.'4(4HE
DISTANCE MEASURED ALONG THE
NEEDLE ITSELF FROM POINT TO END
2!$)534HE DISTANCE FROM
THE CENTER OF THE CIRCLE TO THE
BODY OF THE NEEDLE IF THE
CURVATURE OF THE NEEDLE WERE
CONTINUED TO MAKE A FULL CIRCLE
$)!-%4%24HE GAUGE OR
THICKNESS OF THE NEEDLE WIRE
6ERY SMALL NEEDLES OF FINE GAUGE
ARE NEEDED FOR MICROSURGERY
,ARGE HEAVY GAUGE NEEDLES ARE
USED TO PENETRATE THE STERNUM
AND TO PLACE RETENTION SUTURES
IN THE ABDOMINAL WALL ! BROAD
SPECTRUM OF SIZES ARE AVAILABLE
BETWEEN THE TWO EXTREMES
4(% .%%$,% %9%
4HE EYE FALLS INTO ONE OF THREE CATE
GORIES CLOSED EYE &RENCH SPLIT OR
SPRING EYE OR SWAGED EYELESS
4HE CLOSED EYE IS SIMILAR TO A
HOUSEHOLD SEWING NEEDLE 4HE SHAPE
OF THE EYE MAY BE ROUND OBLONG
OR SQUARE &RENCH EYE NEEDLES HAVE A
SLIT FROM INSIDE THE EYE TO THE END
OF THE NEEDLE WITH RIDGES THAT CATCH
AND HOLD THE SUTURE IN PLACE
%YED NEEDLES MUST BE THREADED A
TIME
CONSUMING PROCEDURE FOR THE
SCRUB PERSON 4HIS PRESENTS THE
DISADVANTAGE OF HAVING TO PULL A
DOUBLE STRAND OF SUTURE MATERIAL
THROUGH TISSUE CREATING A LARGER HOLE
WITH ADDITIONAL TISSUE DISRUPTION
)N ADDITION THE SUTURE MAY STILL
BECOME UNTHREADED WHILE THE
SURGEON IS USING IT 7HILE TYING THE
SUTURE TO THE EYE MAY MINIMIZE THIS
POSSIBILITY IT ALSO ADDS TO THE BULK
OF THE SUTURE !NOTHER DISADVANTAGE
OF EYED NEEDLES IS THAT REPEATED USE
OF THESE NEEDLES WITH MORE THAN
ONE SUTURE STRAND CAUSES THE NEEDLE
TO BECOME DULL THEREBY MAKING
SUTURING MORE DIFFICULT
6IRTUALLY ALL NEEDLES USED TODAY ARE
SWAGED 4HIS CONFIGURATION JOINS
THE NEEDLE AND SUTURE TOGETHER AS
A CONTINUOUS UNITONE THAT IS
CONVENIENT TO USE AND MINIMIZES
TRAUMA 4HE METHOD OF ATTACHING
THE SUTURE TO THE NEEDLE VARIES WITH
THE NEEDLE DIAMETER )N LARGER
DIAMETER NEEDLES A HOLE IS DRILLED
IN THE NEEDLE END )N SMALLER
DIAMETER NEEDLES A CHANNEL IS
MADE BY FORMING A 5 AT THE
SWAGE END OR A HOLE IS DRILLED IN
THE WIRE WITH A LASER %ACH HOLE OR
CHANNEL IS SPECIFICALLY ENGINEERED
FOR THE TYPE AND SIZE OF SUTURE
MATERIAL IT WILL HOLD AND CRIMPED
OR CLOSED AROUND THE SUTURE TO HOLD
IT SECURELY 7HEN THE SURGEON HAS
FINISHED PLACING THE SUTURE LINE IN
THE PATIENTgS TISSUE THE SUTURE MAY
BE CUT OR EASILY RELEASED FROM THE
NEEDLE AS IS THE CASE WHEN USING
#/.42/, 2%,%!3%
NEEDLES
0ATENT .O
4HE DIAMETER OF A NEEDLE SWAGED
TO SUTURE MATERIAL IS NO LARGER
THAN NECESSARY TO ACCOMMODATE
THE DIAMETER OF THE SUTURE STRAND
ITSELF 3WAGED SUTURES OFFER SEVERAL
ADVANTAGES TO THE SURGEON NURSE
AND PATIENT
4HE SCRUB PERSON DOES NOT HAVE
TO SELECT A NEEDLE WHEN THE
SURGEON REQUESTS A SPECIFIC SUTURE
MATERIAL SINCE IT IS ALREADY
ATTACHED
(ANDLING AND PREPARATION ARE
MINIMIZED 4HE STRAND WITH
NEEDLE ATTACHED MAY BE USED
DIRECTLY FROM THE PACKET 4HIS
HELPS MAINTAIN THE INTEGRITY OF
THE SUTURE STRAND
4ISSUES ARE SUBJECTED TO MINIMAL
TRAUMA
4ISSUE TRAUMA IS FURTHER REDUCED
BECAUSE A NEW SHARP UNDAMAGED
NEEDLE IS PROVIDED WITH EACH
SUTURE STRAND
3WAGED SUTURES DO NOT UNTHREAD
PREMATURELY
)F A NEEDLE IS ACCIDENTALLY
DROPPED INTO A BODY CAVITY THE
ATTACHED SUTURE STRAND MAKES IT
EASIER TO FIND
)NVENTORY AND TIME SPENT
CLEANING SHARPENING HANDLING
AND STERILIZING REUSABLE EYED
NEEDLES IS ELIMINATED THEREBY
REDUCING COST AS WELL AS RISK OF
NEEDLE PUNCTURES
#/.42/, 2%,%!3% NEEDLES
ALLOW PLACEMENT OF MANY SUTURES
RAPIDLY 4HIS MAY REDUCE
4RADEMARK
4(% 352')#!, .%%$,%
4(% .%%$,% %9%
&)'52%
#LOSED EYE
&RENCH EYE
3WAGED
COMPARED IN LABORATORY TESTS
SOME WITH SPLIT CHANNELS AND
SOME WITH LASER
DRILLED HOLES 4HE
NEEDLES WITH LASER
DRILLED HOLES
PRODUCED LESS DRAG FORCE AS THEY
PASSED THROUGH A MEMBRANE THAT
SIMULATED VASCULAR TISSUE 4HIS
COULD BE ASSOCIATED WITH LESS
TRAUMA TO THE VESSEL WALLS
4HE SWAGED !42!,/# SURGICAL
NEEDLES MADE BY %4()#/.
ARE SUPPLIED IN A VARIETY OF SIZES
SHAPES AND STRENGTHS 3OME OF
THEM INCORPORATE THE #/.42/,
2%,%!3% NEEDLE SUTURE PRINCIPLE
WHICH FACILITATES FAST SEPARATION
OF THE NEEDLE FROM THE SUTURE
WHEN DESIRED BY THE SURGEON
4HIS FEATURE ALLOWS RAPID PLACEMENT
OF MANY SUTURES AS IN INTERRUPTED
SUTURING TECHNIQUES %VEN THOUGH
THE SUTURE IS SECURELY FASTENED
TO THE NEEDLE A SLIGHT STRAIGHT TUG
WILL RELEASE IT 4HIS NEEDLESUTURE
CONFIGURATION WAS CREATED ORIGINALLY
FOR ABDOMINAL CLOSURE AND
HYSTERECTOMIES BUT IS NOW USED
IN A WIDE VARIETY OF PROCEDURES
4(% .%%$,% "/$9
4HE BODY OF THE NEEDLE IS THE
PORTION WHICH IS GRASPED BY THE
NEEDLEHOLDER DURING THE SURGICAL
PROCEDURE 4HE BODY OF THE NEEDLE
SHOULD BE AS CLOSE AS POSSIBLE TO THE
DIAMETER OF THE SUTURE MATERIAL TO
MINIMIZE BLEEDING AND LEAKAGE
4HIS IS ESPECIALLY TRUE FOR
CARDIOVASCULAR GASTROINTESTINAL
AND BLADDER PROCEDURES
4HE CURVATURE OF THE NEEDLE BODY
MAY COME IN A VARIETY OF DIFFERENT
SHAPES %ACH SHAPE GIVES THE NEEDLE
DIFFERENT CHARACTERISTICS
342!)'(4 .%%$,%
4HIS SHAPE MAY BE PREFERRED WHEN
&)'52%
OPERATING TIME AND ULTIMATELY
THE LENGTH OF TIME THE PATIENT
IS ANESTHETIZED
#/.42/,
2%,%!3%
.%%$,%
35452%
4HE !42!,/#
SURGICAL NEEDLE
AND #/.42/, 2%,%!3%
NEEDLE ENSURE CONSISTENT QUALITY
AND PERFORMANCE
3WAGED SUTURES ELIMINATE SUTURE
FRAYING OR DAMAGE DUE TO SHARP
COMERS IN THE EYE OF EYED
NEEDLES
.EEDLES ARE CORROSION
FREE
3MALL DIAMETER %4()#/. TAPER
POINT NEEDLES COMMONLY USED
IN CARDIOVASCULAR SURGERY WERE
(OLDING THE NEEDLE SECURELY IN THE NEEDLEHOLDER THE SUTURE
SHOULD BE GRASPED SECURELY AND PULLED STRAIGHT AND TAUT 4HE
NEEDLE WILL BE RELEASED WITH A STRAIGHT TUG OF THE NEEDLEHOLDER
#(!04%2
SUTURING EASILY ACCESSIBLE TISSUE
-OST OF THESE NEEDLES ARE DESIGNED
TO BE USED IN PLACES WHERE DIRECT
FINGER
HELD MANIPULATION CAN EASILY
BE PERFORMED
4HE +EITH NEEDLE IS A STRAIGHT
CUTTING NEEDLE )T IS USED PRIMARILY
FOR SKIN CLOSURE OF ABDOMINAL
WOUNDS 6ARYING LENGTHS ARE ALSO
USED FOR ARTHROSCOPIC SUTURING OF
THE MENISCUS IN THE KNEE
"UNNELL ". NEEDLES ARE USED FOR
TENDON REPAIR 4APER POINT NEEDLE
VARIATIONS MAY ALSO BE USED FOR
3(!0%
3TRAIGHT
SUTURING THE GASTROINTESTINAL TRACT
3OME MICROSURGEONS PREFER STRAIGHT
NEEDLES FOR NERVE AND VESSEL REPAIR
)N OPHTHALMOLOGY THE STRAIGHT TRAN
SCHAMBER NEEDLE PROTECTS ENDOTHE
LIAL CELLS AND FACILITATES PLACEMENT OF
INTRAOCULAR LENSES
(!,&
#526%$ .%%$,%
4HE HALF
CURVED OR SKI NEEDLE
MAY BE USED FOR SKIN CLOSURE OR IN
LAPAROSCOPY )TS LOW PROFILE ALLOWS
EASY PASSAGE DOWN LAPAROSCOPIC
TROCARS )TS USE IN SKIN CLOSURE IS
!00,)#!4)/.
GASTROINTESTINAL TRACT NASAL
CAVITY NERVE ORAL CAVITY
PHARYNX SKIN TENDON VESSELS
(ALF CURVED
SKIN RARELY USED
LAPAROSCOPY
EYE PRIMARY APPLICATION
MICROSURGERY
#IRCLE
&)'52%
#IRCLE
APONEUROSIS BILIARY TRACT CARDIOVASCULAR
SYSTEM DURA EYE GASTROINTESTINAL TRACT
MUSCLE MYOCARDIUM NERVE PERICHON
DRIUM PERIOSTEUM PLEURA SKIN TENDON
UROGENITAL TRACT VESSELS
#IRCLE
BILIARY TRACT CARDIOVASCULAR SYSTEM EYE
FASCIA GASTROINTESTINAL TRACT MUSCLE
NASAL CAVITY ORAL CAVITY PELVIS PERI
TONEUM PHARYNX PLEURA RESPORATORY
TRACT SKIN TENDON SUBCUTANEOUS FAT
UROGENITAL TRACT
#IRCLE
ANAL HEMORRHOIDECTOMY NASAL
CAVITY PELVIS UROGENITAL TRACT PRIMARY
APPLICATION
#OMPOUND
#URVED
EYE ANTERIOR SEGMENT
LAPAROSCOPY
.%%$,%
3(!0%3
!.$ 490)#!,
!00,)#!4)/.3
LIMITED BECAUSE WHILE THE CURVED
PORTION PASSES THROUGH TISSUE EASILY
THE REMAINING STRAIGHT PORTION OF
THE BODY IS UNABLE TO FOLLOW THE
CURVED PATH OF THE NEEDLE WITHOUT
BENDING OR ENLARGING ITS PATH IN
THE TISSUE
#526%$ .%%$,%
#URVED NEEDLES ALLOW PREDICTABLE
NEEDLE TURNOUT FROM TISSUE AND
ARE THEREFORE USED MOST OFTEN
4HIS NEEDLE SHAPE REQUIRES LESS
SPACE FOR MANEUVERING THAN A
STRAIGHT NEEDLE BUT THE CURVE
NECESSITATES MANIPULATION WITH A
NEEDLEHOLDER 4HE CURVATURE MAY
BE OR CIRCLE
4HE MOST COMMON USE FOR THE
CIRCLE IS SKIN CLOSURE 4HE SURGEON
CAN EASILY MANIPULATE THIS CURVATURE
WITH SLIGHT PRONATION OF THE WRIST IN
A RELATIVELY LARGE AND SUPERFICIAL
WOUND )T IS VERY DIFFICULT TO USE
THIS NEEDLE IN A DEEP BODY CAVITY OR
RESTRICTED AREA BECAUSE A LARGER ARC OF
MANIPULATION IS REQUIRED
4HE CIRCLE NEEDLE WAS DESIGNED
FOR USE IN A CONFINED SPACE
ALTHOUGH IT REQUIRES MORE PRONATION
AND SUPINATION OF THE WRIST "UT
EVEN THE TIP OF THIS NEEDLE MAY
BE OBSCURED BY TISSUE DEEP IN
THE PELVIC CAVITY ! CIRCLE
NEEDLE MAY BE MORE USEFUL IN
THIS SITUATION ESPECIALLY IN SOME
ANAL UROGENITAL INTRAORAL AND
CARDIOVASCULAR PROCEDURES
#/-0/5.$
#526%$ .%%$,%
4HE COMPOUND CURVED NEEDLE
0ATENT .O WAS
ORIGINALLY DEVELOPED FOR ANTERIOR
SEGMENT OPHTHALMIC SURGERY )T
ALLOWS THE SURGEON TO TAKE PRECISE
4RADEMARK
4(% 352')#!, .%%$,%
UNIFORM BITES OF TISSUE 4HE TIGHT
CURVATURE OF THE TIP FOLLOWS INTO
A CURVATURE THROUGHOUT THE
REMAINDER OF THE BODY 4HE INITIAL
CURVE ALLOWS REPRODUCIBLE SHORT
DEEP BITES INTO THE TISSUE 4HE
CURVATURE OF THE REMAINING PORTION
OF THE BODY FORCES THE NEEDLE OUT OF
THE TISSUE EVERTING THE WOUND EDGES
AND PERMITTING A VIEW INTO THE
WOUND 4HIS ENSURES EQUIDISTANCE OF
THE SUTURE MATERIAL ON BOTH SIDES OF
THE INCISION %QUALIZED PRESSURE ON
BOTH SIDES OF THE COMEAL
SCLERAL
JUNCTION MINIMIZES THE POSSIBILITY
OF ASTIGMATISM FOLLOWING ANTERIOR
SEGMENT SURGERY
4(% .%%$,% 0/).4
4HE POINT EXTENDS FROM THE EXTREME
TIP OF THE NEEDLE TO THE MAXIMUM
CROSS
SECTION OF THE BODY %ACH NEE
DLE POINT IS DESIGNED AND PRODUCED
TO THE REQUIRED DEGREE OF SHARPNESS
TO SMOOTHLY PENETRATE SPECIFIC TYPES
OF TISSUE
!00,)#!4)/.
3(!0%
#ONVENTIONAL #UTTING
SKIN STERNUM
&)'52%
0OINT
"ODY
2EVERSE #UTTING
FASCIA LIGAMENT NASAL CAVITY ORAL
MUCOSA PHARYNX SKIN TENDON SHEATH
0OINT
"ODY
SKIN PLASTIC OR COSMETIC
0RECISION 0OINT #UTTING
0OINT
"ODY
0# 02)-%
.EEDLE
SKIN PLASTIC OR COSMETIC
0OINT
"ODY
-)#2/
0/).4
2EVERSE #UTTING .EEDLE
EYE
0OINT
"ODY
3IDE #UTTING 3PATULA
EYE PRIMARY APPLICATION
MICROSURGERY OPHTHALMIC
RECONSTRUCTIVE
0OINT
"ODY
490%3 /&
.%%$,%3
#3 5,4)-!
/PHTHALMIC .EEDLE
EYE PRIMARY APPLICATION
0OINT
#544).' .%%$,%3
#UTTING NEEDLES HAVE AT LEAST TWO
OPPOSING CUTTING EDGES 4HEY ARE
SHARPENED TO CUT THROUGH TOUGH
DIFFICULT
TO
PENETRATE TISSUE
#UTTING NEEDLES ARE IDEAL FOR SKIN
SUTURES THAT MUST PASS THROUGH
DENSE IRREGULAR AND RELATIVELY
THICK CONNECTIVE DERMAL TISSUE
"ECAUSE OF THE SHARPNESS OF THE
CUTTING EDGE CARE MUST BE TAKEN
IN SOME TISSUE TENDON SHEATH
OR ORAL MUCOUS MEMBRANE TO
AVOID CUTTING THROUGH MORE TISSUE
THAN DESIRED
"ODY
4APER
0OINT
"ODY
4!0%2#54
3URGICAL .EEDLE
0OINT
"ODY
"LUNT
APONEUROSIS BILIARY TRACT DURA FASCIA
GASTROINTESTINAL TRACT LAPAROSCOPY
MUSCLE MYOCARDIUM NERVE PERITONEUM
PLEURA SUBCUTANEOUS FAT UROGENITAL
TRACT VESSELS VALVE
BRONCHUS CALCIFIED TISSUE FASCIA
LAPAROSCOPY LIGAMENT NASAL CAVITY
ORAL CAVITY OVARY PERICHONDRIUM
PERIOSTEUM PHARYNX STERNUM TENDON
TRACHEA UTERUS VALVE VESSELS SCLEROTIC
"LUNT DISSECTION FRIABLE TISSUE
CERVIX LIGATING INCOMPETENT CERVIX
FASCIA INTESTINE KIDNEY LIVER SPLEEN
0OINT
"ODY
.%%$,%
0/).43 !.$
"/$9 3(!0%3
!.$ 490)#!,
!00,)#!4)/.3
#(!04%2
#/.6%.4)/.!,
#544).' .%%$,%3
)N ADDITION TO THE TWO CUTTING EDGES
CONVENTIONAL CUTTING NEEDLES HAVE A
THIRD CUTTING EDGE ON THE INSIDE
CONCAVE CURVATURE OF THE NEEDLE
4HE SHAPE CHANGES FROM A TRIANGULAR
CUTTING BLADE TO THAT OF A FLATTENED
BODY ON BOTH STRAIGHT AND CURVED
NEEDLES 4HIS NEEDLE TYPE MAY BE
PRONE TO CUTOUT OF TISSUE BECAUSE
THE INSIDE CUTTING EDGE CUTS TOWARD
THE EDGES OF THE INCISION OR WOUND
4HE 0# 02)-%
NEEDLE 0RECISION
#OSMETIC 0ATENT .O
IS DESIGNED SPECIFICALLY FOR AESTHETIC
PLASTIC SURGERY AND HAS CONVENTIONAL
CUTTING EDGES 7HERE COSMETIC
RESULTS ARE IMPORTANT THE 0#
02)-% NEEDLE IS SUPERIOR TO ANY
OTHER FOR MORE DELICATE SURGERY
ESPECIALLY FACIAL SURGERY 4HE
NARROW POINT FINE WIRE DIAMETER
AND FINE TAPER RATIO ALLOW SUPERIOR
PENETRATION OF SOFT TISSUE 4HE INSIDE
AND OUTSIDE CURVATURES OF THE BODY
ARE FLATTENED IN THE NEEDLE GRASPING
AREA FOR GREATER STABILITY IN THE
NEEDLEHOLDER &ATTENED SIDES REDUCE
BENDING THAT MIGHT OCCUR DUE TO
THE FINE WIRE DIAMETER
4HE TIP CONFIGURATION OF THE CONVEN
TIONAL CUTTING STERNOTOMY NEEDLE IS
SLIGHTLY ALTERED TO RESIST BENDING AS IT
PENETRATES THE STERNUM 4HE ALLOY USED
FOR THIS NEEDLE PROVIDES THE INCREASED
STRENGTH AND DUCTILITY NEEDED FOR ITS
FUNCTION 4HE CUTTING EDGES OF THE
POINT EXTEND APPROXIMATELY MM
FROM THE ROUND BODY AND TERMINATE IN
A TRIANGULAR
SHAPED TIP 4HIS PARTICULAR
STERNOTOMY NEEDLE MAXIMIZES CUTTING
EFFICIENCY AND CONTROL IN THE NEEDLE
HOLDER 4!0%2#54 SURGICAL NEEDLES
MAY ALSO BE USED FOR THIS PROCEDURE
2%6%23% #544).' .%%$,%3
4HESE NEEDLES WERE CREATED
SPECIFICALLY FOR TOUGH DIFFICULT
TO
PENETRATE TISSUE SUCH AS SKIN TENDON
SHEATH OR ORAL MUCOSA 2EVERSE
CUTTING NEEDLES ARE USED IN
OPHTHALMIC AND COSMETIC SURGERY
WHERE MINIMAL TRAUMA EARLY
REGENERATION OF TISSUE AND LITTLE SCAR
FORMATION ARE PRIMARY CONCERNS
4HE REVERSE CUTTING NEEDLE IS AS
SHARP AS THE CONVENTIONAL CUTTING
NEEDLE BUT ITS DESIGN IS DISTINCTIVELY
DIFFERENT 4HE THIRD CUTTING EDGE
IS LOCATED ON THE OUTER CONVEX
CURVATURE OF THE NEEDLE 4HIS OFFERS
SEVERAL ADVANTAGES
2EVERSE CUTTING NEEDLES HAVE
MORE STRENGTH THAN SIMILAR
SIZED
CONVENTIONAL CUTTING NEEDLES
4HE DANGER OF TISSUE CUTOUT IS
GREATLY REDUCED
4HE HOLE LEFT BY THE NEEDLE LEAVES
A WIDE WALL OF TISSUE AGAINST
WHICH THE SUTURE IS TO BE TIED
4HE -)#2/
0/).4
SURGICAL
NEEDLE FOR OPHTHALMIC PROCEDURES
HAS A SMOOTH SURFACE AND IS HONED
TO EXTREME SHARPNESS 4HIS ALLOWS
THE SURGEON TO SUTURE THE EXTREMELY
TOUGH TISSUES OF THE EYE WITH
OPTIMUM PRECISION AND EASE
! NEEDLE MANUFACTURED BY THE
&)'52%
.ARROW POINT
&INE WIRE DIAMETER
4(% 0#
02)-%
.%%$,%
&LATTENED INSIDE CURVATURE
&LAT SIDES
#ONVENTIONAL
CUTTING TIP
&LATTENED OUTSIDE CURVATURE
#ONVENTIONAL CUTTING EDGES INCH OR MM
&)'52%
34%2./4/-9
.%%$,%
4RADEMARK
4(% 352')#!, .%%$,%
EXCLUSIVE %4()#/.
0RECISION
0OINT 0ROCESS MAY BE USED FOR
PLASTIC OR COSMETIC SURGERY AND
PASSES SMOOTHLY THROUGH TISSUE
CREATING A MINUTE NEEDLE PATH
&)'52%
2%6%23%
#544).'
.%%$,%
4HIS RESULTS IN SUPERIOR APPOSITION
4HE BOTTOM THIRD CUTTING EDGE
ON THE 0RECISION 0OINT NEEDLE
FLATTENS OUT AS IT TRANSITIONS TO THE
NEEDLE BODY FOR GREATER SECURITY IN
THE NEEDLEHOLDER
4HE /3 /RTHOPAEDIC 3URGERY
NEEDLES ARE CURVED HEAVY BODIED
REVERSE
CUTTING NEEDLES 4HE
ORTHOPAEDIC SURGEON MAY USE THE
/3 NEEDLE FOR EXTREMELY TOUGH
TISSUE SUCH AS CARTILAGE WHERE FORCE
IS REQUIRED FOR PENETRATION
3)$% #544).' .%%$,%3
!LSO REFERRED TO AS SPATULA NEEDLES
THEY FEATURE A UNIQUE DESIGN WHICH
IS FLAT ON BOTH THE TOP AND BOTTOM
ELIMINATING THE UNDESIRABLE TISSUE
CUTOUT OF OTHER CUTTING NEEDLES
4HE SIDE
CUTTING EDGES ARE DESIGNED
FOR OPHTHALMIC PROCEDURES 4HEY
PERMIT THE NEEDLE TO SEPARATE OR
SPLIT THROUGH THE THIN LAYERS OF
SCLERAL OR COMEAL TISSUE AND TRAVEL
WITHIN THE PLANE BETWEEN THEM
4HE OPTIMAL WIDTH SHAPE AND
PRECISION SHARPNESS OF THIS NEEDLE
ENSURE MAXIMUM EASE OF PENETRA
TION AND GIVES THE SURGEON GREATER
CONTROL OF THE NEEDLE AS IT PASSES
BETWEEN OR THROUGH TISSUE LAYERS
4HE POSITION OF THE POINT VARIES
WITH THE DESIGN OF EACH SPECIFIC
TYPE OF SPATULATED NEEDLE
4HE 3!"2%,/#
SPATULA NEEDLE
HAS TWO CUTTING EDGES AND A
TRAPEZOIDAL
SHAPED BODY
4HE 3!"2%,/#
NEEDLE WITH
&)'52%
30!45,!
.%%$,%
#2/33
3%#4)/.
THE COBRA
SHAPED TIP HAS FOUR
EQUIDISTANT DEFINED EDGES
4HE #3 5,4)-!
OPHTHALMIC
NEEDLE #ORNEAL
3CLERAL 0ATENT .O
IS THE SHARPEST NEEDLE
IN ITS CATEGORY AND IS USED FOR
CORNEAL SCLERAL CLOSURE 4HE SMALLER
ANGLES AND INCREASED CUTTING
EDGE
LENGTH RESULT IN SUPERIOR SHARPNESS
FACILITATING EASY TISSUE PENETRATION
4HE 4' 0,53
NEEDLE 4RANSVERSE
'ROUND HAS A LONG ULTRA
SHARP
SLIM TIP 4HIS NEEDLE UNDERGOES A
UNIQUE HONING PROCESS WHICH RESULTS
IN A SHARPER NEEDLE 4HE SURGEON
ENCOUNTERS LOW PENETRATION RESIST
ANCE WITH THE 4' 0,53 NEEDLE AND
GETS EXCELLENT TACTILE FEEDBACK
4!0%2 0/).4 .%%$,%3
!LSO REFERRED TO AS ROUND NEEDLES
TAPER POINT NEEDLES PIERCE AND
SPREAD TISSUE WITHOUT CUTTING IT 4HE
NEEDLE POINT TAPERS TO A SHARP TIP
4HE NEEDLE BODY THEN FLATTENS TO AN
OVAL OR RECTANGULAR SHAPE 4HIS
INCREASES THE WIDTH OF THE BODY TO
HELP PREVENT TWISTING OR TURNING IN
THE NEEDLEHOLDER
#(!04%2
4APER POINT NEEDLES ARE USUALLY
USED IN EASILY PENETRATED TISSUE
SUCH AS THE PERITONEUM ABDOMINAL
VISCERA MYOCARDIUM DURA AND
SUBCUTANEOUS LAYERS 4HEY ARE
PREFERRED WHEN THE SMALLEST POSSIBLE
HOLE IN THE TISSUE AND MINIMUM
TISSUE CUTTING ARE DESIRED 4HEY ARE
ALSO USED IN INTERNAL ANASTOMOSES
TO PREVENT LEAKAGE WHICH CAN
SUBSEQUENTLY LEAD TO CONTAMINATION
OF THE ABDOMINAL CAVITY )N THE
FASCIA TAPER POINT NEEDLES MINIMIZE
THE POTENTIAL FOR TEARING THE THIN
CONNECTIVE TISSUE LYING BETWEEN
PARALLEL AND INTERLACING BANDS OF
DENSER CONNECTIVE TISSUE
4HE -AYO -/ NEEDLE HAS A TAPER
POINT BUT A HEAVIER AND MORE
FLATTENED BODY THAN CONVENTIONAL
TAPER NEEDLES 4HIS NEEDLE WAS
DESIGNED FOR USE IN DENSE TISSUE
INTO THE SURROUNDING TISSUE
PARTICULARLY FOR GYNECOLOGICAL
PROCEDURES GENERAL CLOSURE AND
HERNIA REPAIR
4!0%2#54 352')#!,
.%%$,%3
%4()#/.
MANUFACTURES 4!0%2
#54
NEEDLES WHICH COMBINE THE
FEATURES OF THE REVERSE CUTTING EDGE
TIP AND TAPER POINT NEEDLES 4HREE
CUTTING EDGES EXTEND APPROXIMATELY
BACK FROM THE POINT 4HESE
BLEND INTO A ROUND TAPER BODY !LL
THREE EDGES ARE SHARPENED TO PROVIDE
UNIFORM CUTTING ACTION 4HE POINT
SOMETIMES REFERRED TO AS A TROCAR
POINT READILY PENETRATES DENSE
TOUGH TISSUE 4HE OBJECTIVE SHOULD
BE FOR THE POINT ITSELF NOT TO EXCEED
THE DIAMETER OF THE SUTURE MATERIAL
4HE TAPER BODY PORTION PROVIDES
SMOOTH PASSAGE THROUGH TISSUE AND
ELIMINATES THE DANGER OF CUTTING
!LTHOUGH INITIALLY DESIGNED FOR
USE IN CARDIOVASCULAR SURGERY ON
SCLEROTIC OR CALCIFIED TISSUE THE
4!0%2#54
NEEDLE IS WIDELY
USED FOR SUTURING DENSE FIBROUS
CONNECTIVE TISSUE ESPECIALLY IN
FASCIA PERIOSTEUM AND TENDON
WHERE SEPARATION OF PARALLEL
CONNECTIVE TISSUE FIBERS COULD OCCUR
WITH A CONVENTIONAL CUTTING NEEDLE
%4()#/.
DEVELOPED A MODIFIED
4!0%2#54 ## NEEDLE #ALCIFIED
#ORONARY FOR ANASTOMOSIS OF SMALL
FIBROTIC AND CALCIFIED BLOOD VESSELS
4HE CALCIFIED PORTION OF AN ARTERY
REQUIRES A CUTTING TIP ONLY FOR INITIAL
PENETRATION TO AVOID TEARING THE
VESSEL 4HIS NEEDLE CONFIGURATION HAS
A SLIMMER GEOMETRY THAN OTHER
4!0%2#54 NEEDLES FROM THE BODY
THROUGH THE POINT WHICH FACILITATES
#/$% -%!.).'
#/$% -%!.).'
#/$% -%!.).'
""
")&
".
"0
"6
"6(
#
##
##3
#%
#&3
#)&
#0
#03
#08
#3
#3"
#3#
#4
#4"
#48
#48"
#6
$#
$0
%.
%34
&.
&3
&3,
&3,8
'
'3
*
+3
,(
,2
,3
-&
-(
-/
-/"
/03
/3
0
0#
03
2"
2$
2(
26
3
3#
3&3
3(
3)&
3+3
334
34"
34#
340
4%
4&
4'
4'7
4.
40
40"
43
41
5#,
52
52"
6
6!3
8 OR 0
8,(
88,(
"LUE "ABY
)NTRAOCULAR &IXATION
"UNNELL
"LUNT 0OINT
"LOOD 6ESSEL
"LOOD 6ESSEL (ALF
#ARDIOVASCULAR
#ALCIFIED #ORNARY
#ONVENTIONAL #UTTING 3TERNOTOMY
#UTTING %DGE
#ONVENTIONAL FOR 3KIN
#UTTING )NTRAOCULAR &IXATION
#UTTING 0OINT
#ONVENTIONAL 0LASTIC 3URGERY
#UTTING 0OINT %XTRA ,ARGE
#ORNEAL
3CLERAL
#ORNEAL
3CLERAL "I
#URVE
#ORNEAL
3CLERAL #OMPOUND #URVE
#IRCLE 4APER
#IRCLE 4APER "LUNT
#IRCLE 4APER %XTRA ,ARGE
#IRCLE 4APER %XTRA ,ARGE "LUNT
#ARDIOVASCULAR
$URA #LOSURE
$OUBLE 0OINT
%NDOSCOPIC .EEDLE
%YED 3TRAIGHT 4APER
&OR 4ONSIL
&OR 3KIN
&OR 3KIN ,ARGE
&OR 3KIN %XTRA ,ARGE
'REISHABER
'REISHABER 3PATULA
#ONJUNCTIVE
+EITH 3TRAIGHT
,ARGE (ALF
,ARGER 2ETENTION
,ARGE 3TERNOTOMY
-USCLE
-ODIFIED &ERGUSAN
-EDIUM (ALF CIRCLE
-AYO
-AYO "LUNT
/CULAR 0LASTIC 3URGERY
/RTHOPAEDIC 3URGERY
0LASTIC
0RECISION #OSMETIC
0LASTIC 3URGERY
2ENAL ARTERY "YPASS
2ETINAL $ETACHMENT
2OUND (ALF CIRCLE
2ETINAL
6ITREOUS
3PATULA
3TRAIGHT #UTTING
3PATULATED FOR 3KIN
3MALL (ALF CIRCLE
3KI )NTRAOCULAR &IXATION
3TERNOTOMY +EITH 3TRAIGHT
3PATULATED -ODULE
3TRAIGHT 4APER
3TRAIGHT "LUNT
3TRAIGHT #UTTING
3TRAIGHT 4APER 0OINT
4HREE
%IGHTHS
4ETRALOGY OF &ALLOT
4RANSVERSE 'ROUND
4RANSVERSE 'ROUND 7IDE
4ROCAR .EEDLE
4APER 0ERICOSTAL 0OINT
4APER 0ERICOSTAL 0OINT "LUNT
4ENDON 3TRAIGHT
4WISTY 1
#IRCLE #OLATERAL ,IGAMENT
5ROLOGY
5ROLOGY "LUNT
4!0%2#54 3URGICAL .EEDLE
6AS $EFERENS
%XODONTAL DENTAL
%XTRA ,ARGE (ALF CIRCLE
%XTRA %XTRA ,ARGE (ALF CIRCLE
4!",%
%4()#/.
.%%$,%
#/$%3
/4(%2
-%!.).'
4RADEMARK
4(% 352')#!, .%%$,%
PENETRATION )T ALSO MINIMIZES THE
RISK OF LEAKAGE FROM FRIABLE VESSELS
OR VASCULAR GRAFT MATERIAL
",5.4 0/).4 .%%$,%3
"LUNT POINT "0 NEEDLES CAN
LITERALLY DISSECT FRIABLE TISSUE RATHER
THAN CUTTING IT 4HEY HAVE A TAPER
BODY WITH A ROUNDED BLUNT POINT
THAT WILL NOT CUT THROUGH TISSUE
4HEY MAY BE USED FOR SUTURING THE
LIVER AND KIDNEY $UE TO SAFETY
CONSIDERATIONS SURGEONS ALSO USE
BLUNT POINT NEEDLES IN OBSTETRIC
AND GYNECOLOGICAL PROCEDURES WHEN
WORKING IN DEEP CAVITIES WHICH
ARE PRONE TO SPACE AND VISIBILITY
LIMITATIONS )N ADDITION BLUNT
POINT NEEDLES FOR GENERAL CLOSURE ARE
ESPECIALLY HELPFUL WHEN PERFORMING
PROCEDURES ON AT
RISK PATIENTS
4HE %4()'5!2$
BLUNT POINT
NEEDLE COMBINES THE SAFETY OF THE
BLUNT POINT WITH THE SECURITY OF A
RIBBED AND FLATTENED DESIGN AND THE
CONVENIENCE OF A SWAGED NEEDLE
.%%$,%(/,$%23
4HE SURGEON USES THE NEEDLEHOLDER
TO PASS A CURVED NEEDLE THROUGH
TISSUE )T MUST BE MADE OF NONCOR
ROSIVE HIGH STRENGTH GOOD QUALITY
STEEL ALLOY WITH JAWS DESIGNED FOR
HOLDING THE SURGICAL NEEDLE SECURELY
.EEDLEHOLDER JAWS MAY BE SHORT OR
FLAT CONCAVE OR CONVEX SMOOTH OR
SERRATED 3MOOTH JAWS MAY ALLOW THE
NEEDLE TO WOBBLE OR TWIST *AWS WITH
TEETH HOLD MOST SECURELY BUT MAY
DAMAGE THE SUTURE OR NEEDLE IF TOO
MUCH PRESSURE IS APPLIED -OST BUT
NOT ALL NEEDLEHOLDERS HAVE A RATCHET
LOCK NEAR TO THUMB AND FINGER RINGS
3URGICAL NEEDLES ARE DESIGNED FOR
&)'52%
2%6%23%
#544).'
.%%$,%
3MOOTH *AWS
*AWS WITH TUNGSTEN
CARBIDE PARTICLES
OPTIMUM NEEDLEHOLDER STABILITY
"ECAUSE THIS TOOL ACTUALLY DRIVES THE
NEEDLE ITS PERFORMANCE WILL HAVE AN
IMPACT UPON THE ENTIRE SUTURING
PROCEDURE 4HE SURGEON HAS MAXI
MUM CONTROL ONLY WHEN THE NEEDLE
SITS WELL IN THE HOLDER WITHOUT WOB
BLING AS IT IS PASSED THROUGH TISSUE
.EEDLEHOLDERS LIKE PLIERS WEAKEN
WITH REPEATED USE 4HEREFORE THE
SCRUB PERSON SHOULD CHECK BEFORE
EACH PROCEDURE TO MAKE SURE THAT
THE NEEDLEHOLDER JAWS ALIGN PROPERLY
AND GRASP SECURELY
7HEN SELECTING A NEEDLEHOLDER
THE FOLLOWING SHOULD BE TAKEN
INTO CONSIDERATION
)T MUST BE THE APPROPRIATE SIZE
FOR THE NEEDLE SELECTED ! VERY
SMALL NEEDLE SHOULD BE HELD WITH
SMALL FINE JAWS 4HE LARGER AND
HEAVIER THE NEEDLE THE WIDER AND
HEAVIER THE JAWS OF THE NEEDLE
HOLDER SHOULD BE
)T SHOULD BE AN APPROPRIATE SIZE
FOR THE PROCEDURE )F THE SURGEON
IS WORKING DEEP INSIDE THE BODY
CAVITY A LONGER NEEDLEHOLDER IS
IN ORDER
*AWS WITH
TEETH
.%%$,%(/,$%2 53%
4HE FOLLOWING GUIDELINES ARE OFFERED
TO THE SCRUB PERSON FOR NEEDLEHOLDER
USE
'RASP THE NEEDLE WITH THE TIP OF
THE NEEDLEHOLDER JAWS IN AN AREA
APPROXIMATELY ONE
THIRD TO
ONE
HALF OF THE DISTANCE FROM THE
SWAGED END TO THE POINT !VOID
PLACING THE HOLDER ON OR NEAR THE
SWAGED AREA WHICH IS THE WEAKEST
PART OF THE NEEDLE
$O NOT GRASP THE NEEDLE TOO
TIGHTLY AS THE JAWS OF THE NEEDLE
HOLDER MAY DEFORM DAMAGE OR
BEND IT IRREVERSIBLY
!LWAYS CHECK ALIGNMENT OF THE
NEEDLEHOLDER JAW TO MAKE CERTAIN
THE NEEDLE DOES NOT ROCK TWIST
OR TURN
(ANDLE THE NEEDLE AND NEEDLE
HOLDER AS A UNIT
0ASS THE NEEDLEHOLDER TO THE
SURGEON SO THAT HE OR SHE WILL NOT
HAVE TO READJUST IT BEFORE PLACING
THE SUTURE IN TISSUE -AKE SURE
THE NEEDLE IS POINTING IN THE
DIRECTION IN WHICH IT WILL BE
USED AND THAT THE SUTURE STRAND IS
#(!04%2
NOT ENTANGLED
!LWAYS PROVIDE A NEEDLEHOLDER
NEVER A HEMOSTATTO PULL THE
NEEDLE OUT THROUGH TISSUE !
HEMOSTAT OR OTHER CLAMP CAN
DAMAGE THE NEEDLE
)MMEDIATELY AFTER USE EVERY
NEEDLE SHOULD BE RETURNED TO THE
SCRUB PERSON WHILE CLAMPED IN A
NEEDLEHOLDER .EEDLES ARE LESS
LIKELY TO BE LOST IF THEY ARE PASSED
ONE
FOR
ONE ONE RETURNED FOR
EACH ONE RECEIVED
&)'52%
4HE SURGEON RECEIVES THE
NEEDLEHOLDER WITH THE NEEDLE
POINT TOWARD THE THUMB TO
PREVENT UNNECESSARY WRIST
MOTION 4HE SCRUB PERSON
CONTROLS THE FREE END OF THE
SUTURE TO PREVENT DRAGGING IT
ACROSS THE STERILE FIELD AND TO
KEEP THE SUTURE FROM ENTERING
THE SURGEONS HAND ALONG
WITH THE NEEDLEHOLDER
4HE SURGEON BEGINS CLOSURE
WITH THESWAGED SUTURE
0,!#%-%.4
/& 4(%
.%%$,% ).
4)335%
0,!#).' 4(% .%%$,%
). 4)335%
4HE ACTUAL PLACEMENT OF THE
NEEDLE IN THE PATIENTgS TISSUE CAN
CAUSE UNNECESSARY TRAUMA IF DONE
INCORRECTLY +EEP THE FOLLOWING IN
MIND DURING SUTURING
4HE NEEDLE IS PASSED INTO THE TISSUE 4HE SURGEON RELEASES THE
!PPLY FORCE IN THE TISSUE TO BE
NEEDLE FROM THE HOLDER AND RECLAMPS THE HOLDER ONTO THE BODY OF THE
NEEDLE NEAR THE POINT END TO PULL THE NEEDLE AND STRAND THROUGH
SUTURED IN THE SAME DIRECTION AS
TISSUE 4HE NEEDLE IS RELEASED OR CUT FROM THE SUTURE STRAND 4HE
THE CURVE OF THE NEEDLE
SURGEON LEAVES THE NEEDLE CLAMPED IN THE SAME POSITION AND RETURNS
IT TO THE SCRUB PERSON 4HE SCRUB PERSON IMMEDIATELY PASSES ANOTHER
$O NOT TAKE EXCESSIVELY LARGE BITES
PREPARED SUTURE TO THE SURGEON ONE
FOR
ONE
OF TISSUE WITH A SMALL NEEDLE
FIBROUS THAN ANTICIPATED AND
SEROLOGICAL TESTING OF THE PATIENT
$O NOT FORCE A DULL NEEDLE
REQUIRE THE USE OF A HEAVIER GAUGE
SHOULD BE UNDERTAKEN FOR
THROUGH TISSUE 4AKE A NEW
NEEDLE #ONVERSELY A SMALLER
TRANSMISSABLE AGENTS SUCH AS
NEEDLE
NEEDLE MAY BE REQUIRED WHEN
HEPATITIS " AND # AND ()6
$O NOT FORCE OR TWIST THE NEEDLE
TISSUE IS MORE FRIABLE THAN USUAL
IN AN EFFORT TO BRING THE POINT
)N A DEEP CONFINED AREA IDEAL
.%%$,%
OUT THROUGH THE TISSUE 7ITHDRAW
POSITIONING OF THE NEEDLE MAY
THE NEEDLE COMPLETELY AND THEN
(!.$,).' 4)03
NOT BE POSSIBLE 5NDER THESE
REPLACE IT IN THE TISSUE OR USE A
.EEDLES SHOULD BE PROTECTED FROM
CIRCUMSTANCES PROCEED WITH
LARGER NEEDLE
BACTERIAL CONTAMINATION AND DAMAGE
CAUTION ! HEAVIER GAUGE NEEDLE
!VOID USING THE NEEDLE TO BRIDGE
OR A DIFFERENT CURVATURE MAY HELP DURING HANDLING BY ADHERING TO THE
OR APPROXIMATE TISSUES FOR
FOLLOWING GUIDELINES
AND A SECOND NEEDLEHOLDER
SUTURING
SHOULD BE USED TO LOCATE A NEEDLE /PEN NEEDLE PACKETS AND PREPARE
$O NOT DAMAGE TAPER POINTS OR
IN A CONFINED BODY CAVITY
SUTURES CAREFULLY PROTECTING
CUTTING EDGES WHEN USING THE
NEEDLE SHARPNESS
)F A GLOVE IS PUNCTURED BY A
NEEDLEHOLDER TO PULL THE NEEDLE
NEEDLE THE NEEDLE MUST BE
-AKE SURE THE NEEDLE IS FREE
THROUGH TISSUE 'RASP AS FAR BACK
DISCARDED IMMEDIATELY AND THE
OF CORROSION
ON THE BODY AS POSSIBLE
GLOVE MUST BE CHANGED FOR THE
)F USING EYED NEEDLES MAKE SURE
$EPENDING UPON THE PATIENT THE
SAFETY OF THE PATIENT AS WELL AS
THEY DO NOT HAVE ROUGH OR SHARP
TISSUE MAY BE TOUGHER OR MORE
THE SURGICAL TEAM !PPROPRIATE
4RADEMARK
4(% 352')#!, .%%$,%
EDGES INSIDE THE EYE TO FRAY OR
BREAK SUTURE STRANDS !LSO CHECK
THE EYES FOR BURRS OR BLUNTNESS TO
ENSURE EASY PENETRATION AND
PASSAGE THROUGH TISSUE
)F A NEEDLE IS DEFECTIVE DISCARD IT
0ASS NEEDLES ON AN EXCHANGE
BASIS ONE IS PASSED TO THE
SURGEON FOR ONE RETURNED
%MPLOY THE NONTRANSFER
TECHNIQUE TO AVOID INADVERTENT
NEEDLESTICKS THE SURGEON PLACES
THE NEEDLE AND NEEDLEHOLDER
DOWN IN A NEUTRAL AREA OF THE
STERILE FIELD THE SCRUB PERSON
THEN PICKS UP THE NEEDLEHOLDER
3ECURE EACH NEEDLE AS SOON AS IT IS
USED $O NOT ALLOW NEEDLES TO LIE
LOOSE ON THE STERILE FIELD OR -AYO
STAND +EEP THEM AWAY FROM
SPONGES AND TAPES SO THEY WILL
NOT INADVERTENTLY BE DRAGGED INTO
THE WOUND
)F A NEEDLE BREAKS ALL PIECES MUST
BE ACCOUNTED FOR
#OUNT ALL NEEDLES BEFORE AND AFTER
USE ACCORDING TO HOSPITAL
PROCEDURE 2ETAIN THE PACKETS
CONTAINING DESCRIPTIVE INFORMA
TION ON QUANTITY AND NEEDLE TYPE
FOR SWAGED NEEDLES TO HELP
DETERMINE IF ALL ARE ACCOUNTED FOR
&OLLOW THESE STEPS FOR SAFE NEEDLE
HANDLING
5SE STERILE ADHESIVE PADS WITH OR
WITHOUT MAGNETS OR DISPOSABLE
MAGNETIC PADS TO FACILITATE
COUNTING AND SAFE DISPOSAL
3WAGED NEEDLES CAN BE INSERTED
THROUGH OR INTO THEIR ORIGINAL
PACKET AFTER USE !N EMPTY
PACKET INDICATES A MISSING NEEDLE
)F USING AN %
0!#+
PROCEDURE
KIT COMPARE THE COUNT OF NEEDLES
USED TO THE NUMBER PREPRINTED
ON THE KIT LABEL
2ETURN EYED NEEDLES TO THE NEEDLE
RACK )F EYED NEEDLES ARE TO BE
REUSED THEY MUST BE CLEANED AND
REPROCESSED AT THE END OF THE
OPERATION
$O NOT COLLECT USED NEEDLES IN A
MEDICINE CUP OR OTHER CONTAINER
SINCE THEY MUST THEN BE HANDLED
INDIVIDUALLY TO COUNT THEM 4HIS
CAN POTENTIALLY CONTAMINATE
GLOVES AND INCREASE THE RISK OF AN
ACCIDENTAL PUNCTURE
$ISCARD USED NEEDLES IN A
SHARPS CONTAINER
). 4(%
.%84 3%#4)/.
)N THE SECTION THAT FOLLOWS THE
DUAL ROLE THAT SUTURE AND NEEDLE
PACKAGING PLAYS WILL BE COVERED
0ACKAGING DOES MUCH MORE THAN
KEEP THE NEEDLE AND SUTURE STERILE
0ACKAGE DESIGN CAN HELP OR
SERIOUSLY HINDER THE EFFICIENCY OF
THE SURGICAL PROCEDURE
CHAPTER 4
PACKAGING
0!#+!').'
!. ).4%'2!, 0!24
/& 4(% 02/$5#4
4HE PURPOSE OF A PACKAGE IS TO
PROTECT ITS CONTENTS AND PROVIDE
CONVENIENCE TO THE USER
%4()#/.
WOUND CLOSURE
PACKAGING IS AN INTEGRAL PART OF
EACH PRODUCT /VER THE PAST HALF A
CENTURY PACKAGING HAS EVOLVED
FROM GLASS TUBES PACKED IN JARS
TO MULTI
LAYERED FOIL AND PAPER
PACKAGES TO NEW MATERIALS THAT
REFLECT CONCERN FOR BOTH THE
ENVIRONMENT AND THE INDIVIDUALS
WHO MUST MAINTAIN OPERATIVE
STERILITY AND EFFICIENCY 0ACKAGING
HAS KEPT PACE WITH THE TECHNOLOGICAL
DEVELOPMENTS OF WOUND CLOSURE
PRODUCTS THEMSELVES 3EVERAL FACTORS
HAVE INFLUENCED THESE DEVELOPMENTS
)NCREASING PRODUCT DIVERSITY
4ECHNOLOGICAL ADVANCES IN
PACKAGING MATERIALS
3TRINGENT REGULATORY REQUIREMENTS
4O PREVENT INFECTION IN AN OPERATIVE
WOUND ALL INSTRUMENTS AND SUPPLIES
THAT COME IN CONTACT WITH THE
WOUND MUST BE STERILE FREE OF
LIVING MICROORGANISMS AND SPORES
INCLUDING SUTURES NEEDLES LIGATING
CLIPS STAPLING INSTRUMENTS ADHESIVE
TAPES AND TOPICAL SKIN ADHESIVES
(IGH STANDARDS AND CRITERIA ARE SET
FOR ALL COMPONENTS IN THE PACKAGING
OF STERILE PRODUCTS
0ROTECT AND PRESERVE PRODUCT
STABILITY AND STERILITY FROM
POTENTIAL DETERIORATION FROM
OUTSIDE FORCES SUCH AS OXYGEN
MOISTURE LIGHT TEMPERATURE
DUST AND VERMIN
0REVENT PRODUCT DAMAGE OR
MICROBIAL CONTAMINATION IN
TRANSIT AND STORAGE
0ROVIDE IDENTIFIABLE PRODUCT
INFORMATION
0ERMIT CONVENIENT SAFE AND
STERILE TRANSFER OF THE PRODUCT
FROM THE PACKAGE TO THE
STERILE FIELD
-EET THE FUNCTIONAL NEEDS OF ALL
MEMBERS OF THE SURGICAL TEAM
2%,!9
35452%
$%,)6%29 3934%-OST SUTURE MATERIALS ARE PACKAGED
AND STERILIZED BY THE MANUFACTURER
4HEY ARRIVE READY FOR USE IN BOXES
WHICH CAN BE STORED UNTIL NEEDED
4HE 2%,!9
SUTURE DELIVERY SYSTEM
DEVELOPED BY %4()#/. WITH
HUMAN CLINICAL AND ENVIRONMENTAL
FACTORS IN MIND STORES AND DELIVERS
SUTURES IN A TIME
EFFICIENT MANNER
AND REDUCES UNNECESSARY HANDLING
TO ACCESS SUTURES 4HE SYSTEM
ALSO PROVIDES CONTROL OVER SUTURE
STORAGE USAGE INVENTORY ROTATION
NEEDLE COUNTING AND COST CONTAIN
MENT 4HE 2%,!9 SUTURE SYSTEM
CONSISTS OF THREE BASIC INTERRELATED
COMPONENTS MODULAR SUTURE
STORAGE RACKS DISPENSER BOXES
AND PRIMARY PACKETS
-/$5,!2 34/2!'% 2!#+3
4HE MODULAR STORAGE RACKS ARE
DESIGNED FOR MAXIMUM CONVENIENCE
AND VERSATILITY TO MEET THE INDIVID
UAL NEEDS OF A PARTICULAR SPECIALTY
NURSE SURGEON OR DEPARTMENT
-ODULES CAN BE EASILY ASSEMBLED
TO ACCOMMODATE BOTH VERTICAL AND
HORIZONTAL SUTURE DISPENSER BOXES
!NY NUMBER OF MODULES CAN BE
FASTENED TOGETHER TO MEET BOTH
SMALL AND LARGE STORAGE NEEDS
/NCE ASSEMBLED THE RACKS MAY BE
USED ON SHELVES MOUNTED ON WALLS
PLACED ON MOBILE CARTS OR
CONNECTED TO )6 POLES 2ACKS CAN
ALSO BE FITTED WITH A ROTATING BASE
FOR MORE CONVENIENT ACCESS AS WELL
AS WITH A HANDLE FOR EASY CARRYING
%ACH MODULE HAS A BUILT
IN
&)'52%
%4()#/.
-/$5,!2
34/2!'%
2!#+3
&ULL
VERTICAL BOXES
(ALF VERTICAL BOXES
(ORIZONTAL BOXES
#OMBINATION OF BOXES
#(!04%2
INVENTORY CONTROL AREA TO FACILITATE
RESTOCKING 4HIS FEATURE ENABLES
UNUSED SUTURE PACKETS TO BE
SYSTEMATICALLY FED BACK INTO THE
PROPER ROTATIONAL FLOW WITHOUT
MIXING LOTS WITHIN THE BOXES
3UTURES MAY BE GROUPED WITHIN
THE MODULAR SYSTEM BY MATERIAL
TYPE OR SIZE OR BY USE IE GENERAL
CLOSURE GASTROINTESTINAL SURGERY
PLASTIC SURGERY ETC
$)30%.3%2 "/8%3
'RAVITY
FED DISPENSER BOXES DISPENSE
SUTURE PACKETS FROM THE OPENING AT
THE BOTTOM OF THE BOX 4HE OPENING
CAN ACCOMMODATE THE REMOVAL OF
SEVERAL SUTURE PACKETS AT ONE TIME
!LL %4()#/.
DISPENSER BOXES
ARE MADE OF RECYCLABLE PAPER
AND PRINTED WITH EITHER WATER OR
SOY
BASED INKS %ACH BOX PROVIDES
CLEAR PRODUCT IDENTIFICATION THROUGH
STREAMLINED GRAPHICS PRODUCT
COLOR CODING BOLD LABEL COPY
AND DESCRIPTIVE SYMBOLS 4HE
INFORMATION REQUIRED FOR QUICK
REFERENCE AND EASY SELECTION OF
SUTURE MATERIALS IS HIGHLIGHTED IN A
LOGICAL SEQUENCE 4HE THREE MOST
IMPORTANT CRITERIA NECESSARY FOR
PROPER IDENTIFICATION AND SUTURE
SELECTION ARE
3UTURE SIZE
3UTURE MATERIAL
4YPE AND SIZE OF NEEDLE
/THER IMPORTANT PRODUCT
INFORMATION FOUND ON ALL SUTURE
BOXES INCLUDES
3URGICAL APPLICATION
0RODUCT CODE NUMBER
3UTURE LENGTH AND COLOR
-ETRIC DIAMETER EQUIVALENT OF
SUTURE SIZE AND LENGTH
3HAPE AND QUANTITY OF NEEDLES
SINGLE
OR DOUBLE
ARMED SHOWN
BY SILHOUETTE
.EEDLE POINT GEOMETRY
,OT NUMBER
%XPIRATION DATE
! PACKAGE INSERT WITH DETAILED INFOR
MATION ABOUT THE SUTURE MATERIAL IS
INSERTED IN EVERY DISPENSER BOX 5SERS
SHOULD BE FAMILIAR WITH THIS INFORMA
TION AS IT CONTAINS &$!
APPROVED
INDICATIONS CONTRAINDICATIONS AND
ALL APPROPRIATE WARNINGS AND PRECAU
TIONARY STATEMENTS FOR EACH PRODUCT
$ISPENSER BOXES SHOULD BE RESTOCKED
WHEN THE LAST FEW SUTURE PACKETS
APPEAR IN THE BOX OPENING BEFORE
THE BOX IS COMPLETELY EMPTY 4HE
UNUSED PACKETS FROM THE PREVIOUS
BOX SHOULD BE USED BEFORE A NEW
DISPENSER BOX IS OPENED 4HIS WILL
HELP TO AVOID MIXING LOT NUMBERS
AND ENSURE PROPER STOCK ROTATION
%4()#/. ADVOCATES ROTATION
OF THE ENTIRE DISPENSER BOX )N
ADDITION TO ENSURING THE USE OF THE
OLDEST SUTURE MATERIALS FIRST THIS
HELPS TO MAINTAIN A FRESH STOCK OF
DISPENSER BOXES
-OST DISPENSER BOXES CONTAIN
THREE DOZEN SUTURE PACKETS /THERS
MAY CONTAIN ONE OR TWO
DOZEN
PACKETS 4HE PRODUCT CODE NUMBER
SUFFIX AND A STATEMENT ON THE BOX
INDICATE THE QUANTITY OF SUTURE
PACKETS IN THE BOX PRODUCT CODE
SUFFIX ' DOZEN $ DOZEN
4 DOZEN ( DOZEN 4HE
DISPENSER BOXES ARE HELD SECURELY FOR
EASY DISPENSING BY FIRMLY PUSHING
THE BOX INTO A LOCK IN THE BACK OF
THE RACK MODULE
02)-!29 0!#+%43
)NDIVIDUAL SUTURES AND MULTIPLE
SUTURE STRANDS ARE SUPPLIED STERILE
WITHIN A PRIMARY PACKET 4HE
EXTERIOR SURFACES OF THE OVERWRAP ARE
NOT STERILE %4()#/. PRIMARY
PACKAGING IS DESIGNED TO PERMIT FAST
AND EASY OPENING IN ONE PEELABLE
MOTION 4HE SINGLE LAYER OVERWRAP
OF PRIMARY PACKAGING IS MADE OF
EITHER FOIL OR COATED 4YVEK ON ONE
SIDE HEAT
SEALED TO POLYETHYLENE FILM
ON THE OTHER !BSORBABLE SUTURES ARE
ALWAYS ENCASED IN FOIL TO PROVIDE A
SAFE AND DURABLE MOISTURE BARRIER
AND TO WITHSTAND STERILIZATION IN
THE MANUFACTURING PROCESS -OST
NONABSORBABLE SUTURES ARE ENCASED
IN COATED 4YVEK OVERWRAPS
)N A CONTINUOUS EFFORT TO BE MORE
ENVIRONMENTALLY CONSCIOUS
%4()#/. HAS CHOSEN MATERIALS
IN THE MANUFACTURE OF PRIMARY
PACKETS WHICH GENERATE MINIMAL
NEGATIVE IMPACT TO THE ENVIRONMENT
UPON INCINERATION OR DISPOSAL
&URTHERMORE WHEREVER POSSIBLE
THE NUMBER OF PRIMARY PACKAGING
LAYERS HAS BEEN REDUCED BY AS
MUCH AS PERCENT THUS REDUCING
THE VOLUME OF ENVIRONMENTAL WASTE
PER /2 PROCEDURE
%ACH PRIMARY PACKET PROVIDES
CRITICAL PRODUCT INFORMATION AND
THE SAME COLOR
CODING AS ITS
DISPENSER BOX 4HE PACKET ALSO
IDENTIFIES THE PRODUCT CODE NUMBER
MATERIAL SIZE NEEDLE TYPE AND THE
NUMBER OF NEEDLES PER PACKET TO
SIMPLIFY NEEDLE COUNTS
0RIMARY PACKETS OF SUTURE MATERIAL
MAY CONTAIN SUTURES IN ONE OF
FIVE STYLES
3TANDARD LENGTHS OF NON
NEEDLED
MATERIAL INCHES CM OF
ABSORBABLE OR INCHES CM
OF NONABSORBABLE SUTURE WHICH
MAY BE CUT IN HALF THIRD OR
QUARTER LENGTHS FOR LIGATING
OR THREADING
35450!+
PRE
CUT STERILE SUTURE
4RADEMARK
0!#+!').'
!"3/2"!",% 35452%
,!9%23
4!",%
3URGICAL 'UT 3UTURE
4YVEK OVERWRAP FOIL PRIMARY
PACKAGE CONTAINING ONE STEP
2%,!9
SUTURE DELIVERY SYSTEM TRAY
#OATED 6)#29,
2!0)$%
POLYGLACTIN SUTURE
4YVEK OVERWRAP FOIL PRIMARY PACKAGE
PAPER FOLDER
-/./#29,
POLIGLECAPRONE SUTURE
0EELABLE FOIL OVERWRAP ONE STEP
2%,!9 TRAY
#OATED 6)#29,
0LUS
POLYGLACTIN SUTURE
0EELABLE FOIL OVERWRAP ONE STEP
2%,!9 TRAY
#OATED 6)#29,
POLYGLACTIN SUTURE
0EELABLE FOIL OVERWRAP ONE STEP
2%,!9 TRAY
0$3
))
POLYDIOXANONE SUTURE
0EELABLE FOIL OVERWRAP ONE STEP
2%,!9 TRAY
./.!"3/2"!",% 35452%
-/34
#/--/.
%4()#/.
35452%
0!#+!').'
,!9%23
0%2-!
(!.$
3ILK 3UTURE
4YVEK OVERWRAP ONE STEP 2%,!9 TRAY
3TAINLESS 3TEEL 3UTURE
4YVEK OVERWRAP PAPER FOLDER
%4(),/.
NYLON SUTURE
0EELABLE FOIL OVERWRAP ONE STEP
2%,!9 TRAY
.52/,/.
NYLON SUTURE
4YVEK OVERWRAP ONE STEP 2%,!9 TRAY
-%23),%.%
POLYESTER FIBER SUTURE
4YVEK OVERWRAP ONE STEP 2%,!9 TRAY
%4()"/.$
%8#%,
POLYESTER FIBER SUTURE
4YVEK OVERWRAP ONE STEP 2%,!9 TRAY
02/,%.%
POLYPROPYLENE SUTURE
4YVEK OVERWRAP ONE STEP 2%,!9 TRAY
02/./6!
POLY HEXAFLUOROPROPYLENE
6$& SUTURE
4YVEK OVERWRAP ONE STEP 2%,!9 TRAY
4YVEK IS A REGISTERED TRADEMARK OF %) DU 0ONT DE .EMOURS AND #OMPANY
&)'52%
-%4(/$ &/2
02%0!2).'
/.%
34%0
2%,!9
0!#+!'%
35452%3
!RM THE NEEDLE DIRECTLY FROM THE ONE
STEP 2%,!9 TRAY AND
DELIVER THE SINGLE SUTURE TO THE SURGEON
IS NONNEEDLED MATERIAL FOR
LIGATING OR THREADING 4HESE
LENGTHS MAY BE SUPPLIED IN A
MULTISTRAND LABYRINTH PACKET OR
IN A FOLDER PACKET BOTH OF WHICH
ARE DESIGNED TO DELIVER ONE STRAND
AT A TIME 35450!+ SUTURES
MAY BE REMOVED FROM THE PACKET
AND PLACED IN THE SUTURE BOOK
/NE SINGLE STRAND OF MATERIAL
WITH SINGLE
OR DOUBLE
ARMED
SWAGED NEEDLES .EEDLES FOR
ONE
STEP 2%,!9 SUTURE PACKETS
MICRO
SURGERY AND SOME
OPHTHALMIC NEEDLES ARE SECURED IN
A NEEDLE PARK 4HE NEEDLE PARK
IS DESIGNED TO PROVIDE A STANDARD
LOCATION FOR AND EASY ACCESS TO
THE NEEDLE !LL OTHER NEEDLES ARE
PROTECTED WITHIN AN INNER
FOLDER OR OTHER SPECIFIC CHANNEL
WITHIN A PAPER FOLDER
-OST SINGLE STRAND NEEDLED
SUTURES ARE SEALED IN CONVENIENT
ONE
STEP 2%,!9 DELIVERY
PACKAGES /NE
STEP 2%,!9 PACK
AGES ALLOW THE NEEDLE TO BE ARMED
IN THE NEEDLEHOLDER FROM ANY
ANGLE WITHOUT TOUCHING THE
NEEDLE 4HIS INCREASES THE SAFETY
OF HANDLING NEEDLES INTRAOPERA
TIVELY )F IT IS PREFERRED TO LOCATE
THE NEEDLE BY HAND THIS CAN BE
ACCOMPLISHED WITH THE ONE
STEP
2%,!9 PACKAGE BY PUSHING UP
THE FLAP BEHIND THE NEEDLE PARK
THEREBY ELEVATING THE NEEDLE SO IT
CAN BE GRASPED BY HAND
-ULTIPLE SUTURE STRANDS EITHER
SWAGED TO A SINGLE NEEDLE OR
DOUBLE
ARMED 4HIS TYPE IS
APPROPRIATE FOR PROCEDURES
REQUIRING NUMEROUS INTERRUPTED
SUTURES OF THE SAME TYPE )T SAVES
VALUABLE OPERATIVE TIME BY
ENABLING THE SURGEON TO USE ONE
#(!04%2
SUTURE WHILE THE NEXT IS BEING
ARMEDWITHOUT DELAY OF OPEN
ING PACKETS OR THREADING NEEDLES
-ULTISTRAND PACKETS ARE LABELED
WITH THE SYMBOL -3 THAT
DENOTES MULTIPLE STRANDSNUMBER
OF STRANDS OF SURGICAL NEEDLES PER
PACKET -ULTISTRAND PACKETS MAY
CONTAIN TO SWAGED SUTURES
4HE INNER FOLDER FOR THESE
PRODUCTS IS WHITE
!LL PACKETS CONTAINING
#/.42/, 2%,%!3%
NEEDLE
SUTURES HAVE MULTIPLE STRANDS
OR AND ARE
DESIGNATED #2 #2 #2
#2 OR #2 #/.42/,
2%,%!3% SUTURES MAY BE
AVAILABLE IN FOIL OR 4YVEK
OVERWRAP PACKETS FOR SINGLE
STRAND DELIVERY 4HE SINGLE STRAND
DELIVERY FOLDER IS USED FOR SOME
COATED 6)#29,
POLYGLACTIN
SUTURES -/./#29,
POLIGLECAPRONE SUTURES
0$3
)) POLYDIOXANONE SUTURES
%4()"/.$
%8#%, POLYESTER
SUTURES .52/,/.
NYLON
SUTURES -%23),%.%
POLYESTER
SUTURES AND 0%2-!
(!.$
SILK SUTURES 4HE SUTURE MATERIAL
STRAIGHTENS AS IT IS DELIVERED FROM
THE FOLDER %ACH SUTURE MAY BE
DELIVERED TO THE SURGEON INDIVID
UALLY FROM THE OPENING PACKET OR
REMOVED FROM THE FOLDER AND
PLACED IN THE SUTURE BOOK 4HE
INNER FOLDER FOR THESE PRODUCTS IS
EITHER RED WITH A BLACK #2
SYMBOL OR WHITE WITH RED
LETTERING 4HE SAFETY ORGANIZER
TRAY IS USED FOR COATED 6)#29,
SUTURES -/./#29, SUTURES
0$3 )) SUTURES %4()"/.$
%8#%, SUTURES 0%2-!
(!.$
SILK SUTURES .52/,/. NYLON
SUTURES -%23),%.% SUTURES
AND SURGICAL GUT SUTURES 4HE
SAFETY ORGANIZER TRAY ALLOWS FOR
SINGLE STRAND ARMING AND
DISPENSING 4HE NEEDLES ARE
SITUATED IN INDIVIDUALLY NUM
BERED NEEDLE PARKS AND MAY BE
ARMED AND DISPENSED WITH LITTLE
OR NO HAND
TO
NEEDLE CONTACT
,IGATING MATERIAL USED AS EITHER
SINGLE STRAND FREE OR FREEHAND
TIES OR AS CONTINUOUS TIES
UNWOUND FROM A REEL OR OTHER
DEVICE 4HE LENGTH OF SINGLE
STRAND TIES IS DETERMINED BY THE
DEPTH OF THE WOUND )N SUBCUTA
NEOUS TISSUE QUARTER LENGTHS
APPROXIMATELY INCHES ARE
USUALLY LONG ENOUGH FOR LIGATING
3INGLE STRAND LIGATING MATERIAL IS
AVAILABLE IN PRE
CUT LENGTHS OR
AND INCH STRANDS
ABDOMINAL INCISION TO
INCHES LONG MIGHT REQUIRE
ONE TO THREE PACKETS TO
LIGATE THE SUBCUTANEOUS
BLOOD VESSELS
!LL SUTURE MATERIAL IS PACKAGED
DRY WITH THE EXCEPTION OF SURGICAL
GUT AND PLIABILIZED %4(),/.
SUTURES .ATURAL ABSORBABLE SUTURE
MATERIALS ARE PACKAGED WITH A
SMALL AMOUNT OF STERILE FLUID
USUALLY ALCOHOL WITH WATER TO
MAINTAIN PLIABILITY 4HEY SHOULD
THEREFORE BE OPENED OVER A BASIN TO
PREVENT ANY SOLUTION FROM SPILLING
ONTO THE STERILE FIELD
!LL NEEDLES SHOULD BE COUNTED
AFTER PACKETS OF SWAGED SUTURES
ARE OPENED ACCORDING TO
ESTABLISHED HOSPITAL PROCEDURE
4HE PACKETS SHOULD BE RETAINED
TO FACILITATE VERIFICATION OF THE
-ANY SURGEONS PREFER CONTINUOUS FINAL NEEDLE COUNT AFTER THE
TIES 3OME PREFER ,)'!0!+
SURGICAL PROCEDURE
LIGATURE WHICH IS SUPPLIED ON
DISC LIKE PLASTIC RADIOPAQUE
DISPENSING REELS THAT ARE COLOR
%
0!#+
CODED BY MATERIAL 4HE SIZE OF
THE LIGATURE MATERIAL IS INDICATED 02/#%$52% +)4
BY THE NUMBER OF HOLES VISIBLE ON 4HE %
0!#+ PROCEDURE KIT
THE SIDE OF THE REEL EG HOLES CONTAINS NUMEROUS SUTURES AND
SUTURE 4HE REEL IS HELD IN
OTHER PRODUCTS FOR A SPECIFIC
THE PALM OF THE HAND AS BLOOD
PROCEDURE SURGEON OR SURGICAL
VESSELS ARE LIGATED /THER
SPECIALTY 4HE PACKAGING CONCEPT
SURGEONS MAY PREFER THE LIGATING
SAVES VALUABLE TIME IN THE /2 BY
MATERIAL REWOUND ONTO A RUBBER
ELIMINATING THE NEED TO OPEN AND
REEL GAUZE SPONGE METAL BOBBIN COORDINATE MULTIPLE INDIVIDUAL
OR OTHER DEVICE
SUTURE PACKAGES 4HE %
0!#+
PROCEDURE KIT IS ALSO AN EFFECTIVE
4HE NUMBER OF PACKETS OF
MEANS OF REDUCING INVENTORY
LIGATING MATERIAL REQUIRED TO TIE
LEVELS OF INDIVIDUAL PRODUCT
OFF SUBCUTANEOUS VESSELS
CODES AND PROVIDING A RECORD
BLEEDERS WILL VARY WITH PATIENT
FOR DETERMINING THE SUTURE
SIZE AND AGE THE AMOUNT OF
COSTS ASSOCIATED WITH A GIVEN
BLEEDING THE TYPE OF OPERATION
SURGICAL PROCEDURE
THE LENGTH OF THE INCISION AND
4HE SUTURE PACKAGES ARE SECURED
THE SURGICAL TECHNIQUE !N
4RADEMARK
0!#+!').'
IN AN ORGANIZER SLEEVE TO FACILITATE
STERILE TRANSFER TO THE STERILE FIELD
4HE PROCEDURE KIT LABEL PROVIDES ALL
THE PERTINENT INFORMATION REGARDING
THE NUMBER AND TYPES OF NEEDLES AS
WELL AS SIZES AND TYPES OF SUTURE
3UTURE QUANTITIES ARE LISTED ON THE
LABEL MAKING IT EASY TO QUICKLY
DETERMINE HOW MANY NEEDLES HAVE
BEEN USED AND THUS SIMPLIFYING
NEEDLE ACCOUNTABILITY AT THE END OF
THE PROCEDURE 4HE ORGANIZER SLEEVE
IS DELIVERED IN A 4YVEK POUCH
%80)2!4)/. $!4%
4HE EXPIRATION DATE OF A PRODUCT IS
DETERMINED BY PRODUCT STABILITY
STUDIES 4HE &OOD AND $RUG
!DMINISTRATION &$! REQUIRES
THAT ALL SYNTHETIC ABSORBABLE SUTURE
PRODUCTS HAVE AN EXPIRATION DATE
STAMPED ON EACH DISPENSER BOX
AND PRIMARY PACKET TO INDICATE
THE KNOWN SHELF LIFE OF THE MATERIAL
PROVIDED THE PHYSICAL INTEGRITY
OF THE PACKAGE IS MAINTAINED
4ESTS CONDUCTED BY %4()#/.
SHOW CONCLUSIVELY THAT SYNTHETIC
ABSORBABLE SUTURE PRODUCTS SUCH
AS #OATED 6)#29,
SUTURE AND
0$3
)) SUTURE CONTINUE TO MEET
ALL PRODUCT REQUIREMENTS EVEN AT
FIVE YEARS OF STORAGE
)N ADDITION ALL %4()#/.
NONABSORBABLE SUTURE PRODUCTS
CONTAIN A FIVE
YEAR EXPIRY DATING
ON EACH DISPENSER BOX AND
PRIMARY PACKET 4HIS EXPIRY
DATING IS NECESSARY TO COMPLY
WITH VARIOUS INTERNATIONAL
REGULATORY GUIDELINES AND IS AN AID
IN INVENTORY MANAGEMENT
4HE 2%,!9 SUTURE DELIVERY SYSTEM
IS DESIGNED AS A FIRST
IN FIRST
OUT
INVENTORY CONTROL SYSTEM $ISPENSER
BOXES ARE ROTATED PERMITTING THE
OLDEST SUTURES TO BE USED FIRST 4HE
EXPIRATION DATE STAMPED ON THE
OUTSIDE OF EACH BOX AND EVERY
PACKET CLEARLY INDICATES THE MONTH
AND YEAR OF PRODUCT EXPIRATION
35452%
34%2)) ):!4)/.
3UTURES STERILIZED BY %4()#/. ARE
EITHER IRRADIATED WITH COBALT OR
EXPOSED TO ETHYLENE OXIDE GAS "OTH
PROCESSES ALTER PROTEINS ENZYMES
AND OTHER CELLULAR COMPONENTS TO
THE EXTENT THAT MICROORGANISMS ARE
UNABLE TO SURVIVE OR CAUSE INFECTION
)RRADIATION AND ETHYLENE OXIDE GAS
ARE CONSIDERED COLD STERILIZATION
PROCESSES BECAUSE RADIATION STERILIZES
AT ROOM TEMPERATURE AND ETHYLENE
OXIDE GAS STERILIZES AT MUCH LOWER
TEMPERATURES THAN OTHER STERILIZATION
METHODS SUCH AS DRY HEAT OR STEAM
UNDER PRESSURE
)RRADIATION STERILIZATION EXPOSES
PRODUCTS TO IONIZING RADIATION
EITHER BETA RAYS PRODUCED BY HIGH
ENERGY ELECTRON ACCELERATORS OR
GAMMA RAYS FROM RADIOISOTOPES
UNTIL ABSORBED IN APPROPRIATE
STERILIZING DOSE %4()#/. WAS
A PIONEER IN BOTH BETA AND
GAMMA IRRADIATION AND ROUTINELY
STERILIZES PRODUCTS WITH COBALT
WHICH EMITS GAMMA RAYS
#OBALT IRRADIATION IS THE SIMPLEST
OF ALL STERILIZATION PROCESSES
3OME SUTURE MATERIALS CANNOT
WITHSTAND THE EFFECTS OF IRRADIATION
STERILIZATION BECOMING UNUSABLE
)NSTEAD THEY ARE GAS STERILIZED
'AS STERILIZATION USES
ETHYLENE OXIDE GAS !S AN ENVIRON
MENTAL MEASURE %4()#/.
REPLACED CHLOROFLUOROCARBONS
#&#S WITH MORE ENVIRONMENTALLY
FRIENDLY COMPOUNDS IN ALL GAS
STERILIZATION PROCESSES 4HE
COMBINATION OF ETHYLENE OXIDE
GAS CONCENTRATION TEMPERATURE
HUMIDITY AND EXPOSURE TIME MUST
BE CAREFULLY CONTROLLED TO ENSURE
RELIABLE STERILIZATION
7!2.).' 3URGICAL SUTURES ARE
LABELED AS DISPOSABLE SINGLE
USE
MEDICAL DEVICES 3UTURE PRODUCTS
MANUFACTURED BY %4()#/. ARE
PROVIDED IN EASY
TO
USE PACKAGES
DESIGNED TO MAINTAIN THE STABILITY
AND STERILITY OF THE SUTURE AND
NEEDLE MATERIALS 4HE COMPONENT
LAYERS OF PACKAGING MATERIALS DO
NOT PERMIT EXPOSURE TO HIGH
TEMPERATURES OR EXTREMES OF PRES
SURE WITHOUT AFFECTING PACKAGE AND
PRODUCT INTEGRITY &OR THIS REASON
ALL STERILE PRODUCTS MANUFACTURED
BY %4()#/. ARE CLEARLY LABELED
$/ ./4 2%34%2),):%
-ANUFACTURERS CANNOT BE HELD
RESPONSIBLE FOR THE QUALITY
EFFECTIVENESS OR INTEGRITY OF
SUTURE MATERIALS RESTERILIZED IN
THE HOSPITAL OFFICE OR BY OUTSIDE
VENDORS 4HEREFORE IF CUSTOMERS
UTILIZE THE SERVICES OF A STERILIZATION
REPROCESSOR FOR SUTURE %4()#/.
WILL DISCLAIM ANY RESPONSIBILITY FOR
STERILIZATION ANDOR OTHER PRODUCT
FAILURES RESULTING FROM THE RESTERIL
IZATION PROCESS 4HE PRACTICE OF
RESTERILIZATION IS NOT RECOMMENDED
EXCEPT FOR %4()
0!#+
PRE
CUT
STEEL SUTURES AND SPOOLS OR CARDREELS
OF NONABSORBABLE MATERIALS
SUPPLIED NONSTERILE
#(!04%2
!.4)#)0!4).'
35452% .%%$3
4ODAYgS HEALTHCARE ENVIRONMENT
DICTATES THAT HOSPITALS CONTINUE TO
MAINTAIN QUALITY STANDARDS WHILE
LOWERING COSTS TO REMAIN FINANCIALLY
VIABLE 4HROUGH TOTAL QUALITY MAN
AGEMENT INITIATIVES MANY HOSPITALS
HAVE IDENTIFIED MATERIAL USE AS AN
OPPORTUNITY TO LOWER COST 4O
INCREASE THE EFFICIENCY OF SUTURE
UTILIZATION DURING A SURGICAL
PROCEDURE IT IS IMPORTANT TO
DETERMINE AND ANTICIPATE THE
SURGEONgS NEEDS MORE PRECISELY
&OR THIS REASON A FILE SYSTEM OF
PREFERENCE CARDS FOR EACH SURGEON
ON STAFF IS USUALLY MAINTAINED IN THE
OPERATING SUITE 4HE CARDS CONTAIN
SUCH INFORMATION AS THE SURGEONgS
SUTURE ROUTINE SUTURE MATERIALS
SIZES NEEDLES ANDOR PRODUCT
CODE NUMBERS CUSTOMARILY USED IN
SPECIFIC PROCEDURES
"ECOMING MORE AWARE OF EACH
SURGEONgS ROUTINE THROUGH GOOD
COMMUNICATION AND REGULARLY
UPDATED PREFERENCE CARDS CAN HELP
REDUCE PREPARATION TIME MINIMIZE
WASTE AND ASSURE COST EFFECTIVENESS
0RIOR TO DISPENSING SUTURE PACKETS
THE CIRCULATING NURSE SHOULD HAVE A
BRIEF DISCUSSION WITH THE SURGEON TO
ASCERTAIN WHETHER A CHANGE IN SUTURE
ROUTINE IS ANTICIPATED DUE TO A
SPECIFIC PATIENTgS NEEDS
/PENING SUFFICIENT SUTURE PACKETS
TO PREVENT PROLONGING OPERATIVE
TIME AND CAUSING SURGEON
INCONVENIENCE
,EFTOVER SUTURE ON THE SURGICAL
FIELD MUST BE DISCARDED
4HEREFORE OPENING TOO MANY
SUTURE PACKETS SHOULD BE
AVOIDED TO REDUCE WASTE AND TO
LOWER COST
!LTHOUGH IT IS IMPORTANT TO BE
PREPARED TO ANSWER REQUESTS AT A
MOMENTgS NOTICE IT IS NOT NECESSARY
TO OVERLOAD THE TABLE WITH SUTURES
4HE INTRODUCTION OF SINGLE
LAYER
PEELABLE PACKAGING SUCH AS ONE
STEP
2%,!9
PACKAGING HELPS ENCOURAGE
LESS HANDLING TO ACCESS THE SUTURE
ENHANCING QUICK DELIVERY OF SUTURE
MATERIALS TO THE SURGEON IN THE
STERILE FIELD 5NEXPECTED SUTURE
NEEDS CAN ALSO BE OBTAINED RAPIDLY
FROM THE STORAGE RACKS
34%2),% 42!.3&%2 /&
35452% 0!#+%43
!T SOME POINT SUTURE PACKETS
MUST CROSS THE STERILE BARRIERTHE
INVISIBLE LINE OF DEMARCATION
BETWEEN THE STERILE AND THE NONSTER
ILE )N ALL SETTINGS EG OPERATING
ROOM DELIVERY ROOM EMERGENCY
DEPARTMENT OR PHYSICIANgS OFFICE
THE INDIVIDUAL WHO REMOVES
THE NONSTERILE OVERWRAP MUST
REMEMBER THESE THREE POINTS ABOUT
STERILE TRANSFER
7HILE IT IS DIFFICULT TO SAY PRECISELY
/UTER SURFACES OF THE OVERWRAP
HOW MANY SUTURE PACKETS ARE
ARE NOT STERILE AND MAY BE
ENOUGH THREE MAJOR FACTORS SHOULD
HANDLED WITH NONSTERILE HANDS
BE CONSIDERED IN DECIDING HOW
4HE STERILE INNER PACKET OR TRAY
MANY PACKETS TO OPEN
MUST BE TRANSFERRED TO THE STERILE
&EWER PACKETS WILL BE NEEDED IF
FIELD WITHOUT BEING TOUCHED OR
PRODUCTS WITH MULTIPLE STRANDS OF
CONTACTING ANY NONSTERILE OBJECT
SUTURE MATERIAL ARE USED
OR SURFACE
.ONSTERILE HANDS OVER THE STERILE
FIELD VIOLATE ASEPTIC TECHNIQUE
4HERE ARE TWO METHODS COMMONLY
USED FOR ACHIEVING STERILE TRANSFER
OF SUTURE PACKETS HANDING
OFF THE
STERILE INNER ONE
STEP 2%,!9 TRAY
DIRECTLY TO THE SCRUB PERSON OR
FLIPPING THE INNER CONTENTS OF THE
PRIMARY PACKET ONTO THE STERILE FIELD
2EGARDLESS OF THE ASEPTIC TECHNIQUE
PERFORMED ALL ITEMS INTRODUCED
ONTO THE STERILE FIELD SHOULD BE
OPENED DISPENSED AND TRANSFERRED
BY METHODS THAT MAINTAIN PRODUCT
STERILITY AND INTEGRITY !/2.
'UIDELINES RECOMMEND THE
hHAND
OFF v METHOD SINCE ITEMS
TOSSED OR FLIPPED HAVE A GREATER
POTENTIAL TO ROLL OFF THE EDGE OF THE
STERILE FIELD CAUSING CONTAMINATION
OR OTHER ITEMS TO BE DISPLACED
-%4(/$ ) 34%2),% 42!.3&%2 4/
4(% 3#25" 0%23/.
'RASP THE TWO FLAPS OF THE PEELABLE
OVERWRAP BETWEEN THE KNUCKLES OF
THE THUMBS AND FOREFINGERS 7ITH
A ROLLING
OUTWARD MOTION PEEL
THE FLAPS APART TO APPROXIMATELY
ONE
THIRD OF THE WAY DOWN THE
SEALED EDGES +EEPING PRESSURE
BETWEEN THE KNUCKLES FOR CONTROL
OFFER THE STERILE INNER PACKET OR
TRAY TO THE SCRUB PERSON WHO TAKES
IT WITH A GLOVED HAND OR STERILE
INSTRUMENT #ARE MUST BE TAKEN TO
AVOID CONTACT WITH THE NONSTERILE
OVERWRAP AS THE PACKET OR TRAY
IS WITHDRAWN
4HIS METHOD MUST BE USED TO
REMOVE PAPER FOLDER PACKETS OF SUR
GICAL STEEL AND 02/,%.%
SUTURES
FROM LONG STRAIGHT OVERWRAPS AND TO
REMOVE THE ORGANIZER SLEEVES FROM
%
0!#+
PROCEDURE KITS )T SHOULD
ALSO BE USED FOR TRANSFER OF FLEXIBLE
4RADEMARK
0!#+!').'
&)'52%
34%2),%
42!.3&%2
4/ 4(%
3#25"
0%23/.
LIGHTWEIGHT TRANSPARENT PACKETS
CONTAINING MICROSURGERY AND OPH
THALMIC PRODUCTS
-%4(/$ )) 34%2),% 42!.3&%2 4/
4(% 34%2),% &)%,$
&LIPPING IS A RAPID AND EFFICIENT
METHOD OF EJECTING STERILE PRODUCT
FROM ITS OVERWRAP ONTO THE STERILE
FIELD WITHOUT CONTACTING THE
UNSTERILE OUTER PACKET OR REACHING
OVER THE FIELD (OWEVER SKILL MUST
BE ACQUIRED TO ENSURE ITS EFFECTIVE
USE 4HE CIRCULATING NURSE MUST
STAND NEAR ENOUGH TO THE STERILE
TABLE TO PROJECT THE SUTURE PACKET
OR TRAY ONTO IT BUT NOT TOO CLOSE
AS TO RISK CONTAMINATING THE TABLE
BY TOUCHING IT OR EXTENDING
NONSTERILE HANDS OVER IT 4O
ACCOMPLISH THIS GRASP THE FLAPS
OF THE OVERWRAP AS DESCRIBED IN
-ETHOD ) AND PEEL THE FLAPS APART
WITH THE SAME ROLLING
OUTWARD
MOTION 4HE STERILE PACKET OR TRAY
IS PROJECTED ONTO THE STERILE TABLE
AS THE OVERWRAP IS COMPLETELY
PEELED APART
./4% $/ ./4 ATTEMPT TO PROJ
ECT THE INNER FOLDER OF LONG STRAIGHT
PACKETS ONTO THE STERILE TABLE
)NSTEAD PRESENT THEM TO THE SCRUB
PERSON AS OUTLINED IN -ETHOD )
35452% 02%0!2!4)/.
). 4(% 34%2),% &)%,$
3UTURE PREPARATION MAY BE MORE
CONFUSING THAN VIRTUALLY ANY OTHER
ASPECT OF CASE PREPARATION
&AMILIARITY AND UNDERSTANDING OF
THE SEQUENCE IN WHICH TISSUE LAYERS
ARE HANDLED BY THE SURGEON WILL HELP
TO ELIMINATE THIS CONFUSION 3EE THE
3UTURING 3ECTION #HAPTER
/NCE THE SUTURE PACKETS ARE OPENED
AND PREPARED ACCORDING TO THE
SURGEONgS PREFERENCE CARD SUTURES
CAN BE ORGANIZED IN THE SEQUENCE IN
WHICH THE SURGEON WILL USE THEM
,IGATURES TIES ARE OFTEN USED FIRST
IN SUBCUTANEOUS TISSUE SHORTLY AFTER
THE INCISION IS MADE UNLESS LIGATING
CLIPS OR AN ELECTROSURGICAL CAUTERY
DEVICE IS USED TO COAGULATE SEVERED
BLOOD VESSELS
!FTER THE LIGATING MATERIALS HAVE
BEEN PREPARED THE SUTURING
SEWING MATERIALS CAN BE PREPARED
IN THE SAME MANNER 0REPARING LARGE
AMOUNTS OF SUTURE MATERIAL IN
02%0!2!4)/. /&
34!.$!2$ ,%.'4(
,)'!452% 342!.$3
&)'52%
0REPARE CUT LENGTHS OF LIGATURE
MATERIAL COIL AROUND FINGERS OF LEFT
HAND GRASP FREE ENDS WITH RIGHT
HAND AND UNWIND TO FULL LENGTH
-AINTAIN LOOP IN LEFT HAND AND TWO
FREE ENDS IN RIGHT HAND 'ENTLY PULL
THE STRAND TO STRAIGHTEN
4O MAKE LENGTHS 0ASS ONE FREE
END OF STRAND FROM RIGHT TO LEFT HAND
3IMULTANEOUSLY CATCH A LOOP AROUND
THIRD FINGER OF RIGHT HAND -AKE
STRANDS EQUAL IN THIRDS AND CUT THE
LOOPS WITH SCISSORS
4O MAKE LENGTHS 0ASS BOTH FREE
ENDS FROM RIGHT TO LEFT HAND
3IMULTANEOUSLY CATCH A DOUBLE LOOP
AROUND THIRD FINGER OF RIGHT HAND
#UT THE LOOPS
0LACE PACKETS OR STRANDS IN SUTURE
BOOK FOLDED TOWEL OR UNDER -AYO
TRAYWITH ENDS EXTENDED FAR
ENOUGH TO PERMIT RAPID EXTRACTION
#(!04%2
02%0!2!4)/. /& #/.4).5/53 4)%3
/. ! ,)'!0!+ $)30%.3).' 2%%,
&)'52%
/PEN THE PACKET CONTAIN
ING THE APPROPRIATE
MATERIAL ON A REEL 4RANSFER
THE INNER CONTENTS OF THE
PRIMARY PACKET TO THE
STERILE FIELD USING ASEPTIC
TECHNIQUE
%XTEND THE STRAND END
SLIGHTLY FOR EASY GRASP
ING 0LACE REEL CONVIENTLY
ON THE -AYO TRAY
(AND REEL TO SURGEON AS
NEEDED BEING CERTAIN THAT
THE END OF THE LIGATING
MATERIAL IS FREE TO GRASP
3URGEON HOLDS REEL IN
PALM FEEDS STRAND
BEWEEN FINGERS AND
PLACES AROUND TIP OF
HEMOSTAT
&)'52%
0%0!2!4)/.
/& 02%
#54
35452%3
&/2 4)%3 /2
,)'!452%
35452%3
2EMOVE ONE PRE
CUT LENGTH FROM NONABSORBABLE
SUTURE AT A TIME FROM THE LABRINTH PACKET AS IT IS
NEEDED BY THE SURGEON
ADVANCE SHOULD BE AVOIDED &OR
EXAMPLE IF THE SURGEON OPENS THE
PERITONEUM THE LINING OF THE
ABDOMINAL CAVITY AND DISCOVERS
DISEASE OR A CONDITION THAT ALTERS
PLANS FOR THE SURGICAL PROCEDURE
AND ANTICIPATED USE OF SUTURES
OPENED PACKETS WOULD BE WASTED
!T CLOSURE FOLLOWING ABDOMINAL
SURGERY REMEMBERING THE LETTERS
0&3 PERITONEUM FASCIA SKIN WILL
BE HELPFUL FOR ORGANIZING SUTURES
"Y WATCHING THE PROGRESS OF THE
PROCEDURE CLOSELY LISTENING TO
COMMENTS BETWEEN THE SURGEON
AND ASSISTANTS AND EVALUATING
THE SITUATION SUTURE NEEDS CAN
BE ANTICIPATED &REE MOMENTS CAN
%XTRACT PRE
CUT STRANDS OF 35450!+
STERILE
ABSORBABLE OR NONABSORBABLE SUTURE 3TRAIGHTEN
SURGICAL GUT WITH A GENTLE PULL 0LACE STRANDS IN
THE SUTURE BOOK OR UNDER -AYO TRAY
BE USED TO PREPARE SUFFICIENT SUTURE
MATERIAL TO STAY ONE STEP AHEAD OF
THE SURGEON 4HE GOAL SHOULD BE TO
HAVE NO UNUSED STRANDS AT THE END
OF THE PROCEDURE
,IGATURE MATERIAL WHICH REMAINS
TOWARD THE END OF THE PROCEDURE
MAY BE THE SAME MATERIAL AND SIZE
SPECIFIED BY THE SURGEON FOR SUTURES
IN THE SUBCUTANEOUS LAYER OF WOUND
CLOSURE )N THIS CASE THE REMAINING
LIGATING MATERIAL SHOULD BE USED
RATHER THAN OPENING AN ADDITIONAL
SUTURE PACKET
)F THE SURGEON REQUIRES ONLY
ONE MORE SUTURE AND STRANDS OF
SUITABLE MATERIAL REMAIN WHICH
ARE SHORTER THAN THOSE PREPARED
ORIGINALLY DO NOT BE RELUCTANT TO
ASK THE SURGEON IF ONE OF THE
STRANDS WILL SERVE THE PURPOSE
BEFORE OPENING A NEW PACKET
-OST SURGEONS ARE COOPERATIVE IN
EFFORTS TO CONSERVE VALUABLE SUPPLIES
35452% (!.$,).'
4%#(.)15%
$URING THE FIRST POSTOPERATIVE WEEK
THE PATIENTgS WOUND HAS LITTLE OR NO
STRENGTH 4HE SUTURES OR MECHANICAL
DEVICES MUST BEAR THE RESPONSIBILITY
OF HOLDING THE TISSUES TOGETHER
DURING THIS PERIOD 4HEY CAN ONLY
PERFORM THIS FUNCTION RELIABLY IF THE
QUALITY AND INTEGRITY OF THE WOUND
4RADEMARK
0!#+!').'
CLOSURE MATERIALS ARE PRESERVED
DURING HANDLING AND PREPARATION
PRIOR TO USE )T IS THEREFORE ESSENTIAL
FOR EVERYONE WHO WILL HANDLE THE
SUTURE MATERIALS TO UNDERSTAND
PROPER PROCEDURE TO PRESERVE
SUTURE TENSILE STRENGTH
)N GENERAL AVOID CRUSHING OR
CRIMPING SUTURES WITH SURGICAL
INSTRUMENTS SUCH AS NEEDLEHOLDERS
AND FORCEPS EXCEPT AS NECESSARY
TO GRASP THE FREE END OF A SUTURE
DURING AN INSTRUMENT TIE 4HERE
ARE ALSO SPECIFIC PROCEDURES TO
FOLLOW TO PRESERVE SUTURE TENSILE
STRENGTH WHICH DEPEND UPON
WHETHER THE MATERIAL IS ABSORBABLE
OR NONABSORBABLE 4HE FOLLOWING
SUMMARIZES THE MOST IMPORTANT
POINTS FOR EACH MEMBER OF THE
SURGICAL TEAM TO REMEMBER AND
OBSERVE IN HANDLING SUTURE MATERIALS
AND SURGICAL NEEDLES
&/2 4(% #)2#5,!4).' .523%
#ONSULT THE SURGEONgS PREFERENCE
CARD FOR SUTURE ROUTINE
#HECK THE LABEL ON THE DISPENSER
BOX FOR TYPE AND SIZE OF SUTURE
MATERIAL AND NEEDLES .OTE THE
NUMBER OF STRANDS PER PACKET
&EWER PACKETS WILL BE NEEDED IF
MULTISTRAND OR #/.42/,
2%,%!3%
SUTURES ARE USED
%STIMATE SUTURE REQUIREMENTS
ACCURATELY AND DISPENSE ONLY THE
TYPE AND NUMBER OF SUTURES
REQUIRED FOR THE PROCEDURE
2EAD THE LABEL ON THE PRIMARY
PACKET OR OVERWRAP BEFORE USING
TO AVOID OPENING THE WRONG
PACKET
3UTURE PACKETS IDENTIFY THE
NUMBER OF NEEDLES PER PACKET TO
5SE ASEPTIC TECHNIQUE WHEN
SIMPLIFY NEEDLE COUNTS 2ETAIN
PEELING THE OVERWRAP 4RANSFER
THIS INFORMATION DURING THE
THE INNER CONTENTS OF THE PRIMARY
PROCEDURE ANDOR UNTIL FINAL
PACKET TO THE STERILE FIELD BY
NEEDLE COUNTS ARE COMPLETED
OFFERING IT TO THE SCRUB PERSON OR
#OUNT NEEDLES WITH THE SCRUB
PERSON PER HOSPITAL PROCEDURE
&)'52%
%4()#/.
-/$5,!2
34/2!'%
2!#+3
7ITH A ROLLING
OUTWARD MOTION
PEEL THE FLAPS APART TO APPROXI
MATELY ONT
THIRD THE WAY DOWN
THE SEALED EDGES +EEPING PRES
SURE BEWEEN THE KNUCKLES FOR
CONTROL OFFER THE STERILE INNER
2%,!9 TRAY TO THE SCRUB PERSON
BY PROJECTING FLIPPING IT ONTO
THE STERILE TABLE AVOIDING
CONTAMINATION
4O OPEN LONG STRAIGHT PACKETS
PEEL OVERWRAP DOWN TO INCH
ES AND PRESENT TO THE SCRUB
PERSON $O NOT ATTEMPT TO
PROJECT THE INNER FOLDER OF LONG
STRAIGHT PACKETS ONTO THE
STERILE TABLE
-AINTAIN AN ADEQUATE SUPPLY OF
THE MOST FREQUENTLY USED SUTURES
READILY ACCESSIBLE
2OTATE STOCK USING THE FIRST
IN
FIRST
OUT RULE TO AVOID EXPIRA
TION OF DATED PRODUCTS AND KEEP
INVENTORIES CURRENT
#LAMP THE NEEDLEHOLDER APPROX
IMATELY ONE
THIRD TO ONE
HALF OF
THE DISTANCE FROM THE SWAGE
AREA TO THE NEEDLE POINT $O NOT
CLAMP THE SWAGED AREA 'ENTLY
PULL THE SUTURE TO THE RIGHT IN A
STRAIGHT LINE
!DDITIONAL SUTURE STRAIGHTENING
SHOULD BE MINIMAL )F THE STRAND
MUST BE STRAIGHTENED HOLD THE
ARMED NEEDLEHOLDER AND GENTLY
PULL THE STRAND MAKING CERTAIN
NOT TO DISARM THE NEEDLE FROM
THE SUTURE
&/2 4(% 3#25" 0%23/.
)F APPROPRIATE REMOVE THE INNER
ONE
STEP 2%,!9
TRAY OR FOLDER
CONTAINING SUTURE MATERIALS FROM
THE PRIMARY PACKET BEING OFFERED
FROM THE CIRCULATING NURSE
(OLD THE ONE
STEP 2%,!9 TRAY OR
FOLDER IN GLOVED HAND AND ARM
THE NEEDLE USING THE NO
TOUCH
TECHNIQUE 'ENTLY DISPENSE THE
SUTURE
,EAVE PRE
CUT SUTURE LENGTHS IN
LABYRINTH PACKET ON THE -AYO
TRAY 3TRANDS CAN THEN BE
REMOVED ONE AT A TIME AS NEEDED
3URGICAL GUT AND COLLAGEN SUTURES
FOR OPHTHALMIC USE MUST FIRST BE
RINSED BRIEFLY IN TEPID WATER TO
AVOID IRRITATING SENSITIVE TISSUES
#(!04%2
)F THE SURGEON PREFERS TO USE
SUTURES WET DIP ONLY MOMENTAR
ILY $O NOT SOAK 3ILK SUTURES
SHOULD BE USED DRY
$O NOT PULL OR STRETCH SURGICAL
GUT OR COLLAGEN %XCESSIVE
HANDLING WITH RUBBER GLOVES CAN
WEAKEN AND FRAY THESE SUTURES
#OUNT NEEDLES WITH THE
CIRCULATING NURSE PER HOSPITAL
PROCEDURE
(OLD SINGLE STRANDS TAUT FOR
SURGEON TO GRASP AND USE AS A
FREEHAND TIE
$O NOT PULL ON NEEDLES TO
STRAIGHTEN AS THIS MAY CAUSE
PREMATURE SEPARATION OF
#/.42/, 2%,%!3% NEEDLE
SUTURE
!LWAYS PROTECT THE NEEDLE TO
PREVENT DULLING POINTS AND
CUTTING EDGES #LAMP THE NEEDLE
HOLDER FORWARD OF THE SWAGED
AREA APPROXIMATELY ONE
THIRD TO
ONE
HALF THE DISTANCE FROM THE
SWAGE TO THE POINT
-ICROSURGERY SUTURES AND
NEEDLES ARE SO FINE THAT THEY MAY
BE DIFFICULT TO SEE AND HANDLE
4HEY ARE PACKAGED WITH THE
NEEDLES PARKED IN FOAM TO
PROTECT DELICATE POINTS AND
EDGES 4HE NEEDLES MAY BE
ARMED DIRECTLY FROM THE FOAM
NEEDLE PARK )F THE MICROSURGEON
PREFERS TO ARM THE NEEDLE THE
REMOVABLE ORANGE COLORED TAB
MAY BE USED TO TRANSPORT THE
NEEDLE INTO THE MICROSCOPIC
FIELD
(ANDLE ALL SUTURES AND NEEDLES
AS LITTLE AS POSSIBLE 3UTURES
SHOULD BE HANDLED WITHOUT USING
INSTRUMENTS UNLESS ABSOLUTELY
NECESSARY #LAMPING INSTRUMENTS
ON STRANDS CAN CRUSH CUT AND
WEAKEN THEM
#UT SUTURES ONLY WITH SUTURE
SCISSORS #UT SURGICAL STEEL WITH
WIRE SCISSORS
7HEN REQUESTING ADDITIONAL
SUTURE MATERIAL FROM THE
CIRCULATING NURSE ESTIMATE USAGE
AS ACCURATELY AS POSSIBLE TO
AVOID WASTE
&/2 4(% 352'%/.
!VOID DAMAGE TO THE SUTURE
STRAND WHEN HANDLING 4HIS IS
PARTICULARLY CRITICAL WHEN
HANDLING FINE SIZES OF MONOFILA
MENT MATERIAL 4OUCH STRANDS
ONLY WITH GLOVED HAND OR CLOSED
BLUNT INSTRUMENT $O NOT CRUSH
OR CRIMP SUTURES WITH INSTRU
MENTS SUCH AS NEEDLEHOLDERS OR
FORCEPS EXCEPT WHEN GRASPING THE
FREE END OF THE SUTURE DURING AN
INSTRUMENT TIE
#LAMP A RUBBER SHOD HEMOSTAT
ONTO THE SUTURE TO ANCHOR THE
FREE NEEDLE ON A DOUBLE
ARMED
STRAND UNTIL THE SECOND NEEDLE IS
USED .EVER CLAMP THE PORTION OF
SUTURE THAT WILL BE INCORPORATED
INTO THE CLOSURE OR THE KNOT
5SE A CLOSED NEEDLEHOLDER OR
NERVE HOOK TO DISTRIBUTE TENSION
ALONG A CONTINUOUS SUTURE LINE
"E CAREFUL NOT TO DAMAGE THE
SUTURE
5SE KNOT TYING TECHNIQUES THAT
ARE APPROPRIATE FOR THE SUTURE
MATERIAL BEING USED
4RADEMARK
0!#+!').'
0ROTECT ABSORBABLE SUTURES FROM HEAT AND MOISTURE
A 3TORE SUTURE PACKETS AT ROOM TEMPERATURE !VOID PROLONGED STORAGE IN HOT
AREAS SUCH AS NEAR STEAM PIPES OR STERILIZERS
B $O NOT SOAK ABSORBABLE SUTURES !LSO AVOID PROLONGED PLACEMENT OF SUTURES
IN A MOIST SUTURE BOOK
C 3URGICAL GUT CAN BE DIPPED MOMENTARILY IN TEPID ROOM TEMPERATURE WATER
OR SALINE TO RESTORE PLIABILITY IF STRANDS DRY OUT BEFORE USE 3URGICAL GUT OR
COLLAGEN FOR USE IN OPHTHALMIC SURGERY SHOULD BE RINSED BRIEFLY IN TEPID
WATER BEFORE USE AS THEY ARE PACKED IN A SOLUTION USUALLY CONSISTING OF
ALCOHOL AND WATER TO MAINTAIN PLIABILITY
D 3YNTHETIC ABSORBABLE SUTURES MUST BE KEPT DRY 5SE STRANDS DIRECTLY FROM
PACKET WHEN POSSIBLE 3TORE SUTURES IN A DRY SUTURE BOOK IF NECESSARY
4!",%
02%3%26!4)/.
/& 4%.3),%
342%.'4(
!"3/2"!",%
35452%3
3TRAIGHTEN STRANDS WITH A GENTLY STEADY EVEN PULL *ERKING AND TUGGING CAN
WEAKEN SUTURES
$O NOT TEST SUTURE STRENGTH
$O NOT RESTERILIZE
3),+ n 3TORE STRANDS IN A DRY TOWEL $RY STRANDS ARE STRONGER THAN WET STRANDS 7ET SILK
LOSES UP TO IN STRENGTH (ANDLE CAREFULLY TO AVOID ABRASION KINKING NICKING OR
INSTRUMENT DAMAGE $O NOT RESTERILIZE
352')#!, 34!).,%33 34%%, n (ANDLE CAREFULLY TO AVOID KINKS AND BENDS 2EPEATED
BENDING CAN CAUSE BREAKAGE 3TAINLESS STEEL SUTURE CAN BE STEAM STERILIZED WITHOUT ANY
LOSS OF TENSILE STRENGTH (OWEVER $/ ./4 STEAM STERILIZE ON SPOOL OR IN CONTACT WITH
WOOD ,IGNIN IS LEACHED FROM WOOD SUBJECTED TO HIGH TEMPERATURE AND MAY CLING TO
SUTURE MATERIAL (ANDLE CAREFULLY TO AVOID ABRASION KINKING NICKING OR INSTRUMENT DAM
AGE
0/,9%34%2 &)"%2 n 5NAFFECTED BY MOISTURE -AY BE USED WET OR DRY (ANDLE CAREFULLY
TO AVOID ABRASION KINKING NICKING OR INSTRUMENT DAMAGE $O NOT RESTERILIZE
.9,/. n 3TRAIGHTEN KINKS OR BENDS BY CARESSING STRAND BETWEEN GLOVED FINGERS A FEW
TIMES (ANDLE CAREFULLY TO AVOID ABRASION KINKING NICKING OR INSTRUMENT DAMAGE
0/,902/09,%.% n 5NAFFECTED BY MOISTURE -AY BE USED WET OR DRY 3TRAIGHTEN
STRANDS WITH A GENTLE STEADY EVEN PULL (ANDLE WITH SPECIAL CARE TO AVOID ABRASION
KINKING NICKING OR INSTRUMENT DAMAGE $O NOT RESTERILIZE
4!",%
02%3%26!4)/.
/& 4%.3),%
342%.'4(
./.!"3/2"!",%
35452%3
CHAPTER 5
TOPICAL SKIN ADHESIVES
4/0)#!, 3+). !$(%3)6%3
,OW TENSION WOUNDS THOSE WHERE
THE SKIN EDGES LIE CLOSE TOGETHER
WITHOUT SIGNIFICANT TENSION CAN BE
CLOSED BY GLUING THE SKIN EDGES
TOGETHER WITH A SKIN ADHESIVE
"UTYLCYANOACRYLATE ADHESIVES HAVE
BEEN AVAILABLE IN %UROPE )SRAEL AND
#ANADA FOR DECADES 4HEY HAVE
BEEN USED SUCCESSFULLY FOR THE
CLOSURE OF TRAUMATIC LACERATIONS AND
SURGICAL INCISIONS !PPLICATION OF
BUTYLCYANOACRYLATE WAS FOUND TO BE
MORE RAPID AND COST EFFECTIVE THAN
SUTURING BUT ONLY RECENTLY HAS IT
BEEN EVALUATED IN WELL
DESIGNED
CLINICAL TRIALS FOR WOUND CLOSURE
4HE MOST SIGNIFICANT ADVANCE IN
THE FIELD OF TOPICAL SKIN ADHESIVES
HAS BEEN THE DEVELOPMENT OF
OCTYL CYANOACRYLATE MARKETED AS
$%2-!"/.$
4OPICAL 3KIN
!DHESIVE BY %4()#/. 0RODUCTS
4HIS TOPICAL SKIN ADHESIVE FORMS A
TRANSPARENT AND FLEXIBLE BOND
UNLIKE THE OPAQUE AND BRITTLE BOND
FORMED BY BUTYLCYANOACRYLATE
ADHESIVES 4HE FLEXIBILITY OF
OCTYL CYANOACRYLATE ALLOWS IT TO BE
APPLIED OVER NONUNIFORM SURFACES
4HIS FLEXIBILITY ALSO COMBATS THE
TOPICAL SHEAR FORCES EXERTED ON THE
ADHESIVE REDUCING THE RISK OF
PREMATURE SLOUGHING AND WOUND
DEHISCENCE !DDITIONALLY OCTYL
CYANOACRYLATE ADHESIVE HAS BEEN
FOUND TO HAVE THREE TIMES THE
BREAKING STRENGTH OF BUTYLCYANO
ACRYLATE SO IT CAN BE USED ON LONGER
INCISIONS AND LACERATIONS
$%2-!"/.$
4/0)#!, 3+). !$(%3)6%
/#49, #9!./!#29,!4%
IS A STERILE LIQUID TOPICAL ADHESIVE
DESIGNED TO HOLD CLOSED EASILY
APPROXIMATED SKIN EDGES OF
LACERATIONS AND SURGICAL INCISIONS
)T UTILIZES THE MOISTURE ON THE SKINgS
SURFACE TO FORM A STRONG FLEXIBLE
BOND AND CAN BE USED IN MANY
INSTANCES WHERE SUTURES STAPLES OR
SKIN STRIPS HAVE BEEN TRADITIONALLY
USED $%2-!"/.$ ADHESIVE IS
IDEALLY SUITED FOR WOUNDS ON THE
FACE TORSO AND LIMBS )T CAN BE USED
IN CONJUNCTION WITH BUT NOT IN
PLACE OF DEEP DERMAL SUTURES
!PPROVED BY THE &$! IN
$%2-!"/.$ ADHESIVE HAS
BEEN USED EXTENSIVELY BY HEALTH
PROFESSIONALS IN THE FIELDS OF
TRAUMA AND OTHER SURGERIES
EMERGENCY MEDICINE AND PEDIATRICS
3INCE ITS APPROVAL $%2-!"/.$
ADHESIVE HAS BEEN PROVEN EFFECTIVE
IN CLOSING A VARIETY OF SURGICAL
INCISIONS AND WOUNDS 5NLIKE
SUTURES THE ADHESIVE DOES NOT PRO
DUCE SUTURE OR TRACK MARKS ALONG
THE HEALED INCISION AND A PATIENT
CAN SHOWER RIGHT AWAY WITHOUT FEAR
OF COMPROMISING THE INCISION
()'( 6)3#/3)49
$%2-!"/.$
4/0)#!, 3+). !$(%3)6%
/#49, #9!./!#29,!4%
(IGH 6ISCOSITY $%2-!"/.$
ADHESIVE IS TIMES THICKER FOR
BETTER CONTROL ESPECIALLY WHERE
RUNOFF IS MOST LIKELY TO OCCUR SUCH
AS AROUND THE EYES AND NOSE
$OME
0RECISION
4IP AND .%7
$%2-!"/.$ 0RO0EN ADHESIVE
APPLICATORS ALLOW FOR FINE
LINE DELIV
ERY OF ADHESIVE n IDEAL FOR DELICATE
SKIN CLOSURES ON THE FACE AND NEAR
THE EYES
.EW $%2-!"/.$ 0RO0EN
ADHESIVE AND $%2-!"/.$
0RO0EN 8, ADHESIVE DELIVER THE HIGH
VISCOSITY FORMULATION WITH GREATER
EASE OF USE $%2-!"/.$
0RO0EN 8, ADHESIVE DELIVERS TWICE AS
MUCH ADHESIVE FOR USE ON LONGER
INCISIONS AND LACERATIONS
342%.'4( !.$ 3%#52)49
)N LESS THAN THREE MINUTES
$%2-!"/.$ ADHESIVE PROVIDES
THE STRENGTH OF HEALED TISSUE AT
DAYS ! STRONG FLEXIBLE
DIMENSIONAL BOND MAKES IT
SUITABLE FOR USE IN CLOSING EASILY
APPROXIMATED INCISIONS OF MANY
TYPES EXAMPLEDEEP SHORT LONG
3%!,3 /54 "!#4%2)!
$%2-!"/.$ ADHESIVE IS
APPROVED TO PROTECT WOUNDS AND
INCISIONS FROM COMMON MICROBES THAT
CAN LEAD TO INFECTION &OR TRAUMA AND
POST
SURGICAL PATIENTS INFECTIONS ARE
OFTEN THE MOST COMMON AND IN
SOME CASES THE MOST SERIOUS
COMPLICATIONS $%2-!"/.$
ADHESIVE HELPS PROTECT AGAINST THE
PENETRATION OF BACTERIA COMMONLY
ASSOCIATED WITH SURGICAL SITE
INFECTIONS )N VITRO STUDIES
DEMONSTRATED THAT $%2-!"/.$
ACTS AS A BARRIER AGAINST
3TAPHYLOCOCCUS EPIDERMIDIS
3TAPHYLOCOCCUS AUREUS %SCHERICHIA
COLI 0SEUDOMONAS AERUGINOSA AND
%NTEROCOCCUS FAECIUM AS LONG AS THE
ADHESIVE FILM REMAINS INTACT
02/-/4%3 ! -/)34
7/5.$ (%!,).' %.6)2/.-%.4
$%2-!"/.$ ADHESIVE CREATES A
PROTECTIVE SEAL AND IS AN OCCLUSIVE
DRESSING THAT HELPS THE WOUND STAY
MOIST -AINTAINING A MOIST WOUND
HEALING ENVIRONMENT AROUND THE
WOUND HAS BEEN SHOWN TO SPEED THE
RATE OF EPITHELIALIZATION !S THE
WOUND HEALS $%2-!"/.$
ADHESIVE WILL GRADUALLY SLOUGH OFF
GENERALLY BETWEEN TO DAYS
#(!04%2
02/6)$%3 %8#%,,%.4
#/3-%4)# 2%35,43
)N A PROSPECTIVE RANDOMIZED
CONTROLLED UNMASKED STUDY OF
PATIENTS $%2-!"/.$ ADHESIVE
PROVIDED COSMESIS EQUIVALENT TO THAT
OF SUTURES !T MONTHS IT PRODUCED
OPTIMAL COSMESIS IN OF
PATIENTS USING THE -ODIFIED
(OLLANDER #OSMESIS 3CALE
!$$)4)/.!, 0(93)#)!. !.$
0!4)%.4 "%.%&)43
)N MOST CASES $%2-!"/.$
ADHESIVE ALLOWS FOR SIGNIFICANTLY
FASTER CLOSURE THAN SUTURES
$%2-!"/.$ ADHESIVE
APPLICATION REQUIRES FEWER SURGICAL
SUPPLIES REDUCED EQUIPMENT
NEEDS AND ELIMINATES THE NEED FOR
SUTURE REMOVAL
$%2-!"/.$ ADHESIVE IS ALSO
MORE CONVENIENT AND COMFORTABLE
FOR THE PATIENT BECAUSE IT OFTEN
DOES NOT REQUIRE ANESTHETIC IS
GENTLER TO THE SKIN THAN SUTURES OR
STAPLES AND DOES NOT REQUIRE SUTURE
REMOVAL $%2-!"/.$ ADHESIVE
ALSO REDUCES THE RISK OF NEEDLE
STICK INJURY
).$)#!4)/.3 !.$
#/.42!).$)#!4)/.3
$%2-!"/.$ ADHESIVE IS INTENDED
FOR TOPICAL APPLICATION ONLY TO HOLD
CLOSED EASILY APPROXIMATED SKIN EDGES
OF WOUNDS FROM SURGICAL INCISIONS
INCLUDING PUNCTURES FROM MINIMALLY
INVASIVE SURGERY AND SIMPLE
THOROUGHLY CLEANSED TRAUMA
INDUCED
LACERATIONS $%2-!"/.$ ADHESIVE
MAY BE USED IN CONJUNCTION WITH BUT
NOT IN PLACE OF DEEP DERMAL SUTURES
4OPICAL SKIN ADHESIVES ARE NOT
APPROPRIATE FOR CLOSING WOUNDS THAT
ARE SUBJECT TO SIGNIFICANT STATIC OR
DYNAMIC TENSIONS UNLESS DEEP
SUTURES IMMOBILIZATION OR BOTH
ARE ALSO USED
$%2-!"/.$ ADHESIVE IS
CONTRAINDICATED FOR USE ON ANY
WOUNDS WITH EVIDENCE OF ACTIVE
INFECTION OR GANGRENE )T SHOULD ALSO
NOT BE USED ON MUCOSAL SURFACES OR
ACROSS MUCOCUTANEOUS JUNCTIONS
EG LIPS ORAL CAVITY OR ON SKIN
THAT IS REGULARLY EXPOSED TO
BODY FLUIDS OR WITH DENSE HAIR
EG SCALP $%2-!"/.$ ADHE
SIVE SHOULD NOT BE USED ON PATIENTS
WITH A KNOWN HYPERSENSITIVITY TO
CYANOACRYLATE OR FORMALDEHYDE
!00,)#!4)/.
-ASTERY OF TISSUE ADHESIVE USE
IS GENERALLY QUITE RAPID 0ROPER
WOUND SELECTION EVALUATION AND
PREPARATION BEFORE CLOSURE IS
IMPORTANT 7OUNDS MUST BE
THOROUGHLY CLEANSED AND DEBRIDED
IN ACCORDANCE WITH STANDARD PRACTICE
BEFORE USING ADHESIVES 4HE WOUND
EDGES MUST BE TIGHTLY APPOSED SO
THAT THE ADHESIVE IS NOT PLACED
INTO THE WOUND 0ATIENT POSITIONING
IS ALSO IMPORTANT TO REDUCE RUNOFF
OF TISSUE ADHESIVE 4HE PATIENT
SHOULD BE POSITIONED SO THAT THE
WOUND SURFACE IS PARALLEL TO THE
FLOOR TAKING SPECIAL CARE THAT
ANY RUNOFF DOES NOT FLOW IN THE
DIRECTION OF VITAL STRUCTURES SUCH
AS THE EYE
4%#(.)15%
&OLLOW STANDARD SURGICAL PRACTICE
FOR WOUND PREPARATION AND
ACHIEVE HEMOSTASIS
!PPROXIMATE SKIN EDGES AND USE
DEEP SUTURES TO RELIEVE
TENSION IF NECESSARY
#RACK THE $%2-!"/.$
ADHESIVE VIAL IN THE UPRIGHT
POSITION INVERT AND APPLY
PRESSURE TO SATURATE THE TIP
2ELEASE PRESSURE THEN REAPPLY
PRESSURE TO EXPRESS ADHESIVE
7HEN USING THE .%7
$%2-!"/.$ 0RO0EN ADHESIVE
APPLICATOR SIMPLY TWIST THE COLLAR
TO CRACK THE VIAL AND LIGHTLY PRESS
THE BUTTON TO SATURATE THE TIP AND
EXPRESS THE ADHESIVE
!PPLY THIN LAYERS OF ADHESIVE
WAITING APPROXIMATELY SECONDS
BETWEEN LAYERS ./4% LAYERS
OF ADHESIVE ARE REQUIRED WHEN
USING ORIGINAL $%2-!"/.$
ADHESIVE
$)2%#4)/.3 &/2 53%
4HE APPLICATION OF HIGH VISCOSITY
$%2-!"/.$ ADHESIVE REQUIRES
THOROUGH WOUND CLEANSING &OLLOW
STANDARD SURGICAL PRACTICE FOR WOUND
PREPARATION BEFORE APPLICATION OF HIGH
VISCOSITY $%2-!"/.$ ADHESIVE
IE ANESTHETIZE IRRIGATE DEBRIDE OBTAIN
HEMOSTASIS AND CLOSE DEEP LAYERS
0AT THE WOUND DRY WITH DRY STERILE GAUZE
TO ASSURE DIRECT TISSUE CONTACT FOR
ADHERENCE OF THE HIGH VISCOSITY
$%2-!"/.$ ADHESIVE TO THE SKIN
-OISTURE ACCELERATES HIGH VISCOSITY
$%2-!"/.$ ADHESIVES
POLYMERIZATION AND MAY AFFECT
WOUND CLOSURE RESULTS
4O PREVENT INADVERTENT FLOW OF LIQUID
HIGH VISCOSITY $%2-!"/.$ ADHESIVE
TO UNINTENDED AREAS OF THE BODY THE
WOUND SHOULD BE HELD IN A HORIZONTAL
POSITION AND THE HIGH VISCOSITY
$%2-!"/.$ ADHESIVE SHOULD BE
APPLIED FROM ABOVE THE WOUND
4RADEMARK
4/0)#!, 3+). !$(%3)6%3
(/7 4/ #!2% &/2 ! 7/5.$
!&4%2 )43 42%!4%$ 7)4(
$%2-!"/.$
4/0)#!, 3+). !$(%3)6%
4!",%
$%2-!"/.$ 4OPICAL 3KIN !DHESIVE
OCTYL
CYANOACRYLATE IS A STERILE LIQUID SKIN ADHESIVE THAT
HOLDS WOUND EDGES TOGETHER 4HE FILM WILL USUALLY
REMAIN IN PLACE FOR TO DAYS THEN NATURALLY FALLS
OFF THE SKIN
!6/)$ 4/0)#!, -%$)#!4)/.3
)NSTRUCT PATIENTS NOT TO APPLY LIQUID OR OINTMENT
MEDICATIONS OR ANY OTHER PRODUCT TO THE WOUND WHILE
THE $%2-!"/.$ ADHESIVE FILM IS IN PLACE 4HESE
MAY LOOSEN THE FILM BEFORE THE WOUND IS HEALED
4HE FOLLOWING PROVIDES INSTRUCTIONS FOR PROPER CARE OF
THE WOUND WHILE IT IS HEALING
+%%0 7/5.$ $29 !.$ 02/4%#4%$
0ATIENTS MAY OCCASIONALLY AND BRIEFLY WET THE WOUND
IN THE SHOWER OR BATH 4HEY SHOULD NOT SOAK OR SCRUB
THE WOUND 4HEY SHOULD NOT SWIM AND SHOULD
AVOID PERIODS OF HEAVY PERSPIRATION UNTIL THE
$%2-!"/.$ ADHESIVE HAS NATURALLY FALLEN OFF
!FTER SHOWERING OR BATHING THE PATIENT SHOULD BLOT
THE WOUND DRY WITH A SOFT TOWEL )F A PROTECTIVE
DRESSING IS BEING USED A FRESH DRY BANDAGE SHOULD
BE APPLIED BEING SURE TO KEEP THE TAPE OFF THE
$%2-!"/.$ ADHESIVE FILM
#(%#+ 7/5.$ !00%!2!.#%
3OME SWELLING REDNESS AND PAIN ARE COMMON WITH ALL
WOUNDS AND NORMALLY WILL GO AWAY AS THE WOUND
HEALS )F SWELLING REDNESS OR PAIN INCREASES OR IF THE
WOUND FEELS WARM TO THE TOUCH INSTRUCT PATIENTS TO
CONTACT A DOCTOR ! DOCTOR SHOULD ALSO BE CONTACTED IF
THE WOUND EDGES REOPEN OR SEPARATE
2%0,!#% "!.$!'%3
)F THE WOUND IS BANDAGED THE PATIENT SHOULD BE
INSTRUCTED TO KEEP THE BANDAGE DRY 4HE DRESSING
SHOULD BE REPLACED DAILY UNTIL THE ADHESIVE FILM HAS
FALLEN OFF OR IF THE BANDAGE SHOULD BECOME WET UNLESS
OTHERWISE INSTRUCTED BY THE PHYSICIAN
7HEN CHANGING THE DRESSING TAPE SHOULD NOT BE
PLACED DIRECTLY OVER THE $%2-!"/.$ ADHESIVE
FILM BECAUSE REMOVING THE TAPE LATER MAY ALSO
REMOVE THE FILM
!DDITIONAL INSTRUCTIONS FOR PATIENTS INCLUDE
s !PPLY A CLEAN DRY BANDAGE OVER THE WOUND IF
NECESSARY TO PROTECT IT
s 0ROTECT THE WOUND FROM INJURY UNTIL THE SKIN HAS
HAD SUFFICIENT TIME TO HEAL
s $O NOT SCRATCH RUB OR PICK AT THE $%2-!"/.$
ADHESIVE FILM 4HIS MAY LOOSEN THE FILM BEFORE THE
WOUND IS HEALED
s 0ROTECT THE WOUND FROM PROLONGED EXPOSURE TO
SUNLIGHT OR TANNING LAMPS WHILE THE FILM IS IN PLACE
#(!04%2
(IGH VISCOSITY $%2-!"/.$ ADHESIVE
HOULD BE USED IMMEDIATELY AFTER
CRUSHING THE GLASS AMPULE SINCE THE
LIQUID HIGH VISCOSITY $%2-!"/.$
ADHESIVE WILL FLOW FREELY FROM THE TIP FOR
ONLY A FEW MINUTES 2EMOVE THE
APPLICATOR FROM THE BLISTER POUCH
(OLD THE APPLICATOR WITH THE THUMB AND
FINGER AND AWAY FROM THE PATIENT TO
PREVENT ANY UNINTENTIONAL PLACEMENT
OF THE LIQUID HIGH VISCOSITY
$%2-!"/.$ ADHESIVE INTO THE
WOUND OR ON THE PATIENT 7HILE HOLDING
THE APPLICATOR AND WITH THE APPLICATOR
TIP POINTED UPWARD APPLY PRESSURE AT
THE MIDPOINT OF THE AMPULE TO CRUSH THE
INNER GLASS AMPULE )NVERT AND GENTLY
SQUEEZE THE APPLICATOR JUST SUFFICIENTLY TO
EXPRESS THE LIQUID HIGH VISCOSITY
$%2-!"/.$ ADHESIVE TO MOISTEN
THE APPLICATOR
!PPROXIMATE WOUND EDGES WITH GLOVED
FINGERS OR STERILE FORCEPS 3LOWLY
APPLY THE LIQUID HIGH VISCOSITY
$%2-!"/.$ ADHESIVE IN MULTIPLE
AT LEAST THIN LAYERS TO THE SURFACE OF
THE APPROXIMATED WOUND EDGES USING A
GENTLE BRUSHING MOTION 7AIT
APPROXIMATELY SECONDS BETWEEN
APPLICATIONS OR LAYERS -AINTAIN MANUAL
APPROXIMATION OF THE WOUND EDGES FOR
APPROXIMATELY SECONDS AFTER THE
FINAL LAYER
./4% (IGH VISCOSITY $%2-!"/.$
ADHESIVE POLYMERIZES THROUGH AN
EXOTHERMIC REACTION )F THE LIQUID HIGH
VISCOSITY $%2-!"/.$ ADHESIVE IS
APPLIED SO THAT LARGE DROPLETS ARE ALLOWED
TO REMAIN WITHOUT BEING EVENLY SPREAD
THE PATIENT MAY EXPERIENCE A SENSATION
OF HEAT OR DISCOMFORT 4HE SENSATION
MAY BE HIGHER ON SENSITIVE TISSUES 4HIS
CAN BE MINIMIZED BY APPLYING HIGH
VISCOSITY $%2-!"/.$ ADHESIVE IN
MULTIPLE THIN LAYERS AT LEAST
./4% %XCESSIVE PRESSURE OF THE
APPLICATOR TIP AGAINST THE WOUND EDGES
OR SURROUNDING SKIN CAN RESULT IN FORCING
THE WOUND EDGES APART AND ALLOWING
HIGH VISCOSITY $%2-!"/.$ ADHESIVE
INTO THE WOUND (IGH VISCOSITY
$%2-!"/.$ ADHESIVE WITHING
THE WOUND COULD DELAY WOUND
HEALING ANDOR RESULT IN ADVERSE
COSMETIC OUTCOME
./4% &ULL APPOSITION STRENGTH IS
EXPECTED TO BE ACHIEVED ABOUT
MINUTES AFTER THE FINAL LAYER IS
APPLIED ALTHOUGH THE TOP ADHESIVE
LAYER MAY REMAIN TACKY FOR UP TO
APPROXIMATELY MINUTES &ULL
POLYMERIZATION IS EXPECTED WHEN THE TOP
HIGH VISCOSITY $%2-!"/.$ ADHESIVE
LAYER IS NO LONGER STICKY
$O NOT APPLY LIQUID OR OINTMENT
MEDICATIONS ONTO WOUNDS CLOSED WITH
HIGH VISCOSITY $%2-!"/.$ ADHESIVE
BECAUSE THESE SUBSTANCES CAN WEAKEN THE
POLYMERIZED FILM LEADING TO WOUND
DEHISCENCE
0ROTECTIVE DRY DRESSING SUCH AS GAUZE
MAY BE APPLIED ONLY AFTER HIGH VISCOSITY
$%2-!"/.$ ADHESIVE FILM IS
COMPLETELY SOLIDPOLYMERIZED NOT TACKY
TO THE TOUCH APPROXIMATELY FIVE MINUTES
AFTER APPLICATION !LLOW THE TOP LAYER TO
FULLY POLYMERIZE BEFORE APPLYING
A BANDAGE
)F A DRESSING BANDAGE ADHESIVE BACKING
OR TAPE IS APPLIED BEFORE COMPLETE
POLYMERIZATION THE DRESSING CAN ADHERE
TO THE FILM 4HE FILM CAN BE DISRUPTED
FROM THE SKIN WHEN THE DRESSING IS
REMOVED AND WOUND DEHISCENCE
CAN OCCUR
0ATIENTS SHOULD BE INSTRUCTED TO NOT PICK
AT THE POLYMERIZED FILM OF HIGH VISCOSITY
$%2-!"/.$ ADHESIVE 0ICKING AT
THE FILM CAN DISRUPT ITS ADHESION TO THE
SKIN AND CAUSE DEHISCENCE OF THE WOUND
0ICKING AT THE FILM CAN BE DISCOURAGED
BY AN OVERLYING DRESSING
!PPLY A DRY PROTECTIVE DRESSING FOR
CHILDREN OR OTHER PATIENTS WHO MAY NOT
BE ABLE TO FOLLOW INSTRUCTIONS FOR PROPER
WOUND CARE
0ATIENTS TREATED WITH HIGH VISCOSITY
$%2-!"/.$ ADHESIVE SHOULD BE
PROVIDED THE PRINTED INSTRUCTION SHEET
ENTITLED (OW TO #ARE FOR 9OUR 7OUND
!FTER )TS 4REATED 7ITH HIGH VISCOSITY
$%2-!"/.$ 4OPICAL 3KIN !DHESIVE
4HIS INSTRUCTION SHEET SHOULD BE
REVIEWED WITH EACH PATIENT OR GUARDIAN
TO ASSURE UNDERSTANDING OF THE PROPER
CARE FOR THE TREATMENT SITE
0ATIENTS SHOULD BE INSTRUCTED THAT UNTIL
THE POLYMERIZED FILM OF HIGH VISCOSITY
$%2-!"/.$ ADHESIVE HAS SLOUGHED
NATURALLY USUALLY IN
DAYS THERE
SHOULD BE ONLY TRANSIENT WETTING OF THE
TREATMENT SITE 0ATIENTS MAY SHOWER AND
BATHE THE SITE GENTLY 4HE SITE SHOULD NOT
BE SCRUBBED SOAKED OR EXPOSED TO
PROLONGED WETNESS UNTIL AFTER THE FILM
HAS SLOUGHED NATURALLY AND THE WOUND
HAS HEALED CLOSED 0ATIENTS SHOULD BE
INSTRUCTED NOT TO GO SWIMMING DURING
THIS PERIOD
)F REMOVAL OF HIGH VISCOSITY
$%2-!"/.$ ADHESIVE IS NECESSARY
FOR ANY REASON CAREFULLY APPLY PETROLEUM
JELLY OR ACETONE TO THE HIGH VISCOSITY
$%2-!"/.$ FILM TO HELP LOOSEN THE
BOND 0EEL OFF THE FILM DO NOT PULL THE
SKIN APART
2%&%2%.#%3
3INGER !DAM * ,ACERATIONS AND
!CUTE 7OUNDS !N %VIDENCE
"ASED 'UIDE &! $AVIS
#OMPANY P
$ATA ON FILE %4()#/. ).#
1UINN ' 7ELLS 4 3UTCLIFFE
ET AL ! 2ANDOMIZED 4RIAL
#OMPARING /CTYL #YANOACRYLATE
4ISSUE !DHESIVE AND 3UTURES IN
THE -ANAGEMENT OF ,ACERATIONS
*!-!
3INGER !* (OLLANDER *% 1UINN
*6 %VALUATION AND MANAGEMENT
OF TRAUMATIC LACERATIONS
. %NGL * -ED
"RUNS 4" 2OBINSON "3 3MITH
2* ET AL ! NEW TISSUE ADHESIVE
FOR LACERATION REPAIR IN CHILDREN
* 0EDIATR
4HEODORE . ET AL 4HE
%CONOMICS OF $%2-!"/.$
IN .EUROSURGICAL 7OUND
#LOSURE 0HOENIX !RIZ
.EUROSCIENCE 0UBLICATIONS
"ARROW .EUROLOGICAL )NSTITUTE
-ARCH
/SMOND -( +LASSEN 40
1UINN *6 %CONOMIC COMPARISON
OF A TISSUE ADHESIVE AND SUTURING
IN THE REPAIR OF PEDIATRIC FACIAL
LACERATIONS * 0EDIATR
4RADEMARK
CHAPTER 6
OTHER SURGICAL
PRODUCTS
/4(%2 352')#!, 02/$5#43
!$(%3)6% 4!0%3
4HERE ARE MANY SURGICAL PRODUCTS
AVAILABLE WHICH MAY BE USED DURING
WOUND CLOSURE AND OTHER OPERATIVE
PROCEDURES WHICH INVOLVE SUTURING
%ACH OF THESE PRODUCTS HAS SPECIFIC
INDICATIONS FOR USE !DHESIVE TAPES
ARE USED FOR APPROXIMATING THE
EDGES OF LACERATIONS SKIN CLOSURES
REPAIR ANDOR SUPPORT IN SELECTED
OPERATIVE PROCEDURES
!DHESIVE TAPES ARE ASSOCIATED WITH
MINIMAL TISSUE REACTIVITY AND YIELD
THE LOWEST RATE OF INFECTION BUT
THEY TEND TO SLOUGH OFF IN THE
PRESENCE OF TENSION OR MOISTURE
!DVANTAGES OF ADHESIVE TAPES
INCLUDE RAPID APPLICATION LITTLE OR
NO PATIENT DISCOMFORT LOW COST AND
NO RISK OF NEEDLE
STICK INJURIES 4HEY
ARE ASSOCIATED WITH MINIMAL TISSUE
REACTIVITY AND YIELD THE LOWEST INFEC
TION RATES OF ANY WOUND CLOSURE
METHOD 4HEY MAY BE LEFT ON FOR
LONG PERIODS WITHOUT RESULTING IN
SUTURE HATCH MARKS
3URGICAL TAPES ARE NOT COMMONLY
RECOMMENDED AS THE SOLE MODALITY
FOR PRIMARY WOUND CLOSURE DUE
TO THE HIGH PROBABILITY OF
!$6!.4!'%3
DISLODGEMENT AND DEHISCENCE
THE INABILITY TO USE THEM IN
HAIR
BEARING AREAS AND THE NEED
TO KEEP THEM DRY 4HEIR USE IS
TYPICALLY RESERVED FOR LINEAR LACERA
TIONS UNDER MINIMAL TENSION
&URTHERMORE SURGICAL TAPES DO NOT
APPROXIMATE DEEPER TISSUES AND DO
NOT CONTROL BLEEDING
).$)#!4)/.3 !.$ 53!'%
3KIN CLOSURE TAPES ARE AN EFFECTIVE
ALTERNATIVE TO SUTURES OR STAPLES
WHEN TENSILE STRENGTH AND RESISTANCE
TO INFECTION ARE NOT CRITICAL FACTORS
3KIN CLOSURE TAPES CAN ALSO BE
USED TO COMPLEMENT SUTURE OR
STAPLE CLOSURES 3TRESS IS APPLIED
UNIFORMLY TO THE COLLAGEN FIBERS
AIDING IN RAPID FIBER ORIENTATION
AND INCREASED TENSILE STRENGTH
!00,)#!4)/.
3KIN CLOSURE TAPES MAY BE APPLIED TO
THE SKIN OVER A SUBCUTICULAR CLOSURE
IN LIEU OF SKIN SUTURES OR USED AS A
PRIMARY CLOSURE IN CONJUNCTION WITH
SUTURES IN AN ALTERNATING PATTERN
4HE TAPE IS PLACED ON ONE SIDE OF
THE WOUND AT ITS MIDPOINT WHILE
GRASPING IT WITH FORCEPS IN THE
DOMINANT HAND 4HE OPPOSITE
$)3!$6!.4!'%3
s 2APID AND SIMPLE
CLOSURE
s 2ELATIVELY POOR
ADHERENCE
s ,EAST DAMAGE TO
HOST DEFENSES
s %ASILY REMOVED BY
PATIENT
s .O RISK OF NEEDLE
STICK
INJURIES
s -UST BE KEPT DRY
s $O NOT CAUSE TISSUE
ISCHEMIA OR NECROSIS
s #ANNOT BE USED OVER
OILY OR HAIR
BEARING
AREAS
4!",%
!$6!.4!'%3
!.$
$)3!$6!.4!'%3
/& !$(%3)6%
4!0%3 &/2
3+). #,/352%
WOUND EDGE IS THEN GENTLY APPOSED
BY PUSHING WITH A FINGER OF THE
NONDOMINANT HAND 4HE WOUND
EDGES SHOULD NOT BE APPOSED BY
PULLING ON THE FREE END OF THE
TAPE 4HIS CAN RESULT IN UNEQUAL
DISTRIBUTION OF SKIN TENSIONS
CAUSING ERYTHEMA OR EVEN BLISTERING
OF THE SKIN !DDITIONAL STRIPS ARE
THEN PLACED PERPENDICULAR TO THE
LACERATION ON EITHER SIDE OF THE
ORIGINAL TAPE BISECTING THE
REMAINING OPEN WOUND WITH EACH
STRIP UNTIL THE SPACE BETWEEN TAPES
IS NO MORE THAN ABOUT TO MM
!DDITIONAL STRIPS ARE THEN PLACED
OVER THE ENDS OF THE OTHER STRIPS
PARALLEL TO THE LACERATION
3KIN CLOSURE TAPES MAY ALSO BE USED
AS A REPLACEMENT FOR SUTURES OR
STAPLES WHICH ARE REMOVED ON THE
FIRST TO FOURTH POSTOPERATIVE DAY
%FFECTIVE SKIN CLOSURE TAPES PROVIDE
GOOD POROSITY IN TERMS OF AIR INFLOW
TO THE WOUND AND WATER VAPOR
TRANSMISSION ESCAPING FROM THE
WOUND DURING THE HEALING PROCESS
!&4%2 #!2% !.$ 2%-/6!,
!DHESIVE TAPES SHOULD BE LEFT IN
PLACE AS LONG AS POSSIBLE AT LEAST AS
LONG AS SUTURES WOULD BE LEFT BEFORE
REMOVAL 4O PREVENT THE TAPES FROM
PREMATURELY COMING LOOSE PATIENTS
MUST BE WARNED TO KEEP THEM AS
DRY AS POSSIBLE AND NOT TO COVER
THEM WITH OINTMENTS 3HOWERING
IS PERMITTED AND DURING THE
FIRST WEEK MANY SURGEONS
RECOMMEND THAT PATIENTS COVER
THEIR WOUNDS AND TAPE WITH A
NONADHERENT DRESSING
#(!04%2
&)'52%
3+).
#,/352%
4!0%3
5SING STERILE TECHNIQUE
REMOVE CARD FROM SLEEVE AND
TEAR OFF TAB
0EEL OFF TAPES AS NEEDED IN
DIAGONAL DIRECTION
!PPLY TAPES AT
INCH
INTERVALS AS NEEDED TO
COMPLETE WOUND APPOSITION
-AKE SURE THE SKIN SURFACE IS
DRY BEFORE APPLYING EACH TAPE
7HEN HEALING IS JUDGED TO BE
ADEQUATE REMOVE EACH TAPE
BY PEELING OFF EACH HALF FROM
THE OUTSIDE TOWARD THE WOUND
MARGIN 4HEN GENTLY LIFT
THE TAPE AWAY FROM THE
WOUND SURFACE
3+). #,/352% 4!0%3
02/8)
342)0
SKIN CLOSURES ARE
LONG NARROW STERILE STRIPS OF TAPE
WITH AN ADHESIVE BACKING 4HEY ARE
USED FOR APPROXIMATING THE EDGES OF
LACERATIONS AND FOR CLOSING SKIN FOL
LOWING MANY OPERATIVE PROCEDURES
02/8)
342)0 SKIN CLOSURES HAVE A
HIGH DEGREE OF POROSITY TO ALLOW THE
WOUND TO BREATHE BUT HAVE SUFFI
CIENT ADHESIVE STRENGTH TO NEGATE THE
USE OF ADJUNCT APPLICATIONS SUCH AS
TINCTURE OF BENZOIN 4HEIR ANTISTATIC
PROPERTIES MINIMIZE THE TENDENCY OF
THE TAPE STRIPS TO CURL UP
0/,9%34%2 &)"%2 342)0
-%23),%.%
POLYESTER FIBER STRIP
IS COMPRISED OF A DOUBLE THICKNESS
OF -%23),%.% POLYESTER FIBER
THAT IS MM WIDE 4HE STRIPS ARE
AVAILABLE WITH AND WITHOUT
NEEDLES AND MAY BE USED INSTEAD
OF LARGE
SIZED SUTURE FOR LIGATION
REPAIR ANDOR SUPPORT IN SELECTED
OPERATIVE PROCEDURES
)NCOMPETENCE OF THE CERVIX IS A
CONDITION CHARACTERIZED BY THE
HABITUAL PREMATURE SPONTANEOUS
ABORTION OF THE FETUS ! LIGATURE IS
PLACED AROUND THE CERVIX IN A
COLLAR
LIKE FASHION DRAWN TIGHT
AND EITHER SUTURED TOGETHER OR TIED
CLOSED ! -%23),%.% STRIP IS
THEN WOVEN CAREFULLY WITH A SWAGE
BLUNT NEEDLE IN AND OUT OF THE
MUCOSA 7HEN PLACED PROPERLY
THE FLATNESS OF THE LIGATURE WILL NOT
CUT OR DAMAGE THE WALL OF THE CERVIX
-%23),%.% STRIP ATTACHED TO
A HEAVY REVERSE CUTTING NEEDLE
PROVIDES A WIDE BAND OF STRONG
MATERIAL FOR ORTHOPAEDIC PROCEDURES
SUCH AS ROTATOR CUFF REPAIR AND
SUPPORT 4HE BLUNT NEEDLES USED FOR
THE INCOMPETENT CERVIX LIGATION MAY
ALSO BE USED FOR THIS PURPOSE
5-"),)#!, 4!0%
5MBILICAL TAPE IS A WHITE WOVEN
COTTON LIGATURE OR INCH
OR CM WIDE THAT IS STRONG
ENOUGH TO TIE OFF THE UMBILICAL CORD
OF THE NEWBORN INFANT 7HILE THIS
WAS ITS ORIGINAL USE UMBILICAL
TAPE IS ALSO USED IN PEDIATRIC AND
CARDIOVASCULAR PROCEDURES TO
SUSPEND SMALL STRUCTURES AND VESSELS
DURING THE OPERATION BUT IS NOT LEFT
IN PLACE
5MBILICAL TAPE EASILY ABSORBS
BLOOD WHEN USED IN AN AREA OF
GROSS BLEEDING 4HE
INCH
CM TAPE IS AVAILABLE WITH A
RADIOPAQUE THREAD WOVEN INTO THE
LENGTH OF THE FABRIC TO FACILITATE
X
RAY IDENTIFICATION
352')#!,
34!0,%3
4HE STAPLE CLOSURE IS MAINLY USED FOR
LARGE WOUNDS THAT ARE NOT ON THE
FACE 3TAPLING IS ESPECIALLY USEFUL
FOR CLOSING SCALP WOUNDS 3TAPLES
ARE ALSO USED FOR LINEAR LACERATIONS
OF THE TORSO AND EXTREMITIES
ESPECIALLY IF THEY ARE RELATIVELY LONG
-ANY SURGEONS ROUTINELY USE SKIN
STAPLES FOR CLOSURE OF STANDARD
ABDOMINAL THORAX AND EXTREMITY
INCISIONS !DVANTAGES OF STAPLING
INCLUDE EASE OF USE RAPIDITY COST
EFFECTIVENESS AND MINIMAL DAMAGE
TO HOST DEFENSES
4RADEMARK
/4(%2 352')#!, 02/$5#43
! VARIETY OF STAPLING DEVICES IS
AVAILABLE FOR WOUND CLOSURE 7ITH
ALL DEVICES THE STAPLE CREATES AN
INCOMPLETE RECTANGLE THE LEGS OF THE
STAPLE EXTEND INTO THE SKIN AND THE
CROSS
LIMB LIES ON THE SKIN SURFACE
ACROSS THE WOUND %ACH DEVICE MAY
DIFFER IN ITS HANDLING CHARACTERISTICS
VISUAL ACCESS THE ANGLE AT WHICH
THE STAPLES ENTER TISSUES THE EASE
OF POSITION AND THE PRE
COCKING
MECHANISM /PTIMAL VISIBILITY AS
THE STAPLE IS PLACED IN THE SKIN IS
IMPORTANT AS IS THE ANGLE AT WHICH
THE STAPLE ENTERS THE SKIN BECAUSE
INSERTION OF THE STAPLE PERPENDICULAR
TO THE SURFACE OF THE SKIN RESULTS IN
DEEP PENETRATION THAT INCREASES THE
LIKELIHOOD OF TISSUE STRANGULATION
AND PERMANENT CROSS
HATCHING OF
THE WOUND 4HE ABILITY OF THE
STAPLE END TO SWIVEL ALLOWS THE HEAD
TO BE ADJUSTED FOR USE IN DEEP
RECESSES &INALLY THE PRESENCE OF A
PRE
COCKING MECHANISM ALLOWS THE
PRACTITIONER TO MAINTAIN CONSTANT
CONTROL WHILE STAPLING THE SKIN
"EFORE INSERTING STAPLES IT IS IMPOR
TANT TO LINE UP THE WOUND EDGES
WITH THE CENTERLINE INDICATOR ON THE
HEAD OF THE STAPLER TO MAKE SURE THAT
THE LEGS OF THE STAPLE WILL ENTER THE
SKIN AT EQUAL DISTANCES ON EITHER SIDE
OF THE WOUND EDGE %ACH EDGE IS
TYPICALLY PICKED UP WITH A FORCEPS
EVERTED AND PRECISELY LINED UP
4HE SURGEON THEN PLACES THE STAPLES
TO CLOSE THE WOUND WHILE THE FIRST
ASSISTANT ADVANCES THE FORCEPS
EVERTING THE EDGES OF THE WOUND
4HIS TECHNIQUE IS CONTINUED UNTIL
THE ENTIRE WOUND IS EVERTED AND
CLOSED WITH STAPLES
).$)#!4)/.3 !.$ 53!'%
7OUND CLOSURE WITH STAPLES IS
INDICATED FOR SCALP LACERATIONS
THAT DO NOT REQUIRE EXTENSIVE
HEMOSTASIS AND DO NOT INVOLVE TEARS
IN THE UNDERLYING FRONTOOCCIPITAL
APONEUROSIS GALEA 4HEY ARE
ALSO INDICATED FOR LINEAR NONFACIAL
LACERATIONS CAUSED BY SHEAR FORCES
EG SHARP OBJECTS
!&4%2#!2% !.$ 2%-/6!,
3KIN STAPLES SHOULD BE REMOVED
AT THE SAME TIME THAT SUTURES
WOULD BE REMOVED BASED ON WOUND
LOCATION AND TENSION &OR SCALP
WOUNDS STAPLES SHOULD BE REMOVED
ON DAY AFTER INSERTION &OR TRUNK
AND EXTREMITY WOUNDS STAPLES
SHOULD BE REMOVED BETWEEN DAYS
AND 7OUNDS CLOSED WITH STAPLES
MAY BE COVERED WITH A TOPICAL
ANTIBIOTIC CREAM OR OINTMENT
0ATIENTS MAY BATHE OR SHOWER
THE NEXT DAY BUT SHOULD AVOID
PROLONGED EXPOSURE TO MOISTURE
7HEN USED ON THE SCALP PATIENTS
SHOULD BE VERY CAREFUL ABOUT
COMBING OR BRUSHING THEIR HAIR
! SPECIALLY DESIGNED SINGLE
HANDED
DISPOSABLE STAPLE REMOVER SHOULD BE
USED TO REMOVE THE STAPLES BY A
HEALTH CARE PROVIDER
02/8)-!4%
3KIN 3TAPLERS
02/8)-!4% 3KIN 3TAPLERS PLACE
SINGLE STAPLES TO CLOSE SURGICAL
INCISIONS 3TAPLES ARE MADE OF
LUBRICANT
COATED STAINLESS STEEL
02/8)-!4%
3+). 34!0,%23
02/8)-!4%
2( 3KIN 3TAPLERS
2OTATING (EAD 3KIN 3TAPLERS
&EATURES
"ENEFITS
02/8)-!4%
08 3KIN 3TAPLERS
&EATURES
"ENEFITS
02/8)-!4%
0,53 -$ 3KIN 3TAPLERS
-ULTI
$IRECTIONAL 3KIN 3TAPLERS
&EATURES
"ENEFITS
2ECTANGULAR
STAPLES
-INIMIZES STAPLE
ROTATION
%RGONOMIC PISTOL
GRIP
)NTUITIVE AND
COMFORTABLE TO USE
)MPROVED KICK
OFF
SPRING DESIGN
-ULTI
DIRECTION
RELEASE
(EAD ROTATES
CARTRIDGE IS CLEAR
)MPROVES VISIBILITY
AND ACCESS
0OSITIVE RATCHET
MECHANISM
%ASY STAPLE
PLACEMENT
%RGONOMIC DESIGN
#OMFORTABLE FOR
SMALLER HANDS
3TAPLES ARE COATED
WITH LUBRICANT
%ASY STAPLE
EXTRACTION
3TAPLES ARE COATED
WITH LUBRICANT
%ASY STAPLE
EXTRACTION
!LIGNMENT INDICATOR
)MPROVES VISIBILITY
0ISTOL GRIP HANDLE
#OMFORTABLE
TO USE
3TAPLES ARE COATED
WITH LUBRICANT
%ASY STAPLE EXTRACTION
4!",%
#(!04%2
THE STAPLERS ARE NOT RELOADABLE
%4()#/. %NDO
3URGERY MAKES
THREE DIFFERENT SKINS STAPLERS TO
MEET SURGEONS NEEDS
02/8)-!4%
08 SKIN STAPLER
PROVIDES MANY OF THE SAME FEATURES
AS THE 02/8)-!4% 2( SKIN
STAPLER BUT IN A FIXED
HEAD FORMAT
02/8)-!4%
0,53 -$ IS A
HIGH
VALUE LOW
COST SKIN STAPLER
THAT PERMITS MULTI
DIRECTIONAL
RELEASE IN AN ERGONOMIC DESIGN
&)'52%
!$*534-%.4
/&
2%4%.4)/.
35452%
"2)$'%
0ASS THE RETENTION SUTURE
THROUGH APPROPRIATE HOLES IN
THE BRIDGE
0LACE THE SUTURE WITH TENSION
OVER THE SLIT IN THE CAPSTAN
AND TIE
4O ADJUST TENSION LIFT CAPSTAN
2OTATE CAPSTAN UNTIL DESIRED
TENSION IS ATTAINED
,//0%$ 35452%
%4()#/. LOOPED SUTURES RANGE IN
LENGTH UP TO A
INCH STRAND WITH
BOTH ENDS SWAGED TO A SINGLE TAPER
POINT NEEDLE !VAILABLE IN VARIOUS
MATERIALS AND SUTURE SIZES THEY
PROVIDE A SIMPLE RELIABLE TECHNIQUE
FOR CONTINUOUS CLOSURE OF THE FASCIA
OF THE ABDOMINAL WALL 4HE NEEDLE
OF THE LOOPED SUTURE IS PASSED
THROUGH THE FASCIA FROM INSIDE OUT
AT ONE END OF THE INCISION THEN
THROUGH THE OPPOSITE WOUND EDGE
FROM OUTSIDE IN AND THEN PASSED
THROUGH THE LOOP 4HE LOCKING STITCH
LIES BENEATH THE WOUND EDGE 4HE
DOUBLE STRAND IS RUN OVER AND OVER
TO THE OTHER END OF THE INCISION
4HE FINAL STITCH IS COMPLETED BY
PASSING THE NEEDLE FROM THE OUTSIDE
IN CUTTING ONE STRAND AND PASSING
THE NEEDLE THROUGH THE OPPOSITE
WOUND EDGE FROM THE OUTSIDE IN
4HE NEEDLE IS THEN CUT OFF AND
THE LOOSE SUTURE ENDS TIED TOGETHER
LEAVING THE KNOT INVERTED UNDER
THE FASCIA
4O LOCK PRESS CAPSTAN DOWN
INTO BRIDGE
2%4%.4)/.
35452% $%6)#%3
2ETENTION SUTURES IF NOT PLACED
CAREFULLY WITHOUT EXCESSIVE TENSION
CAN CUT THE SKIN $EVICES SUCH AS
BOLSTERS AND BRIDGES ARE USED TO
PREVENT SUCH COMPLICATIONS AND
ELIMINATE PRESSURE (OWEVER CARE
SHOULD ALSO BE TAKEN IN THE USE OF
THESE DEVICES
2ETENTION SUTURE BOLSTERS ARE STERILE
INCH CM LENGTHS OF
INCH
CM DIAMETER SURGICAL LATEX
TUBING WITH A
INCH CM
WALL 4HE SUTURE IS THREADED THROUGH
THE BOLSTER AND TIED 3UTURES
SHEATHED IN THIS MANNER CAN CAUSE
AN INFLAMMATORY RESPONSE WITH
REACTION BOTH AT THE SITE OF THE
SUTURE EXIT FROM THE SKIN AND ALONG
THE ENTIRE LENGTH OF THE SUTURE ITSELF
!LSO THE SKIN MAY BECOME NECROTIC
BENEATH THE BOLSTERS IF THE SUTURES
ARE TOO TIGHT 4HIS INVARIABLY OCCURS
IF THE SUTURES ARE TIGHTLY TIED AT THE
TIME OF THE OPERATION AS SUBSEQUENT
TISSUE EDEMA ENSUES
4RADEMARK
/4(%2 352')#!, 02/$5#43
4HE RETENTION SUTURE BRIDGE IS A
STRONG PLASTIC TRUSS THAT CAN BE
ADJUSTED TO RELIEVE THE PRESSURE OF
THE RETENTION SUTURE ON THE SKIN
DURING AND SUBSEQUENT TO INITIAL
SUTURE PLACEMENT !FTER THE DESIRED
NUMBER OF SUTURES IS PLACED IN THE
WOUND A STERILE BRIDGE IS POSITIONED
OVER EACH RETENTION SUTURE %ACH
SIDE OF THE BRIDGE HAS SIX HOLES
SPACED INCH CM APART TO
ACCOMMODATE MANY PATIENT SIZES
4HE ENDS OF THE SUTURES ARE PASSED
THROUGH THE APPROPRIATE HOLES AND
TIED LOOSELY OVER THE BRIDGE 4HE
SUTURE STRAND IS THEN SLIPPED INTO
THE CAPSTAN LOCATED IN THE MIDDLE
OF THE BRIDGE AND THE CAPSTAN IS
ROTATED TO APPLY THE DESIRED
TENSION BEFORE LOCKING INTO PLACE
4HE BRIDGE PERMITS EASY TENSION
READJUSTMENT BY RAISING AND ROTATING
THE CAPSTAN TO COMPENSATE FOR
POSTOPERATIVE WOUND EDEMA AND
AGAIN WHEN THE EDEMA SUBSIDES
4HE SUTURE REMAINS ELEVATED AWAY
FROM THE SKIN WHILE THE BRIDGE HAS
CONTACT ALONG ITS ENTIRE
INCH
CM LENGTH 0RESSURE IS EVENLY
DISTRIBUTED OVER THE AREA AND THE
TRANSPARENT BRIDGE FACILITATES COM
PLETE VISUALIZATION OF THE WOUND
2%&%2%.#%3
3INGER !DAM * ,ACERATIONS AND
!CUTE 7OUNDS !N %VIDENCE
"ASED
'UIDE &! $AVIS #OMPANY
P
3KERRIS $AVID ! -AYO #LINIC
"ASIC 3URGERY 3KILLS -AYO #LINIC
3CIENTIFIC 0RESS P
CHAPTER 7
PRODUCT TERMS
AND TRADEMARKS
02/$5#4 4%2-3 !.$ 42!$%-!2+3
!"3/2"!",% 35452%
#(2/-)# 352')#!, '54
#/-0/5.$ #526%$ .%%$,%
3UTURES WHICH ARE BROKEN DOWN AND
EVENTUALLY ABSORBED BY EITHER
HYDROLYSIS SYNTHETIC ABSORBABLE
SUTURES OR DIGESTION BY LYSOSOMAL
ENZYMES ELICITED BY WHITE BLOOD
CELLS SURGICAL GUT AND COLLAGEN
'UT SUTURE WHICH HAS BEEN TREATED
BY CHROMIUM SALTS TO RESIST
DIGESTION BY LYSOSOMAL ENZYMES
.EEDLE THAT INCORPORATES TWO
CURVATURES IN ONE NEEDLE A TIGHT
CURVE AT THE TIP AND A MORE GRADUAL
CURVE THROUGH THE BODY 5SED FOR
PRECISE POSITIONING OF SUTURES FOR
COMEALSCLERAL CLOSURE AND FOR
SKIN SUTURING
!002/8)-!4%
"RING TOGETHER SIDES OR EDGES
!42!,/#
352')#!, .%%$,%3
%4()#/.
TRADEMARK FOR EYELESS
NEEDLES PERMANENTLY ATTACHED
SWAGED TO SUTURE STRANDS
" 3 '!5'%
"ROWN AND 3HARPE GAUGE COMMONLY
USED IN HOSPITALS TO IDENTIFY WIRE
DIAMETER %4()#/. STAINLESS STEEL
SUTURE PRODUCTS ARE LABELED WITH
BOTH " 3 GAUGE AND 530 SIZE
"52)%$ 35452%
!NY STITCH MADE AND TIED SO THAT
IT REMAINS COMPLETELY UNDER
THE SURFACE
#!,#)&)%$ #/2/.!29
.%%$,% ##
! 4!0%2#54
SURGICAL NEEDLE
WITH A CUTTING TIP AND SLIM
TAPER RATIO FOR SIGNIFICANT EASE OF
PENETRATION WHEN SUTURING TOUGH
VALVE CUFFS OR ATHEROSCLEROTIC VESSELS
#!2$)/6!3#5,!2 35452%3
3WAGED SUTURES DESIGNED TO MEET THE
SPECIFIC NEEDS OF HEART AND BLOOD
VESSEL SURGERY
#!4'54
/UTMODED TERM FOR SURGICAL
GUT SUTURE
#(2/-)#):).'
%4()#/. PROCESS FOR PRODUCING
CHROMIC GUT %ACH RIBBON OF
SURGICAL GUT IS BATHED IN A
CHROMIUM SALT SOLUTION BEFORE
SPINNING INTO STRANDS TO PROVIDE
UNIFORM CONTROLLED ABSORPTION
#/.4!-).!4%
4O CAUSE A STERILE OBJECT OR SURFACE
TO BECOME UNSTERILE
#/!4%$ 6)#29,
0/,9',!#4). 35452%
#/.4).5/53 35452%
4%#(.)15%
%4()#/. TRADEMARK FOR SYNTHETIC
ABSORBABLE SUTURE EXTRUDED FROM A
COPOLYMER OF GLYCOLIDE AND LACTIDE
AND COATED WITH A MIXTURE OF
POLYGLACTIN AND CALCIUM
STEARATE
3INGLE SUTURE STRAND PASSED BACK AND
FORTH BETWEEN THE TWO EDGES OF THE
WOUND TO CLOSE A TISSUE LAYER TIED
ONLY AT EACH END OF THE SUTURE LINE
#/!4%$ 6)#29,
0LUS
!.4)"!#4%2)!,
0/,9',!#4). 35452%
%4()#/. TRADEMARK FOR SYNTHETIC
ABSORBABLE SUTURE EXTRUDED FROM A
COPOLYMER OF GLYCOLIDE AND LACTIDE
POLYGLACTIN AND CALCIUM
STEARATE 4HE FIRST AND ONLY SUTURE
THAT PROTECTS AGAINST BACTERIAL
COLONIZATION OF THE SUTURE
#/!4%$ 6)#29,
2!0)$%
0/,9',!#4). 35452%
%4()#/. TRADEMARK FOR BRAIDED
RAPIDLY ABSORBING SYNTHETIC SUTURE
EXTRUDED FROM A COPOLYMER OF
GLYCOLIDE AND LACTIDE AND COATED
WITH A MIXTURE OF POLYGLACTIN
AND CALCIUM STEARATE
#/"!,4
3OURCE OF IRRADIATION USED BY
%4()#/. ).# TO STERILIZE SOME
SUTURE MATERIALS !LSO USED IN
HOSPITALS TO TREAT SOME CANCER
PATIENTS
#/.42/, 2%,%!3%
.%%$,%
%4()#/. TRADEMARK FOR SWAGING
METHOD WHICH PERMITS FAST AND
CONTROLLED SEPARATION OF THE NEEDLE
FROM THE SUTURE MATERIAL
#/.6%.4)/.!,
#544).' .%%$,%
.EEDLE WITH TRIANGULAR POINT AND
CUTTING EDGE ALONG INNER CURVATURE
OF NEEDLE BODY
#/2.%!, "%!$%$
2%42!#4)/. 35452%
3WAGED SUTURE STRAND WITH A SMALL
BEAD OF EPOXY USED TO ELEVATE CORNEA
FOR PLACEMENT OF INTRAOCULAR LENS
#3 5,4)-!
/0(4(!,-)# .%%$,% #3
%4()#/. TRADEMARK FOR NEEDLE
WITH REDUCED SIDE EDGE ANGLES
PROVIDING EXCELLENT PENETRATION
NECESSARY FOR OPHTHALMIC SURGERY
$ESIGN FACILITATES KNOT ROTATION
DURING SURGERY
#(!04%2
#54)#5,!2 35452%3
%
0!#+
02/#%$52% +)4
%6)3#%2!4)/.
3UTURES DESIGNED FOR SKIN CLOSURE
%4()#/. TRADEMARK FOR SINGLE
OVERWRAPPED ORGANIZER TRAY
CONTAINING MULTIPLE %4()#/.
SUTURE PRODUCTS %ACH %
0!#+ KIT
MAY BE CUSTOMIZED WITH CHOICE OF
SUTURES FOR SPECIFIC PROCEDURES OR
SURGEON PREFERENCES
0ROTRUSION OF BOWEL THROUGH
SEPARATED EDGES OF ABDOMINAL
WOUND CLOSURE
$%!$ 30!#%
0OCKETS LEFT IN A TISSUE LAYER WHEN
TISSUES ARE NOT IN CLOSE
APPROXIMATION
$%#/.4!-).!4)/.
0ROCESS USED TO DESTROY
MICROORGANISMS KNOWN OR THOUGHT
TO BE PRESENT ON A SURFACE OR OBJECT
$%()3#%.#%
4OTAL OR PARTIAL SEPARATION OF
WOUND EDGES
$%2-!"/.$
4/0)#!, 3+). !$(%3)6%
/#49, #9!./!#29,!4%
%4()#/. TRADEMARK FOR STERILE
LIQUID TOPICAL SKIN ADHESIVE FOR
APPROXIMATION OF WOUND EDGES OF
TRAUMA
INDUCED LACERATIONS OR
SURGICAL INCISIONS
$)30%.3%2 "/8%3
'RAVITY
FED VERTICAL OR HORIZONTAL
BOXES THAT READILY DISPENSE WOUND
CLOSURE PRODUCTS ,ABELS ON BOXES
INCLUDE PRODUCT INFORMATION
$/5",%
!2-%$ 35452%
3UTURE STRAND WITH A NEEDLE SWAGED
AT EACH END
%!39 !##%33
0!#+!').'
%4()#/. TRADEMARK FOR PATENTED
DELIVERY SYSTEM THAT PRESENTS THE
NEEDLE IN POSITION FOR IMMEDIATE
ARMING IN THE NEEDLEHOLDER AS SOON
AS THE PRIMARY PACKET IS OPENED
%4(!,,/9
.%%$,% !,,/9
%4()#/. TRADEMARK FOR EXCLUSIVE
PATENTED STAINLESS STEEL ALLOY THAT IS
PERCENT STRONGER THAN NEEDLES
MADE OF 3ERIES STAINLESS
STEEL 0ROVIDES IMPROVED TISSUE
PENETRATION SMOOTHER NEEDLE
TO
SUTURE TRANSITION AND BETTER FLOW
THROUGH TISSUE
%4()"/.$
%8#%,
0/,9%34%2 35452%
%4()#/. TRADEMARK FOR BRAIDED
POLYESTER SUTURE COATED WITH
POLYBUTILATE COATING
%4()'5!2$
",5.4
0/).4 .%%$,%
%4()#/. TRADEMARK FOR SPECIALLY
DESIGNED NEEDLE WHICH HAS A
ROUNDED TIP
%4(),/.
.9,/. 35452%
%4()#/. TRADEMARK FOR SUTURES
MADE OF MONOFILAMENT NYLON
%4()
0!#+
02%
#54 35452%
%4()#/. TRADEMARK FOR
PRE
CUT STRANDS OF NONABSORBABLE
SUTURES WITHOUT NEEDLES STERILE
AND NONSTERILE
%80)2!4)/. $!4%
$ATE ON A SUTURE PRODUCT
REPRESENTING THE TIME THROUGH
WHICH SATISFACTORY STABILITY STUDIES
HAVE BEEN CARRIED OUT
%84253)/. /& +./43 +./4
%84253)/. /2 30)44).'
!TTEMPT BY THE HUMAN BODY TO RID
ITSELF OF NONABSORBABLE SUTURES OR
ABSORBABLE SUTURES WHICH ARE NOT
COMPLETELY ABSORBED hFOREIGN
BODIESv 3UTURE KNOTS ENCAPSULATED
BY CELLS MAY WORK THEIR WAY TO THE
SKIN SURFACE MONTHS OR EVEN YEARS
AFTER SURGERY
&!3#)!
!REOLAR TISSUE LAYERS UNDER THE SKIN
SUPERFICIAL FASCIA OR FIBROUS TISSUE
BETWEEN MUSCLES AND FORMING THE
SHEATHS OF MUSCLES OR INVESTING
OTHER STRUCTURES SUCH AS NERVES OR
BLOOD VESSELS DEEP FASCIA
&$!
!BBREVIATION FOR FEDERAL &OOD AND
$RUG !DMINISTRATION
'!342/).4%34).!, 35452%3
3UTURES DESIGNED FOR USE IN
ANASTOMOSIS OF BOWEL AND STOMACH
SURGERY
'!5'%
%4(9,%.% /8)$% '!3
4ERM USED TO EXPRESS DIAMETER OF
SUTURE STRAND
#HEMICAL AGENT USED TO STERILIZE
SOME SUTURE MATERIALS
'%.%2!, #,/352% 35452%3
3UTURES USED IN CLOSING FASCIA
PARTICULARLY IN THE ABDOMINAL WALL
!LSO FOR HERNIA REPAIR AND OTHER
FASCIAL DEFECTS
4RADEMARK
02/$5#4 4%2-3 !.$ 42!$%-!2+3
'%.4,% "%.$
0!#+!'%
,!"92).4(
0!#+!'%
%4()#/. TRADEMARK FOR
PACKAGING DESIGNED TO DELIVER
MONOFILAMENT 02/,%.%
POLYPROPYLENE SUTURE TO THE SURGICAL
FIELD IN A STRAIGHT USABLE FORM
%4()#/. TRADEMARK FOR UNIQUE
PACKAGE THAT DISPENSES STRAIGHT
KINK
FREE PRE
CUT NONABSORBABLE
SUTURES
(%-/
3%!,
.%%$,% 35452%
%4()#/. TRADEMARK FOR A
NEEDLESUTURE COMBINATION
MANUFACTURED USING A SWAGING
METHOD THAT PROVIDES A SMOOTHER
NEEDLE
TO
SUTURE TRANSITION
"ENEFICIAL IN REDUCING LEAKAGE
FROM THE SUTURE LINE ESPECIALLY IN
CARDIOVASCULAR PROCEDURES
(9$2/,93)3
#HEMICAL PROCESS WHEREBY A
COMPOUND OR POLYMER REACTS WITH
WATER TO CAUSE AN ALTERATION OR
BREAKDOWN OF THE MOLECULAR
STRUCTURE 3YNTHETIC ABSORBABLE
SUTURES ARE DEGRADED IN VIVO BY
THIS MECHANISM
,)'!0!+
$)30%.3).' 2%%,
%4()#/. TRADEMARK FOR DISC
LIKE
PLASTIC REEL THAT CONTAINS AND
DISPENSES SUTURE FOR LIGATION
,)'!0!+ ,)'!452%
,)'!4).' 2%%,
-)#2/
0/).4
30!45,! .%%$,%
4UBE PLASTIC DISC OR OTHER DEVICE
FROM WHICH CONTINUOUS LIGATING
MATERIAL IS UNWOUND AS BLOOD VESSELS
ARE TIED
,)'!452%
3TRAND OF MATERIAL USED TO TIE OFF A
BLOOD VESSEL
)NVASION OF BODY TISSUE BY A
PATHOGEN
3INGLE STRAND OF SUTURE MATERIAL
WITH BOTH ENDS SWAGED ONTO A
SINGLE NEEDLE
+%)4( .%%$,% +3
3TRAIGHT NEEDLE WITH CUTTING EDGES
USED PRIMARILY FOR ABDOMINAL SKIN
CLOSURE .AMED FOR A 3COTTISH
SURGEON $R 4HOMAS +EITH WHO
MADE THE NEEDLE POPULAR
+).+
5NDESIRABLE DEFORMATION OF A
STRAND SUCH AS A SHARP BEND IN WIRE
-%23),%.%
0/,9%34%2
&)"%2 35452%
%4()#/. TRADEMARK FOR UNCOATED
BRAIDED NONABSORBABLE SUTURE
MATERIAL MADE OF POLYESTER POLYMER
,//0%$ 35452%
3INGLE STITCHES SEPARATELY PLACED
TIED AND CUT
%4()#/. TRADEMARK FOR A FLAT
BAND MM WIDE 5SEFUL AS A
CERCLAGE LIGATURE IN PATIENTS WITH AN
INCOMPETENT CERVIX !LSO USED FOR
BLADDER SUPPORT OR REPAIR AND
SUPPORT OF THE ROTATOR CUFF IN
THE SHOULDER
%4()#/. TRADEMARK FOR A LENGTH
OF SUTURE MATERIAL WOUND ON A REEL
PRIMARILY USED FOR LIGATING
).&%#4)/.
).4%22504%$ 35452%
4%#(.)15%
-%23),%.%
0/,9%34%2 &)"%2
342)04!0%
-%23),%.%
0/,9%34%2
&)"%2 -%3(
%4()#/. TRADEMARK FOR MACHINE
KNITTED FABRIC WHICH IS USED IN
HERNIA REPAIR AND OTHER FASCIAL
DEFICIENCIES THAT REQUIRE ADDITION OF
A REINFORCING OR BRIDGING MATERIAL
%4()#/. TRADEMARK FOR
SIDE
CUTTING OPHTHALMIC NEEDLES
WHICH ARE THIN AND FLAT IN PROFILE
AND SPECIALLY HONED FOR EXCEPTIONAL
SHARPNESS
-)#2/
0/).4
352')#!, .%%$,%
%4()#/. TRADEMARK FOR
OPHTHALMIC NEEDLES WHICH ARE
HONED AND POLISHED TO AN EXTREMELY
FINE FINISH AND SHARPNESS
-)#2/352'%29 35452%3
3UTURES FOR SURGERIES IN WHICH AN
OPERATING MICROSCOPE MAY BE USED
TO VISUALIZE THE VERY SMALL STRUCTURES
INVOLVED EG BLOOD VESSELS
AND NERVES
-),
5NIT OF LINEAR MEASUREMENT
EQUIVALENT TO INCH &REQUENTLY
USED TO EXPRESS WIRE DIAMETER OF
SURGICAL NEEDLES
#(!04%2
-/$5,!2 35452%
34/2!'% 2!#+
0LASTIC MODULES OF EXPANDABLE
INTERLOCKING UNITS THAT PROVIDE NEAT
CONVENIENT STORAGE OF %4()#/.
SUTURE DISPENSER BOXES
-/./#29,
0/,)',#!02/.% 35452%
%4()#/. TRADEMARK FOR
MONOFILAMENT SYNTHETIC ABSORBABLE
SUTURE PREPARED FROM A COPOLYMER
OF GLYCOLIDE AND E
CAPROLACTONE
-/./&),!-%.4
! SINGLE FILAMENT STRAND
-5,4)&),!-%.4
./.!"3/2"!",% 35452%
0%2-!
(!.$
3),+ 35452%
-ATERIAL WHICH TISSUE ENZYMES CAN
NOT DISSOLVE 2EMAINS ENCAPSULATED
WHEN BURIED IN TISSUES 2EMOVED
POSTOPERATIVELY WHEN USED AS SKIN
SUTURE
%4()#/. TRADEMARK FOR SUTURES
SPECIALLY PROCESSED TO REMOVE GUM
AND IMPURITIES FROM RAW SILK BEFORE
BRAIDING SELECTED SIZES INTO STRANDS
!LSO TREATED WITH MISMO BEESWAX TO
REDUCE CAPILLARITY
.9,/.
3YNTHETIC SUTURE MATERIAL MADE OF
POLYAMIDE POLYMER
/"
'9. 35452%3
.EEDLESUTURE COMBINATIONS
PARTICULARLY USEFUL IN OBSTETRIC AND
GYNECOLOGICAL OPERATIONS
/0(4(!,-)# 35452%3
0,!). 352')#!, '54
5NTREATED ABSORBABLE SUTURE WITH
SHORT
TERM ABSORPTION PROFILE
0,!34)# 352'%29 35452%3
3UTURES SPECIFICALLY DESIGNED TO
ASSIST THE SURGEON IN OBTAINING
EXCELLENT COSMETIC RESULTS IN PLASTIC
AND RECONSTRUCTIVE SURGERY
3TRAND MADE OF MORE THAN ONE
TWISTED OR BRAIDED FILAMENT
3MALL GAUGE SUTURES ATTACHED TO
ULTRAFINE NEEDLES THAT MEET EXACTING
NEEDS IN OPHTHALMIC SURGERY
-5,4)0!33 .%%$,%
/6%272!0
3MALL PIECES OF 4&% POLYMER FELT
USED AS A BUTTRESS UNDER SUTURES IN
CARDIOVASCULAR SURGERY
%XTERIOR PACKET WHICH PROTECTS THE
STERILITY OF INNER SUTURE PACKET
0/,9"54),!4%
%4()#/. TRADEMARK FOR PATENTED
COATING PROCESS THAT ENHANCES NEEDLE
PERFORMANCE OVER MULTIPLE PENETRATIONS
-5,4)
342!.$ 0!#+!'%
-ULTIPLE SWAGED SUTURES OF ONE TYPE
SUPPLIED IN A SINGLE PACKET
.%%$,%(/,$%2
3URGICAL INSTRUMENT USED TO HOLD
AND DRIVE A SURGICAL NEEDLE DURING
SUTURING
.%%$,%35452%
*5.#4)/. 37!'%
0OINT AT WHICH EYELESS NEEDLES AND
SUTURE STRANDS ARE JOINED
.52/,/.
"2!)$%$
.9,/. 35452%
%4()#/. TRADEMARK FOR
MULTIFILAMENT BRAIDED NYLON SUTURE
0!#+!'% ).3%24
#OMPLETE PRODUCT INFORMATION
INSERTED IN EVERY BOX OF WOUND
CLOSURE PRODUCTS AS REQUIRED BY
THE &$!
0# 02)-%
.%%$,% 0#
%4()#/. TRADEMARK FOR A
CONVENTIONAL CUTTING NEEDLE WITH A
GEOMETRY THAT REDUCES THE ANGLE OF
THE CUTTING EDGE 2EQUIRES LESS FORCE
TO PENETRATE TISSUE MINIMIZING
TISSUE TRAUMA IN PRECISION
COSMETIC SURGERY
0$3
)) 0/,9$)/8!./.%
35452%
%4()#/. TRADEMARK FOR
MONOFILAMENT SYNTHETIC ABSORBABLE
SUTURE PREPARED FROM THE POLYESTER
POLY P
DIOXANONE
0,%$'%43
! NONABSORBABLE NONREACTIVE
POLYESTER LUBRICANT DEVELOPED BY
%4()#/. ).# AS A COATING FOR
%4()"/.$ %8#%, SUTURES
0/,9%34%2 &)"%2
3YNTHETIC MATERIAL MADE OF A
POLYESTER POLYMER OF POLYETHYLENE
TEREPHTHALATE
0/,902/09,%.%
3YNTHETIC MATERIAL OF AN ISOTACTIC
CRYSTALLINE STEREOISOMER OF A LINEAR
HYDROCARBON POLYMER WHICH WILL
NOT ABSORB FLUIDS
0/,902/09,%.% "544/.3
3YNTHETIC MATERIAL MADE INTO
BUTTONS 5SEFUL IN ORTHOPAEDIC
PROCEDURES SUCH AS TENDON REPAIR
3UTURES ARE TIED OVER BUTTONS TO
RELIEVE UNDERLYING SKIN OF EXCESSIVE
PRESSURE
4RADEMARK
02/$5#4 4%2-3 !.$ 42!$%-!2+3
02%#)3)/. #/3-%4)#
.%%$,% 0#
02/,%.%
0/,902/09,%.%
35452%
#ONVENTIONAL CUTTING NEEDLES
SPECIALLY POLISHED AND CAREFULLY
HONED FOR AESTHETIC PLASTIC SURGERY
%4()#/. TRADEMARK FOR SYNTHETIC
NONABSORBABLE SUTURE MATERIAL MADE
OF MONOFILAMENT POLYPROPYLENE
02%#)3)/. 0/).4 .%%$,%
02/./6!
0/,9
(%8!&,5/2/02/09,%.%
6$&
35452%
2EVERSE
CUTTING NEEDLES SPECIALLY
POLISHED AND CAREFULLY HONED FOR
PLASTIC SURGERY
02%
#54 35452%3
3TRANDS OF SUTURE MATERIAL PACKAGED
PRE
CUT INTO VARIOUS LENGTHS
02)-!29 0!#+%4
3UTURE PACKET WHICH CONTAINS THE
STERILE SUTURE
02)-!29 7/5.$ #,/352%
4HE APPROXIMATION OF WOUND EDGES
TO FACILITATE RAPID HEALING
02/$5#4 #/$%
.UMBERS OR COMBINATION OF LETTERS
AND NUMBERS WHICH IDENTIFY A
SPECIFIC PRODUCT
02/,%.%
0/,902/09,%.%
(%2.)! 3934%-
%4()#/. TRADEMARK FOR A STERILE
PRE
SHAPED THREE
DIMENSIONAL
DEVICE CONSTRUCTED OF AN ONLAY PATCH
CONNECTED BY A MESH CYLINDER TO A
CIRCULAR UNDERLAY PATCH 5SED FOR
THE REPAIR OF INDIRECT AND DIRECT
INGUINAL HERNIA DEFECTS
02/,%.%
0/,902/09,%.%
-%3(
%4()#/. TRADEMARK FOR MESH
MADE OF POLYPROPYLENE WHICH IS
KNITTED BY A PROCESS WHICH INTER
LINKS EACH FIBER JUNCTURE 5SED FOR
THE REPAIR OF ABDOMINAL WALL DEFECTS
AND TISSUE DEFICIENCIES
%4()#/. TRADEMARK FOR SYNTHETIC
NONABSORBABLE SUTURE MATERIAL MADE
OF A POLYMER BLEND OF POLY
VINYLIDENE FLUORIDE AND POLY
VINYLIDENE FLUORIDE
COHEXAFLUORO
PROPYLENE
02/8)
342)0
3+). #,/352%3
%4()#/. TRADEMARK FOR ADHESIVE
STRIPS USED FOR SKIN CLOSURE
2%,!9
35452%
$%,)6%29 3934%-
%4()#/. TRADEMARK FOR THE
PACKAGING OF SINGLE STRAND AND
MULTISTRAND SUTURES 0ROVIDES
DELIVERY OF ONE SUTURE AT A TIME
ONE
STEP ARMING INDIVIDUAL NEEDLE
PARKS AND STRAIGHT TANGLE
FREE
SUTURES READY FOR USE
2%4%.4)/. 35452%
"/,34%23
3URGICAL TUBING USED TO SHEATH
RETENTION SUTURES TO PREVENT CUTTING
THE SKIN !LSO KNOWN AS "OOTIES
2%4%.4)/. 35452% "2)$'%
#LEAR PLASTIC DEVICE DESIGNED WITH A
CAPSTAN TO PERMIT POSTOPERATIVE
WOUND MANAGEMENT BY ADJUSTING
THE TENSION OF RETENTION SUTURES
PREVENTING SUTURE CROSSHATCHING ON
THE SKIN
2%6%23% #544).' .%%$,%
.EEDLES PRODUCED BY %4()#/.
0RODUCTS WHICH HAVE TRIANGULAR
SHAPETHROUGHOUT THEIR ENTIRE LENGTH
AND CUTTING EDGE ALONG THE OUTSIDE
NEEDLE CURVATURE TO PREVENT
TISSUE CUTOUT .EEDLES WITH
LONGITUDINAL GROOVES ON THE INNER
AND OUTER FLATTENED CURVATURES 2IBS
ENGAGE THE NEEDLEHOLDER JAW AND
HELP TO MINIMIZE MOVEMENT OF THE
NEEDLE IN THE NEEDLEHOLDER
3!"2%,/#
30!45,! .%%$,%
%4()#/. TRADEMARK FOR
OPHTHALMIC NEEDLES 3IDE
CUTTING
SPATULA
SHAPED EDGES SEPARATE THE
ULTRATHIN LAYERS OF SCLERAL OR COMEAL
TISSUE WITHOUT CUTTING THROUGH
3!&%49 /2'!.):%2 42!9
%4()#/. DESIGN FOR A SUTURE TRAY
WHICH DELIVERS MULTISTRAND PRODUCTS
/FFERS SINGLE STRAND DELIVERY AND A
SINGULATED NEEDLE PARK WHICH
PERMITS ONE
STEP ARMING AND
TANGLEFREE STRAIGHT SUTURE STRANDS
3%#/.$!29 #,/352%
2ETENTION SUTURES PLACED
APPROXIMATELY INCHES FROM WOUND
EDGES TO REINFORCE PRIMARY CLOSURE
AND PROTECT IT FROM STRESS
3)$%
&,!44%.%$ .%%$,%3
#ONFIGURATION OF STAINLESS STEEL ALLOY
NEEDLES DESIGNED TO INCREASE
STRENGTH AND REDUCE BENDING WHEN
PENETRATING VASCULAR PROSTHESES OR
CALCIFIED TISSUES
3).',% 342!.$ $%,)6%29
4ERMINOLOGY USED TO DESCRIBE THE
DELIVERY OF ONE STRAIGHT SUTURE AT A
TIME FROM THE 2%,!9 SUTURE
DELIVERY SYSTEM
#(!04%2
42!.36%23% '2/5.$
.%%$,%3 4'
34%2),%
35452% "//+
&REE OF LIVING MICROORGANISMS
BACTERIA AND THEIR SPORES
VIRUSES ETC
3TERILE TOWEL FOLDED BY THE SCRUB
PERSON AND USED TO CONTAIN MULTIPLE
SUTURES
34%2),% 4%#(.)15%
37!'%$ 35452%
#OLLECTIVELY ALL THE EFFORTS MADE AND
PROCEDURES FOLLOWED TO EXCLUDE
MICROORGANISMS FROM THE OPERATIVE
WOUND AND FIELD
3TRAND OF MATERIAL WITH EYELESS NEE
DLE ATTACHED BY THE MANUFACTURER
34%2),):!4)/.
0ROCESS BY WHICH ALL LIVING
MICROORGANISMS ON AN OBJECT ARE
DESTROYED
%4()#/. TRADEMARK FOR A NEEDLE
WHICH HAS A TRIANGULAR TIP WITH
THREE CUTTING EDGES 2EMAINDER OF
NEEDLE HAS A GRADUALLY TAPERED BODY
%4()#/. PROCESS OF TREATING SILK
FOR NONCAPILLARITY
350%2 3-//4( &).)3(
4!0%2 0/).4 .%%$,% 40
45").' &,5)$
!N EXCLUSIVE PROCESS THAT PROVIDES A
FINISH ON MOST %4()#/. NEEDLES
ENABLING THE NEEDLES TO PENETRATE
AND PASS THROUGH THE TOUGHEST TISSUE
WITH MINIMAL RESISTANCE
.EEDLE WITH A BODY THAT GRADUALLY
TAPERS TO A SHARP POINT MAKING THE
SMALLEST POSSIBLE HOLE IN TISSUE
3OLUTION INSIDE PACKETS OF SURGICAL
GUT AND COLLAGEN 0URPOSE IS TO
MAINTAIN MATERIAL AND NEEDLE IF
ATTACHED IN OPTIMUM CONDITION FOR
IMMEDIATE USE UPON WITHDRAWAL
FROM THE PACKET
352')#!, '54
!BSORBABLE SUTURE MADE FROM
SEROSAL LAYER OF BEEF INTESTINE OR
SUBMUCOSAL LAYER OF SHEEP INTESTINE
352')#!, 34!).,%33
34%%, 35452%
.ONABSORBABLE SUTURE MADE OF
, STEEL ALLOY
35450!+
02%
#54
34%2),% 35452%3
%4()#/. TRADEMARK FOR PACKET
CONTAINING MULTIPLE PRE
CUT LENGTHS
OF SUTURE MATERIAL WITHOUT NEEDLES
STERILE AND READY FOR IMMEDIATE USE
35452%
-ATERIAL USED TO APPROXIMATE
SEW TISSUES OR TIE OFF LIGATE
BLOOD VESSELS
4!0%2#54
352')#!, .%%$,%
4%.3),% 342%.'4(
!MOUNT OF TENSION OR PULL
EXPRESSED IN POUNDS WHICH A
SUTURE STRAND WILL WITHSTAND BEFORE
IT BREAKS
4)%3 ,)'!452%3
3TRANDS OF SUTURE USED TO TIE OFF THE
ENDS OF SEVERED BLOOD VESSELS FREE
OR FREEHANDSINGLE STRANDS USED AS
INDIVIDUAL TIES CONTINUOUSLONG
STRANDS UNWOUND FROM A REEL OR
OTHER DEVICE AS BLOOD VESSELS ARE
TIED SUTURE LIGATURESTRAND ON A
NEEDLE USED TO TRANSFIX SUTURE A
LARGE BLOOD VESSEL TO ENSURE SECURITY
AGAINST KNOT SLIPPAGE STICK TIEA
SUTURE LIGATURE OR A SINGLE STRAND
HANDED TO SURGEON FOR LIGATING WITH
A HEMOSTAT CLAMPED ON ONE SUTURE
END TRANSFIXION SUTURESUTURE
LIGATURE
3PATULATED OPHTHALMIC NEEDLES
SPECIALLY HONED TO A LONG SHARP
SLIM TIP
425
'!5').'
%4()#/. PROCESS WHICH ENSURES
UNIFORM DIAMETER AND UNIFORMLY
HIGHER TENSILE STRENGTH OF
SURGICAL GUT
425
0%2-!.):).'
5-"),)#!, 4!0%
7OVEN COTTON TAPE CLASSIFIED AS A
LIGATURE USED AS A GENTLE MEANS OF
RETRACTING VESSELS IN CARDIOVASCULAR
AND PEDIATRIC SURGERY AND FOR TYING
OFF THE UMBILICUS OF THE NEWBOM
52/,/')#!, 35452%3
3UTURES DESIGNED TO MEET THE NEEDS
OF SURGERY PERFORMED BY UROLOGISTS
&EATURES CIRCLE NEEDLES WHICH
TURN OUT OF TISSUE QUICKLY
6)#29,
0/,9',!#4).
-%3(
%4()#/. TRADEMARK FOR MESH
PREPARED FROM A COPOLYMER OF
GLYCOLIDE AND LACTIDE !N ABSORBABLE
MATERIAL USED AS A BUTTRESS TO
PROVIDE TEMPORARY SUPPORT DURING
HEALING
4RADEMARK
02/$5#4 4%2-3 !.$ 42!$%-!2+3
6)#29,
0/,9',!#4).
0%2)/$/.4!, -%3(
%4()#/. TRADEMARK FOR MESH
PREPARED FROM A COPOLYMER OF GLY
COLIDE AND LACTIDE !N ABSORBABLE
MATERIAL USED IN PERIODONTAL SURGERY
FOR GUIDED TISSUE REGENERATION
6)3)
",!#+
352')#!,
.%%$,%3
%4()#/. TRADEMARK FOR SURGICAL
NEEDLES WITH A BLACK SURFACE
FINISH TO ENHANCE VISIBILITY IN THE
OPERATIVE SITE
7/5.$ $)32504)/.
3EPARATION OF WOUND EDGES
4RADEMARK
CHAPTER 8
PRODUCT INFORMATION
02/$5#4 ).&/2-!4)/.
#OATED 6)#29,
0OLYGLACTIN 3UTURE
$O NOT RESTERILIZE $ISCARD OPENED PACKAGES AND UNUSED SUTURES
!S WITH ANY FOREIGN BODY PROLONGED CONTACT OF ANY SUTURE WITH SALT SOLUTIONS
SUCH AS THOSE FOUND IN THE URINARY OR BILIARY TRACTS MAY RESULT IN CALCULUS
FORMATION !S AN ABSORBABLE SUTURE COATED 6)#29, SUTURE MAY ACT
TRANSIENTLY AS A FOREIGN BODY !CCEPTABLE SURGICAL PRACTICE SHOULD BE FOLLOWED
FOR THE MANAGEMENT OF CONTAMINATED OR INFECTED WOUNDS
530 %8#%04 &/2 $)!-%4%2
$%3#2)04)/.
#OATED 6)#29,
POLYGLACTIN SUTURE IS A SYNTHETIC ABSORBABLE STERILE
SURGICAL SUTURE COMPOSED OF A COPOLYMER MADE FROM GLYCOLIDE AND
,
LACTIDE #OATED 6)#29, SUTURE IS PREPARED BY COATING 6)#29, SUTURE MATERIAL
WITH A MIXTURE COMPOSED OF EQUAL PARTS OF COPOLYMER OF GLYCOLIDE AND LACTIDE
POLYGLACTIN AND CALCIUM STEARATE 0OLYGLACTIN COPOLYMER AND
POLYGLACTIN WITH CALCIUM STEARATE HAVE BEEN FOUND TO BE NONANTIGENIC
NONPYROGENIC AND ELICIT ONLY A MILD TISSUE REACTION DURING ABSORPTION
4HE SUTURES ARE AVAILABLE DYED AND UNDYED NATURAL
#OATED 6)#29, SUTURES ARE 530 EXCEPT FOR DIAMETERS IN THE FOLLOWING SIZES
-!8)-5- 35452% /6%23):% ). $)!-%4%2 MM &2/- 530
530 35452% 3):% $%3)'.!4)/.
-!8)-5- /6%23):% MM
).$)#!4)/.3
#OATED 6)#29, SUTURE IS INDICATED FOR USE IN GENERAL SOFT TISSUE APPROXIMATION
ANDOR LIGATION INCLUDING USE IN OPHTHALMIC PROCEDURES BUT NOT FOR USE IN
CARDIOVASCULAR AND NEUROLOGICAL TISSUES
02%#!54)/.3
3KIN SUTURES WHICH MUST REMAIN IN PLACE LONGER THAN DAYS MAY CAUSE
LOCALIZED IRRITATION AND SHOULD BE SNIPPED OFF OR REMOVED AS INDICATED
5NDER SOME CIRCUMSTANCES NOTABLY ORTHOPAEDIC PROCEDURES IMMOBILIZATION OF
JOINTS BY EXTERNAL SUPPORT MAY BE EMPLOYED AT THE DISCRETION OF THE SURGEON
#ONSIDERATION SHOULD BE TAKEN IN THE USE OF ABSORBABLE SUTURES IN TISSUES WITH
POOR BLOOD SUPPLY AS SUTURE EXTRUSION AND DELAYED ABSORPTION MAY OCCUR
)N HANDLING THIS OR ANY OTHER SUTURE MATERIAL CARE SHOULD BE TAKEN TO AVOID
DAMAGE FROM HANDLING !VOID CRUSHING OR CRIMPING DAMAGE DUE TO APPLICATION
OF SURGICAL INSTRUMENTS SUCH AS FORCEPS OR NEEDLE HOLDERS #OATED 6)#29,
SUTURES WHICH ARE TREATED TO ENHANCE HANDLING CHARACTERISTICS REQUIRE THE
ACCEPTED SURGICAL TECHNIQUE OF FLAT AND SQUARE TIES WITH ADDITIONAL THROWS AS
WARRANTED BY SURGICAL CIRCUMSTANCE AND THE EXPERIENCE OF THE SURGEON
!VOID PROLONGED EXPOSURE TO ELEVATED TEMPERATURES
4O AVOID DAMAGING NEEDLE POINTS AND SWAGE AREAS GRASP THE NEEDLE IN AN AREA
ONE
THIRD TO ONE
HALF OF THE DISTANCE FROM THE SWAGED END TO THE
POINT 2ESHAPING NEEDLES MAY CAUSE THEM TO LOSE STRENGTH AND BE LESS RESISTENT
TO BENDING AND BREAKING 5SERS SHOULD EXERCISE CAUTION WHEN HANDLING
SURGICAL NEEDLES TO AVOID INADVERTENT NEEDLE STICKS $ISCARD USED NEEDLES IN
SHARPS CONTAINER
!$6%23% 2%!#4)/.3
!#4)/.3
#OATED 6)#29, SUTURE ELICITS A MINIMAL ACUTE INFLAMMATORY REACTION IN TISSUE
AND INGROWTH OF FIBROUS CONNECTIVE TISSUE 0ROGRESSIVE LOSS OF TENSILE STRENGTH
AND EVENTUAL ABSORPTION OF COATED 6)#29, SUTURE OCCURS BY MEANS OF
HYDROLYSIS WHERE THE COPOLYMER DEGRADES TO GLYCOLIC AND LACTIC ACIDS WHICH ARE
SUBSEQUENTLY ABSORBED AND METABOLIZED IN THE BODY !BSORPTION BEGINS AS A
LOSS OF TENSILE STRENGTH FOLLOWED BY A LOSS OF MASS )MPLANTATION STUDIES IN RATS
INDICATE THAT COATED 6)#29, SUTURE RETAINS APPROXIMATELY OF THE ORIGI
NAL TENSILE STRENGTH AT TWO WEEKS POST IMPLANTATION !T THREE WEEKS APPROXI
MATELY OF THE ORIGINAL STRENGTH IS RETAINED FOR SIZES
AND LARGER AND
APPROXIMATELY OF ITS ORIGINAL STRENGTH IS RETAINED FOR SIZES
AND SMALLER
!T FOUR WEEKS APPROXIMATELY OF THE ORIGINAL STRENGTH IS RETAINED FOR SIZES
AND LARGER !LL OF THE ORIGINAL TENSILE STRENGTH IS LOST BY FIVE WEEKS POST
IMPLANTATION !BSORPTION OF COATED 6)#29, SUTURE IS ESSENTIALLY COMPLETE
BETWEEN AND DAYS
!002/8)-!4% /2)').!,
$!93 )-0,!.4!4)/.
342%.'4( 2%-!).).'
$AYS
$AYS
AND LARGER
$AYS
AND SMALLER
$AYS
#/.42!).$)#!4)/.3
!DVERSE EFFECTS ASSOCIATED WITH THE USE OF THIS DEVICE INCLUDE WOUND
DEHISCENCE FAILURE TO PROVIDE ADEQUATE WOUND SUPPORT IN CLOSURE OF THE SITES
WHERE EXPANSION STRETCHING OR DISTENSION OCCUR FAILURE TO PROVIDE ADEQUATE
WOUND SUPPORT IN ELDERLY MALNOURISHED OR DEBILITATED PATIENTS OR IN PATIENTS
SUFFERING FROM CONDITIONS WHICH MAY DELAY WOUND HEALING INFECTION MINIMAL
ACUTE INFLAMMATORY TISSUE REACTION LOCALIZED IRRITATION WHEN SKIN SUTURES ARE
LEFT IN PLACE FOR GREATER THAN DAYS SUTURE EXTRUSION AND DELAYED ABSORPTION IN
TISSUE WITH POOR BLOOD SUPPLY CALCULI FORMATION IN URINARY AND BILIARY TRACTS
WHEN PROLONGED CONTACT WITH SALT SOLUTIONS SUCH AS URINE AND BILE OCCURS AND
TRANSITORY LOCAL IRRITATION AT THE WOUND SITE "ROKEN NEEDLES MAY RESULT IN
EXTENDED OR ADDITIONAL SURGERIES OR RESIDUAL FOREIGN BODIES )NADVERTENT NEEDLE
STICKS WITH CONTAMINATED SURGICAL NEEDLES MAY RESULT IN THE TRANSMISSION OF
BLOODBORNE PATHOGENS
(/7 3500,)%$
#OATED 6)#29, SUTURES ARE AVAILABLE STERILE AS BRAIDED DYED VIOLET AND
UNDYED NATURAL STRANDS IN SIZES
THROUGH METRIC SIZES
IN A VARIETY
OF LENGTHS WITH OR WITHOUT NEEDLES AND ON ,)'!0!+
DISPENSING REELS
#OATED 6)#29, SUTURES ARE ALSO AVAILABLE IN SIZE
WITH ATTACHED BEADS FOR
USE IN OPHTHALMIC PROCEDURES #OATED 6)#29, SUTURES ARE ALSO AVAILABLE IN SIZES
THROUGH METRIC SIZES
ATTACHED TO #/.42/, 2%,%!3%
REMOVABLE
NEEDLES #OATED 6)#29, SUTURES ARE AVAILABLE IN ONE TWO AND THREE DOZEN
BOXES
4HIS SUTURE BEING ABSORBABLE SHOULD NOT BE USED WHERE EXTENDED
APPROXIMATION OF TISSUE IS REQUIRED
7!2.).'3
5SERS SHOULD BE FAMILIAR WITH SURGICAL PROCEDURES AND TECHNIQUES INVOLVING
ABSORBABLE SUTURES BEFORE EMPLOYING COATED 6)#29, SUTURE FOR WOUND
CLOSURE AS RISK OF WOUND DEHISCENCE MAY VARY WITH THE SITE OF APPLICATION AND
THE SUTURE MATERIAL USED 0HYSICIANS SHOULD CONSIDER THE IN VIVO PERFORMANCE
UNDER !#4)/.3 SECTION WHEN SELECTING A SUTURE 4HE USE OF THIS SUTURE MAY
BE INAPPROPRIATE IN ELDERLY MALNOURISHED OR DEBILITATED PATIENTS OR IN PATIENTS
SUFFERING FROM CONDITIONS WHICH MAY DELAY WOUND HEALING !S THIS IS AN
ABSORBABLE SUTURE MATERIAL THE USE OF SUPPLEMENTAL NONABSORBABLE SUTURES
SHOULD BE CONSIDERED BY THE SURGEON IN THE CLOSURE OF THE SITES WHICH
MAY UNDERGO EXPANSION STRETCHING OR DISTENTION OR WHICH MAY REQUIRE
ADDITIONAL SUPPORT
4RADEMARK
%4()#/. ).#
#(!04%2
%4(),/.
.9,/. 35452%
./.!"3/2"!",% 352')#!, 35452%3 530
$%3#2)04)/.
%4(),/.
NYLON SUTURE IS A NONABSORBABLE STERILE SURGICAL MONOFILAMENT
SUTURE COMPOSED OF THE LONG
CHAIN ALIPHATIC POLYMERS .YLON AND .YLON
%4(),/. SUTURES ARE DYED BLACK OR GREEN TO ENHANCE VISIBILITY IN TISSUE 4HE
SUTURE IS ALSO AVAILABLE UNDYED CLEAR
02%#!54)/.3
)N HANDLING THIS OR ANY OTHER SUTURE MATERIAL CARE SHOULD BE TAKEN TO AVOID
DAMAGE FROM HANDLING !VOID CRUSHING OR CRIMPING DAMAGE DUE TO APPLICATION
OF SURGICAL INSTRUMENTS SUCH AS FORCEPS OR NEEDLE HOLDERS
!S WITH ANY SUTURE MATERIAL ADEQUATE KNOT SECURITY REQUIRES THE ACCEPTED SUR
GICAL TECHNIQUE OF FLAT AND SQUARE TIES WITH ADDITIONAL THROWS AS WARRANTED BY
SURGICAL CIRCUMSTANCE AND THE EXPERIENCE OF THE SURGEON 4HE USE OF ADDITIONAL
THROWS MAY BE PARTICULARLY APPROPRIATE WHEN KNOTTING MONOFILAMENTS
).$)#!4)/.3
4O AVOID DAMAGING NEEDLE POINTS AND SWAGE AREAS GRASP THE NEEDLE IN AN AREA
ONE
THIRD TO ONE
HALF OF THE DISTANCE FROM THE SWAGED END TO THE POINT
2ESHAPING NEEDLES MAY CAUSE THEM TO LOSE STRENGTH AND BE LESS RESISTANT TO
BENDING AND BREAKING 5SERS SHOULD EXERCISE CAUTION WHEN HANDLING SURGICAL
NEEDLES TO AVOID INADVERTENT NEEDLE STICKS $ISCARD USED NEEDLES IN SHARPS
CONTAINERS
%4(),/. SUTURE IS INDICATED FOR USE IN GENERAL SOFT TISSUE
APPROXIMATION ANDOR LIGATION INCLUDING USE IN CARDIOVASCULAR
OPHTHALMIC AND NEUROLOGICAL PROCEDURES
!$6%23% 2%!#4)/.3
%4(),/. SUTURE MEETS ALL REQUIREMENTS ESTABLISHED BY THE 5NITED 3TATES
0HARMACOPOEIA 530 FOR NONABSORBABLE SURGICAL SUTURE
!#4)/.3
%4(),/. SUTURE ELICITS A MINIMAL ACUTE INFLAMMATORY REACTION IN TISSUE WHICH
IS FOLLOWED BY GRADUAL ENCAPSULATION OF THE SUTURE BY FIBROUS CONNECTIVE TISSUE
7HILE NYLON IS NOT ABSORBED PROGRESSIVE HYDROLYSIS OF THE NYLON IN VIVO MAY
RESULT IN GRADUAL LOSS OVER TIME OF TENSILE STRENGTH
#/.42!).$)#!4)/.3
$UE TO THE GRADUAL LOSS OF TENSILE STRENGTH WHICH MAY OCCUR OVER PROLONGED
PERIODS IN VIVO NYLON SUTURE SHOULD NOT BE USED WHERE PERMANENT RETENTION OF
TENSILE STRENGTH IS REQUIRED
!DVERSE EFFECTS ASSOCIATED WITH THE USE OF THIS DEVICE INCLUDE WOUND DEHIS
CENCE GRADUAL LOSS OF TENSILE STRENGTH OVER TIME CALCULI FORMATION IN URINARY
AND BILIARY TRACTS WHEN PROLONGED CONTACT WITH SALT SOLUTIONS SUCH AS URINE AND
BILE OCCURS INFECTION MINIMAL ACUTE INFLAMMATORY TISSUE REACTION AND TRANSI
TORY LOCAL IRRITATION AT THE WOUND SITE "ROKEN NEEDLES MAY RESULT IN EXTENDED OR
ADDITIONAL SURGERIES OR RESIDUAL FOREIGN BODIES )NADVERTENT NEEDLE STICKS WITH
CONTAMINATED SURGICAL NEEDLES MAY RESULT IN THE TRANSMISSION OF BLOODBORNE
PATHOGENS
(/7 3500,)%$
%4(),/. SUTURES ARE AVAILABLE AS STERILE MONOFILAMENT STRANDS IN 530 SIZES
THROUGH METRIC SIZES
IN A VARIETY OF LENGTHS WITH AND WITHOUT
PERMANENTLY ATTACHED NEEDLES %4(),/. SUTURES ARE AVAILABLE IN ONE TWO AND
THREE DOZEN BOXES
7!2.).'3
5SERS SHOULD BE FAMILIAR WITH SURGICAL PROCEDURES AND TECHNIQUES INVOLVING
NONABSORBABLE SUTURES BEFORE EMPLOYING %4(),/. SUTURE FOR WOUND CLOSURE
AS THE RISK OF WOUND DEHISCENCE MAY VARY WITH THE SITE OF APPLICATION AND THE
SUTURE MATERIAL USED
!S WITH ANY FOREIGN BODY PROLONGED CONTACT OF ANY SUTURE WITH SALT SOLUTIONS
SUCH AS THOSE FOUND IN THE URINARY OR BILIARY TRACTS MAY RESULT IN CALCULUS
FORMATION !CCEPTABLE SURGICAL PRACTICE SHOULD BE FOLLOWED FOR THE MANAGEMENT
OF CONTAMINATED OR INFECTED WOUNDS
$O NOT RESTERILIZE $ISCARD OPEN PACKAGES AND UNUSED SUTURES
4RADEMARK
%4()#/. ).#
02/$5#4 ).&/2-!4)/.
#OATED 6)#29,
2!0)$% 0OLYGLACTIN
"RAIDED #OATED 3YNTHETIC !BSORBABLE
3UTURE 5NDYED
.ON
530
5SERS SHOULD BE FAMILIAR WITH SURGICAL PROCEDURES AND TECHNIQUES INVOLVING
ABSORBABLE SUTURES BEFORE EMPLOYING COATED 6)#29, 2!0)$% SUTURE FOR WOUND
CLOSURE AS A RISK OF WOUND DEHISCENCE MAY VARY WITH THE SITE OF APPLICATION AND
THE SUTURE MATERIAL USED 0HYSICIANS SHOULD CONSIDER THE IN VIVO PERFORMANCE
WHEN SELECTING A SUTURE 4HE USE OF THIS SUTURE MAY BE INAPPROPRIATE IN
ELDERLY MALNOURISHED OR DEBILITATED PATIENTS OR IN PATIENTS SUFFERING FROM
CONDITIONS WHICH MAY DELAY WOUND HEALING
$%3#2)04)/.
$O NOT RESTERILIZE $ISCARD OPENED PACKAGES AND UNUSED SUTURES
#OATED 6)#29,
2!0)$% POLYGLACTIN SUTURE IS A SYNTHETIC ABSORBABLE STER
ILE SURGICAL SUTURE COMPOSED OF A COPOLYMER MADE FROM GLYCOLIDE AND
,
LACTIDE 4HE EMPIRICAL FORMULA OF THE COPOLYMER IS #(/ M#(/ N 4HE
!S WITH ANY FOREIGN BODY PROLONGED CONTACT OF ANY SUTURE WITH SALT SOLUTIONS
SUCH AS THOSE FOUND IN THE URINARY OR BILIARY TRACTS MAY RESULT IN CALCULUS
FORMATION !S AN ABSORBABLE SUTURE COATED 6)#29, 2!0)$% SUTURE MAY ACT
TRANSIENTLY AS A FOREIGN BODY
CHARACTERISTIC OF RAPID LOSS OF STRENGTH IS ACHIEVED BY USE OF A POLYMER MATERI
AL WITH A LOWER MOLECULAR WEIGHT THAN COATED 6)#29,
POLYGLACTIN SUTURE
#OATED 6)#29, 2!0)$% SUTURES ARE OBTAINED BY COATING THE BRAIDED SUTURE
MATERIAL WITH A MIXTURE COMPOSED OF EQUAL PARTS OF COPOLYMER OF GLYCOLIDE AND
LACTIDE POLYGLACTIN AND CALCIUM STEARATE 0OLYGLACTIN COPOLYMER AND
POLYGLACTIN WITH CALCIUM STEARATE HAVE BEEN FOUND TO BE NONANTIGENIC
NONPYROGENIC AND ELICIT ONLY A MILD TISSUE REACTION DURING ABSORPTION
!CCEPTABLE SURGICAL PRACTICE SHOULD BE FOLLOWED FOR THE MANAGEMENT OF
CONTAMINATED OR INFECTED WOUNDS
!S THIS IS AN ABSORBABLE SUTURE MATERIAL THE USE OF SUPPLEMENTAL NONAB
SORBABLE SUTURES SHOULD BE CONSIDERED BY THE SURGEON IN THE CLOSURE OF SITES
WHICH MAY UNDERGO EXPANSION STRETCHING OR DISTENTION OR WHICH MAY REQUIRE
ADDITIONAL SUPPORT
#OATED 6)#29, 2!0)$% SUTURES ARE ONLY AVAILABLE UNDYED
!LTHOUGH THIS SUTURE IS A SYNTHETIC ABSORBABLE SUTURE ITS PERFORMANCE CHARAC
TERISTICS ARE INTENDED TO MODEL THE PERFORMANCE OF COLLAGEN SURGICAL GUT
SUTURE 4HE KNOT TENSILE STRENGTH OF COATED 6)#29, 2!0)$% SUTURE MEETS 530
KNOT TENSILE STRENGTH REQUIREMENTS FOR COLLAGEN SUTURES HOWEVER #OATED
6)#29, 2!0)$% SUTURE STRENGTH IS UP TO LESS THAN KNOT TENSILE STRENGTH
REQUIREMENTS FOR SYNTHETIC ABSORBABLE SUTURES
-!8)-5- 35452% /6%23):% ). $)!-%4%2 MM &2/- 530
530 35452% 3):% $%3)'.!4)/. -!8)-5- /6%23):%MM
).$)#!4)/.3
#OATED 6)#29, 2!0)$% SYNTHETIC ABSORBABLE SUTURE IS INDICATED ONLY FOR USE IN
SUPERFICIAL SOFT TISSUE APPROXIMATION OF THE SKIN AND MUCOSA WHERE ONLY SHORT
TERM WOUND SUPPORT
DAYS IS REQUIRED #OATED 6)#29, 2!0)$% SUTURE IS
NOT INTENDED FOR USE IN LIGATION OPHTHALMIC CARDIOVASCULAR OR NEUROLOGICAL
PROCEDURES
02%#!54)/.3
3KIN SUTURES WHICH REMAIN IN PLACE LONGER THAN DAYS MAY CAUSE LOCALIZED
IRRITATION AND SHOULD BE SNIPPED OFF OR REMOVED AS INDICATED
5NDER SOME CIRCUMSTANCES NOTABLY ORTHOPAEDIC PROCEDURES IMMOBILIZATION OF
JOINTS BY EXTERNAL SUPPORT MAY BE EMPLOYED AT THE DISCRETION OF THE SURGEON
#ONSIDERATION SHOULD BE TAKEN IN THE USE OF ABSORBABLE SUTURES IN TISSUES WITH
POOR BLOOD SUPPLY AS SUTURE EXTRUSION AND DELAYED ABSORPTION MAY OCCUR
)N HANDLING THIS OR ANY OTHER SUTURE MATERIAL CARE SHOULD BE TAKEN TO AVOID
DAMAGE FROM HANDLING !VOID CRUSHING OR CRIMPING DAMAGE DUE TO APPLICATION
OF SURGICAL INSTRUMENTS SUCH AS FORCEPS OR NEEDLE HOLDERS
#OATED 6)#29, 2!0)$% SUTURE WHICH IS TREATED WITH COATING TO ENHANCE
HANDLING CHARACTERISTICS REQUIRES THE ACCEPTED SURGICAL TECHNIQUE OF FLAT AND
SQUARE TIES WITH ADDITIONAL THROWS AS WARRANTED BY SURGICAL CIRCUMSTANCE AND
THE EXPERIENCE OF THE SURGEON
!VOID PROLONGED EXPOSURE TO ELEVATED TEMPERATURES
4O AVOID DAMAGING NEEDLE POINTS AND SWAGE AREAS GRASP THE NEEDLE IN AN AREA
ONE
THIRD TO ONE
HALF OF THE DISTANCE FROM THE SWAGED END TO THE
POINT 2ESHAPING NEEDLES MAY CAUSE THEM TO LOSE STRENGTH AND BE LESS
RESISTANT TO BENDING AND BREAKING
5SERS SHOULD EXERCISE CAUTION WHEN HANDLING SURGICAL NEEDLES TO AVOID IN
ADVERTENT NEEDLE STICKS $ISCARD USED NEEDLES IN hSHARPSv CONTAINERS
!#4)/.3
#OATED 6)#29, 2!0)$% SUTURE WHEN USED IN CLOSURE OF SKIN AND MUCOUS MEM
BRANES TYPICALLY BEGINS TO FALL OFF
DAYS POST
OPERATIVELY AND CAN BE WIPED
OFF SUBSEQUENTLY WITH STERILE GAUZE .ATURAL MECHANICAL ABRASION OF THE SUTURES
WHILE IN SITU MAY ALSO ACCELERATE THIS DISAPPEARANCE RATE 2APID LOSS OF TENSILE
STRENGTH MAY PRECLUDE THE NEED FOR STITCH REMOVAL
#OATED 6)#29, 2!0)$% ELICITS A MINIMAL TO MODERATE ACUTE INFLAMMATORY
REACTION IN TISSUE 0ROGRESSIVE LOSS OF TENSILE STRENGTH AND EVENTUAL ABSORPTION
OF COATED 6)#29, 2!0)$% OCCURS BY MEANS OF HYDROLYSIS WHERE THE COPOLYMER
DEGRADES TO GLYCOLIC AND LACTIC ACIDS WHICH ARE SUBSEQUENTLY ABSORBED AND
METABOLIZED IN THE BODY !BSORPTION BEGINS AS A LOSS OF TENSILE STRENGTH
FOLLOWED BY A LOSS OF MASS
3UBCUTANEOUS TISSUE IMPLANTATION STUDIES OF COATED 6)#29, 2!0)$% SUTURES IN
RATS SHOW THAT DAYS POST
IMPLANTATION APPROXIMATELY OF THE ORIGINAL
TENSILE STRENGTH REMAINS !LL OF THE ORIGINAL TENSILE STRENGTH IS LOST BY APPROXI
MATELY TO DAYS POST
IMPLANTATION )NTRAMUSCULAR IMPLANTATION STUDIES IN
RATS SHOW THAT THE ABSORPTION OF THESE SUTURES OCCURS THEREAFTER AND IS
ESSENTIALLY COMPLETE BY DAYS
#/.42!).$)#!4)/.3
$UE TO THE RAPID LOSS OF TENSILE STRENGTH THIS SUTURE SHOULD NOT BE USED WHERE
EXTENDED APPROXIMATION OF TISSUES UNDER STRESS IS REQUIRED OR WHERE WOUND
SUPPORT BEYOND DAYS IS REQUIRED
!$6%23% 2%!#4)/.3
!DVERSE EFFECTS ASSOCIATED WITH THE USE OF THIS DEVICE INCLUDE WOUND DEHIS
CENCE FAILURE TO PROVIDE ADEQUATE WOUND SUPPORT IN CLOSURE OF THE SITES WHERE
EXPANSION STRETCHING OR DISTENSION OCCUR FAILURE TO PROVIDE ADEQUATE WOUND
SUPPORT IN ELDERLY MALNOURISHED OR DEBILITATED PATIENTS OR IN PATIENTS SUFFERING
FROM CONDITIONS WHICH MAY DELAY WOUND HEALING INFECTION MINIMAL ACUTE
INFLAMMATORY TISSUE REACTION LOCALIZED IRRITATION WHEN SKIN SUTURES ARE LEFT IN
PLACE FOR GREATER THAN DAYS SUTURE EXTRUSION AND DELAYED ABSORPTION IN TISSUE
WITH POOR BLOOD SUPPLY CALCULI FORMATION IN URINARY AND BILIARY TRACTS WHEN PRO
LONGED CONTACT WITH SALT SOLUTIONS SUCH AS URINE AND BILE OCCURS AND TRANSITORY
LOCAL IRRITATION AT THE WOUND SITE "ROKEN NEEDLES MAY RESULT IN EXTENDED OR
ADDITIONAL SURGERIES OR RESIDUAL FOREIGN BODIES )NADVERTENT NEEDLE STICKS WITH
CONTAMINATED SURGICAL NEEDLES MAY RESULT IN THE TRANSMISSION OF BLOODBORNE
PATHOGENS
(/7 3500,)%$
#OATED 6)#29, 2!0)$% SUTURES ARE AVAILABLE STERILE UNDYED AND ATTACHED TO
STAINLESS STEEL NEEDLES OF VARYING TYPES AND SIZES
#OATED 6)#29, 2!0)$% SUTURES ARE AVAILABLE IN VARIOUS LENGTHS IN SIZES
TO
TO METRIC IN ONE AND THREE DOZEN BOXES
7!2.).'3
4RADEMARK
%4()#/. ).#
#(!04%2
02/$5#4 ).&/2-!4)/.
%4()"/.$
%8#%, 0/,9%34%2 35452%
02%#!54)/.3
./.!"3/2"!",% 352')#!, 35452% 530
%XCEPT FOR SIZE
DIAMETER
)N HANDLING THIS OR ANY OTHER SUTURE MATERIAL CARE SHOULD BE TAKEN TO AVOID
DAMAGE FROM HANDLING !VOID CRUSHING OR CRIMPING DAMAGE DUE TO APPLICATION
OF SURGICAL INSTRUMENTS SUCH AS FORCEPS OR NEEDLE HOLDERS
$%3#2)04)/.
!S WITH ANY SUTURE MATERIAL ADEQUATE KNOT SECURITY REQUIRES THE ACCEPTED
SURGICAL TECHNIQUE OF FLAT AND SQUARE TIES WITH ADDITIONAL THROWS AS WARRANTED
BY SURGICAL CIRCUMSTANCE AND THE EXPERIENCE OF THE SURGEON
%4()"/.$
%8#%, POLYESTER SUTURE IS A NONABSORBABLE BRAIDED STERILE
SURGICAL SUTURE COMPOSED OF 0OLY ETHYLENE TEREPHTHALATE )T IS PREPARED FROM
FIBERS OF HIGH MOLECULAR WEIGHT LONG
CHAIN LINEAR POLYESTERS HAVING RECURRENT
AROMATIC RINGS AS AN INTEGRAL COMPONENT %4()"/.$ %8#%, SUTURE IS UNIFORM
LY COATED WITH POLYBUTILATE OR POLY [OXY
BUTANEDIYLOXY
DIOXO
HEXANEDIYL ] 4HE HIGHLY ADHERENT COATING IS A RELATIVELY NONREACTIVE
NONABSORBABLE COMPOUND WHICH ACTS AS A LUBRICANT TO MECHANICALLY IMPROVE
THE PHYSICAL PROPERTIES OF THE UNCOATED SUTURE BY IMPROVING EASE OF PASSAGE
THROUGH TISSUES AND BY PROVIDING OVERALL IMPROVED HANDLING QUALITIES AS
CONTRASTED TO THE BRAIDED UNCOATED FIBER
%4()"/.$ %8#%, SUTURES ARE BRAIDED FOR OPTIMAL HANDLING PROPERTIES AND FOR
GOOD VISIBILITY IN THE SURGICAL FIELD ARE DYED GREEN
3IZE
%4()"/.$ %8#%, SUTURES ARE 530 EXCEPT FOR DIAMETER
-!8)-5- 35452% /6%23):% ). $)!-%4%2 MM &2/- 530
530 35452% 3):% $%3)'.!4)/.
4O AVOID DAMAGING NEEDLE POINTS AND SWAGE AREAS GRASP THE NEEDLE IN AN AREA
ONE
THIRD TO ONE
HALF OF THE DISTANCE FROM THE SWAGED END TO THE
POINT 2ESHAPING NEEDLES MAY CAUSE THEM TO LOSE STRENGTH AND BE LESS
RESISTANT TO BENDING AND BREAKING 5SERS SHOULD EXERCISE CAUTION WHEN
HANDLING SURGICAL NEEDLES TO AVOID INADVERTENT NEEDLE STICKS $ISCARD USED
NEEDLES IN SHARPS CONTAINERS
!$6%23% 2%!#4)/.3
!DVERSE EFFECTS ASSOCIATED WITH THE USE OF THIS DEVICE INCLUDE WOUND
DEHISCENCE CALCULI FORMATION IN URINARY AND BILIARY TRACTS WHEN PROLONGED
CONTACT WITH SALT SOLUTIONS SUCH AS URINE AND BILE OCCURS INFECTION MINIMAL
ACUTE INFLAMMATORY TISSUE REACTION AND TRANSITORY LOCAL IRRITATION AT THE WOUND
SITE "ROKEN NEEDLES MAY RESULT IN EXTENDED OR ADDITIONAL SURGERIES OR RESIDUAL
FOREIGN BODIES )NADVERTENT NEEDLE STICKS WITH CONTAMINATED SURGICAL NEEDLES
MAY RESULT IN THE TRANSMISSION OF BLOODBORNE PATHOGENS
-!8)-5- /6%23):% MM
).$)#!4)/.3
%4()"/.$ %8#%, SUTURE IS INDICATED FOR USE IN GENERAL SOFT TISSUE
APPROXIMATION ANDOR LIGATION INCLUDING USE IN CARDIOVASCULAR OPHTHALMIC AND
NEUROLOGICAL PROCEDURES
!#4)/.3
%4()"/.$ %8#%, SUTURE ELICITS A MINIMAL ACUTE INFLAMMATORY REACTION IN
TISSUE FOLLOWED BY A GRADUAL ENCAPSULATION OF THE SUTURE BY FIBROUS CONNECTIVE
TISSUE )MPLANTATION STUDIES IN ANIMALS SHOW NO MEANINGFUL DECLINE IN
POLYESTER SUTURE STRENGTH OVER TIME "OTH POLYESTER FIBER SUTURE MATERIAL AND
THE POLYBUTILATE COATING ARE PHARMACOLOGICALLY INACTIVE
#/.42!).$)#!4)/.3
.ONE KNOWN
7!2.).'3
5SERS SHOULD BE FAMILIAR WITH SURGICAL PROCEDURES AND TECHNIQUES INVOLVING
NONABSORBABLE SUTURES BEFORE EMPLOYING %4()"/.$ %8#%, SUTURE FOR WOUND
CLOSURE AS RISK OF WOUND DEHISCENCE MAY VARY WITH THE SITE OF APPLICATION AND
THE SUTURE MATERIAL USED
$O NOT RESTERILIZE $ISCARD OPENED PACKAGES AND UNUSED SUTURES
!S WITH ANY FOREIGN BODY PROLONGED CONTACT OF ANY SUTURE WITH SALT SOLUTIONS
SUCH AS THOSE FOUND IN THE URINARY OR BILIARY TRACTS MAY RESULT IN CALCULUS
FORMATION !CCEPTABLE SURGICAL PRACTICE SHOULD BE FOLLOWED FOR THE
MANAGEMENT OF INFECTED OR CONTAMINATED WOUNDS
(/7 3500,)%$
%4()"/.$ %8#%, SUTURES ARE AVAILABLE AS STERILE BRAIDED GREEN AND UNDYED
WHITE STRANDS IN SIZES
THROUGH METRIC SIZES
IN A VARIETY OF LENGTHS
WITH AND WITHOUT PERMANENTLY ATTACHED NEEDLES
%4()"/.$ %8#%, SUTURES GREEN BRAIDED IN SIZES
THROUGH METRIC SIZES
ARE ALSO AVAILABLE ATTACHED TO #/.42/, 2%,%!3%
REMOVABLE NEEDLES
%4()"/.$ %8#%, SUTURES GREEN AND UNDYED ARE ALSO AVAILABLE ATTACHED TO
4&% POLYMER PLEDGETS MEASURING X X MM X MM X MM
X X MM X MM X MM
%4()"/.$ %8#%, SUTURES ARE AVAILABLE IN ONE TWO AND THREE DOZEN BOXES
4RADEMARK
%4()#/. ).#
#(!04%2
%4(),/.
.9,/. 35452%
./.!"3/2"!",% 352')#!, 35452%3 530
$%3#2)04)/.
%4(),/.
NYLON SUTURE IS A NONABSORBABLE STERILE SURGICAL MONOFILAMENT
SUTURE COMPOSED OF THE LONG
CHAIN ALIPHATIC POLYMERS .YLON AND .YLON
%4(),/. SUTURES ARE DYED BLACK OR GREEN TO ENHANCE VISIBILITY IN TISSUE 4HE
SUTURE IS ALSO AVAILABLE UNDYED CLEAR
02%#!54)/.3
)N HANDLING THIS OR ANY OTHER SUTURE MATERIAL CARE SHOULD BE TAKEN TO AVOID
DAMAGE FROM HANDLING !VOID CRUSHING OR CRIMPING DAMAGE DUE TO APPLICATION
OF SURGICAL INSTRUMENTS SUCH AS FORCEPS OR NEEDLE HOLDERS
!S WITH ANY SUTURE MATERIAL ADEQUATE KNOT SECURITY REQUIRES THE ACCEPTED SUR
GICAL TECHNIQUE OF FLAT AND SQUARE TIES WITH ADDITIONAL THROWS AS WARRANTED BY
SURGICAL CIRCUMSTANCE AND THE EXPERIENCE OF THE SURGEON 4HE USE OF ADDITIONAL
THROWS MAY BE PARTICULARLY APPROPRIATE WHEN KNOTTING MONOFILAMENTS
).$)#!4)/.3
4O AVOID DAMAGING NEEDLE POINTS AND SWAGE AREAS GRASP THE NEEDLE IN AN AREA
ONE
THIRD TO ONE
HALF OF THE DISTANCE FROM THE SWAGED END TO THE POINT
2ESHAPING NEEDLES MAY CAUSE THEM TO LOSE STRENGTH AND BE LESS RESISTANT TO
BENDING AND BREAKING 5SERS SHOULD EXERCISE CAUTION WHEN HANDLING SURGICAL
NEEDLES TO AVOID INADVERTENT NEEDLE STICKS $ISCARD USED NEEDLES IN SHARPS
CONTAINERS
%4(),/. SUTURE IS INDICATED FOR USE IN GENERAL SOFT TISSUE
APPROXIMATION ANDOR LIGATION INCLUDING USE IN CARDIOVASCULAR
OPHTHALMIC AND NEUROLOGICAL PROCEDURES
!$6%23% 2%!#4)/.3
%4(),/. SUTURE MEETS ALL REQUIREMENTS ESTABLISHED BY THE 5NITED 3TATES
0HARMACOPOEIA 530 FOR NONABSORBABLE SURGICAL SUTURE
!#4)/.3
%4(),/. SUTURE ELICITS A MINIMAL ACUTE INFLAMMATORY REACTION IN TISSUE WHICH
IS FOLLOWED BY GRADUAL ENCAPSULATION OF THE SUTURE BY FIBROUS CONNECTIVE TISSUE
7HILE NYLON IS NOT ABSORBED PROGRESSIVE HYDROLYSIS OF THE NYLON IN VIVO MAY
RESULT IN GRADUAL LOSS OVER TIME OF TENSILE STRENGTH
#/.42!).$)#!4)/.3
$UE TO THE GRADUAL LOSS OF TENSILE STRENGTH WHICH MAY OCCUR OVER PROLONGED
PERIODS IN VIVO NYLON SUTURE SHOULD NOT BE USED WHERE PERMANENT RETENTION OF
TENSILE STRENGTH IS REQUIRED
!DVERSE EFFECTS ASSOCIATED WITH THE USE OF THIS DEVICE INCLUDE WOUND DEHIS
CENCE GRADUAL LOSS OF TENSILE STRENGTH OVER TIME CALCULI FORMATION IN URINARY
AND BILIARY TRACTS WHEN PROLONGED CONTACT WITH SALT SOLUTIONS SUCH AS URINE AND
BILE OCCURS INFECTION MINIMAL ACUTE INFLAMMATORY TISSUE REACTION AND TRANSI
TORY LOCAL IRRITATION AT THE WOUND SITE "ROKEN NEEDLES MAY RESULT IN EXTENDED OR
ADDITIONAL SURGERIES OR RESIDUAL FOREIGN BODIES )NADVERTENT NEEDLE STICKS WITH
CONTAMINATED SURGICAL NEEDLES MAY RESULT IN THE TRANSMISSION OF BLOODBORNE
PATHOGENS
(/7 3500,)%$
%4(),/. SUTURES ARE AVAILABLE AS STERILE MONOFILAMENT STRANDS IN 530 SIZES
THROUGH METRIC SIZES
IN A VARIETY OF LENGTHS WITH AND WITHOUT
PERMANENTLY ATTACHED NEEDLES %4(),/. SUTURES ARE AVAILABLE IN ONE TWO AND
THREE DOZEN BOXES
7!2.).'3
5SERS SHOULD BE FAMILIAR WITH SURGICAL PROCEDURES AND TECHNIQUES INVOLVING
NONABSORBABLE SUTURES BEFORE EMPLOYING %4(),/. SUTURE FOR WOUND CLOSURE
AS THE RISK OF WOUND DEHISCENCE MAY VARY WITH THE SITE OF APPLICATION AND THE
SUTURE MATERIAL USED
!S WITH ANY FOREIGN BODY PROLONGED CONTACT OF ANY SUTURE WITH SALT SOLUTIONS
SUCH AS THOSE FOUND IN THE URINARY OR BILIARY TRACTS MAY RESULT IN CALCULUS
FORMATION !CCEPTABLE SURGICAL PRACTICE SHOULD BE FOLLOWED FOR THE MANAGEMENT
OF CONTAMINATED OR INFECTED WOUNDS
$O NOT RESTERILIZE $ISCARD OPEN PACKAGES AND UNUSED SUTURES
4RADEMARK
%4()#/. ).#
02/$5#4 ).&/2-!4)/.
&!34 !"3/2").'
352')#!, '54 0,!).
!"3/2"!",% 352')#!, 35452%3
.ON
530
$%3#2)04)/.
&AST ABSORBING SURGICAL GUT SUTURE IS A STRAND OF COLLAGENOUS MATERIAL PREPARED
FROM THE SUBMUCOSAL LAYERS OF THE SMALL INTESTINE OF HEALTHY SHEEP OR FROM THE
SEROSAL LAYERS OF THE SMALL INTESTINE OF HEALTHY CATTLE
&AST ABSORBING SURGICAL GUT SUTURES ARE STERILE AND ELICIT ONLY A SLIGHT TO
MINIMAL TISSUE REACTION DURING ABSORPTION
&AST ABSORBING SURGICAL GUT SUTURES DIFFER FROM 530 MINIMUM STRENGTH
REQUIREMENTS BY LESS THAN
).$)#!4)/.3
&AST ABSORBING SURGICAL GUT SUTURES ARE INTENDED FOR DERMAL SKIN SUTURING
ONLY 4HEY SHOULD BE UTILIZED ONLY FOR EXTERNAL KNOT TYING PROCEDURES
!#4)/.3
4HE RESULTS OF IMPLANTATION STUDIES OF FAST ABSORBING SURGICAL GUT SUTURES IN THE
SKIN OF ANIMALS INDICATE THAT NEARLY ALL OF ITS ORIGINAL STRENGTH IS LOST WITHIN
APPROXIMATELY SEVEN DAYS OF IMPLANTATION
7HEN SURGICAL GUT SUTURE IS PLACED IN TISSUE A MODERATE TISSUE INFLAMMATION
OCCURS WHICH IS CHARACTERISTIC OF FOREIGN BODY RESPONSE TO A SUBSTANCE 4HIS IS
FOLLOWED BY A LOSS OF TENSILE STRENGTH FOLLOWED BY A LOSS OF SUTURE MASS AS THE
PROTEOLYTIC ENZYMATIC DIGESTIVE PROCESS DISSOLVES THE SURGICAL GUT 4HIS PROCESS
CONTINUES UNTIL THE SUTURE IS COMPLETELY ABSORBED -ANY VARIABLE FACTORS MAY
AFFECT THE RATE OF ABSORPTION 3OME OF THE MAJOR FACTORS WHICH CAN AFFECT TENSILE
STRENGTH LOSS AND ABSORPTION RATES ARE
4YPE OF SUTURE
PLAIN GUT GENERALLY ABSORBS MORE RAPIDLY THAN CHROMIC GUT
)NFECTION
SURGICAL GUT IS ABSORBED MORE RAPIDLY IN INFECTED TISSUE THAN IN
NON
INFECTED TISSUE
4ISSUE SITES
SURGICAL GUT WILL ABSORB MORE RAPIDLY IN TISSUE WHERE INCREASED
LEVELS OF PROTEOLYTIC ENZYMES ARE PRESENT AS IN THE SECRETIONS EXHIBITED IN
THE STOMACH CERVIX AND VAGINA
$ATA OBTAINED FROM IMPLANTATION STUDIES IN RATS SHOW THAT THE ABSORPTION OF
THESE SUTURES IS ESSENTIALLY COMPLETE BY THE TWENTY
FIRST ST TO FORTY
SECOND
ND POST IMPLANTATION DAY
#/.42!).$)#!4)/.3
4HESE SUTURES BEING ABSORBABLE SHOULD NOT BE USED WHERE PROLONGED
APPROXIMATION OF TISSUE UNDER STRESS IS REQUIRED 4HESE SUTURES HAVE BEEN
DESIGNED TO ABSORB AT A RAPID RATE AND MUST BE USED ON DERMAL TISSUE ONLY
4HESE SUTURES SHOULD NEVER BE USED ON INTERNAL TISSUE 4HE USE OF THIS SUTURE IS
CONTRAINDICATED IN PATIENTS WITH KNOWN SENSITIVITIES OR ALLERGIES TO COLLAGEN AS
GUT IS A COLLAGEN BASED MATERIAL
7!2.).'3
5SERS SHOULD BE FAMILIAR WITH SURGICAL PROCEDURES AND TECHNIQUES INVOLVING GUT
SUTURE BEFORE USING FAST ABSORBING SURGICAL GUT SUTURE FOR WOUND CLOSURE AS
THE RISK OF WOUND DEHISCENCE MAY VARY WITH THE SITE OF APPLICATION AND THE
SUTURE MATERIAL USED 0HYSICIANS SHOULD CONSIDER THE IN VIVO PERFORMANCE WHEN
SELECTING A SUTURE FOR USE IN PATIENTS
4HE USE OF THIS SUTURE MAY BE INAPPROPRIATE IN ELDERLY MALNOURISHED OR DEBIL
ITATED PATIENTS OR IN PATIENTS SUFFERING FROM CONDITIONS WHICH MAY DELAY WOUND
HEALING !S THIS IS AN ABSORBABLE MATERIAL THE USE OF SUPPLEMENTAL NONAB
SORBABLE SUTURES SHOULD BE CONSIDERED BY THE SURGEON IN THE CLOSURE OF SITES
WHICH MAY UNDERGO EXPANSION STRETCHING OR DISTENTION OR WHICH MAY REQUIRE
ADDITIONAL SUPPORT
!S WITH ANY FOREIGN BODY PROLONGED CONTACT OF ANY SUTURE WITH SALT SOLUTIONS
SUCH AS THOSE FOUND IN THE URINARY OR BILIARY TRACTS MAY RESULT IN CALCULUS FOR
MATION !S AN ABSORBABLE SUTURE FAST ABSORBING SURGICAL GUT MAY ACT TRAN
SIENTLY AS A FOREIGN BODY !CCEPTABLE SURGICAL PRACTICE SHOULD BE FOLLOWED FOR
THE MANAGEMENT OF CONTAMINATED OR INFECTED WOUNDS
$O NOT RESTERILIZE $ISCARD OPEN PACKAGES AND UNUSED SUTURES 3TORE AT ROOM
TEMPERATURE
#ERTAIN PATIENTS MAY BE HYPERSENSITIVE TO COLLAGEN AND MIGHT EXHIBIT AN
IMMUNOLOGICAL REACTION RESULTING IN INFLAMMATION TISSUE GRANULATION OR FIBRO
SIS WOUND SUPPURATION AND BLEEDING AS WELL AS SINUS FORMATION
02%#!54)/.3
)N HANDLING THIS OR ANY OTHER SUTURE MATERIAL CARE SHOULD BE TAKEN TO AVOID
DAMAGE FROM HANDLING !VOID CRUSHING OR CRIMPING DAMAGE DUE TO APPLICATION
OF SURGICAL INSTRUMENTS SUCH AS FORCEPS OR NEEDLE HOLDERS 3URGICAL GUT SUTURES
REQUIRE THE ACCEPTED SURGICAL TECHNIQUE OF FLAT AND SQUARE TIES WITH ADDITIONAL
THROWS AS WARRANTED BY SURGICAL CIRCUMSTANCE AND THE EXPERIENCE OF THE
SURGEON
5NDER SOME CIRCUMSTANCES NOTABLY ORTHOPAEDIC PROCEDURES IMMOBILIZATION OF
JOINTS BY EXTERNAL SUPPORT MAY BE EMPLOYED AT THE DISCRETION OF THE SURGEON
4HE SURGEON SHOULD AVOID UNNECESSARY TENSION WHEN RUNNING DOWN KNOTS TO
REDUCE THE OCCURRENCE OF SURFACE FRAYING AND WEAKENING OF THE STRAND
!VOID PROLONGED EXPOSURE TO ELEVATED TEMPERATURES
4O AVOID DAMAGING NEEDLE POINTS AND SWAGE AREAS GRASP THE NEEDLE IN AN AREA
ONE
THIRD TO ONE
HALF OF THE DISTANCE FROM THE SWAGED END TO
THE POINT 2ESHAPING NEEDLES MAY CAUSE THEM TO LOSE STRENGTH AND BE LESS
RESISTANT TO BENDING AND BREAKING 5SERS SHOULD EXERCISE CAUTION WHEN
HANDLING SURGICAL NEEDLES TO AVOID INADVERTENT NEEDLE STICKS $ISCARD USED
NEEDLES IN SHARPS CONTAINERS
!$6%23% 2%!#4)/.3
!DVERSE EFFECTS ASSOCIATED WITH THE USE OF THIS DEVICE INCLUDE WOUND
DEHISCENCE VARIABLE RATES OF ABSORPTION OVER TIME DEPENDING ON SUCH FACTORS
AS THE TYPE OF SUTURE USED THE PRESENCE OF INFECTION AND THE TISSUE SITE FAILURE
TO PROVIDE ADEQUATE WOUND SUPPORT IN CLOSURE OF SITES WHERE EXPANSION
STRETCHING OR DISTENTION OCCUR ETC UNLESS ADDITIONAL SUPPORT IS SUPPLIED
THROUGH THE USE OF NONABSORBABLE SUTURE MATERIAL FAILURE TO PROVIDE ADEQUATE
WOUND SUPPORT IN ELDERLY MALNOURISHED OR DEBILITATED PATIENTS OR IN PATIENTS
SUFFERING FROM CANCER ANEMIA OBESITY DIABETES INFECTION OR OTHER CONDITIONS
WHICH MAY DELAY WOUND HEALING ALLERGIC RESPONSE IN PATIENTS WITH KNOWN
SENSITIVITIES TO COLLAGEN WHICH MAY RESULT IN AN IMMUNOLOGICAL REACTION RESULT
ING IN INFLAMMATION TISSUE GRANULATION OR FIBROSIS WOUND SUPPURATION AND
BLEEDING AS WELL AS SINUS FORMATION INFECTION MODERATE TISSUE INFLAMMATORY
RESPONSE CHARACTERISTIC OF FOREIGN BODY RESPONSE CALCULI FORMATION IN URINARY
AND BILIARY TRACTS WHEN PROLONGED CONTACT WITH SALT SOLUTIONS SUCH AS URINE AND
BILE OCCURS AND TRANSITORY LOCAL IRRITATION AT THE WOUND SITE "ROKEN NEEDLES
MAY RESULT IN EXTENDED OR ADDITIONAL SURGERIES OR RESIDUAL FOREIGN BODIES
)NADVERTENT NEEDLE STICKS WITH CONTAMINATED SURGICAL NEEDLES MAY RESULT IN THE
TRANSMISSION OF BLOODBORNE PATHOGENS
(/7 3500,)%$
&AST ABSORBING SURGICAL GUT SUTURES ARE AVAILABLE IN SIZES
METRIC SIZE
AND
METRIC SIZE WITH NEEDLES ATTACHED IN ONE TWO AND THREE DOZEN
BOXES
4RADEMARK
%4()#/. ).#
#(!04%2
-%23),%.%
0/,9%34%2 &)"%2 35452%
./.!"3/2"!",% 352')#!, 35452% 530
%XCEPT FOR SIZE
DIAMETER
$%3#2)04)/.
-%23),%.%
POLYESTER SUTURE IS A NONABSORBABLE BRAIDED STERILE SURGICAL
SUTURE COMPOSED OF 0OLY ETHYLENE TEREPHTHALATE )T IS PREPARED FROM FIBERS OF
HIGH MOLECULAR WEIGHT LONG
CHAIN LINEAR POLYESTERS HAVING RECURRENT AROMATIC
RINGS AS AN INTEGRAL COMPONENT -%23),%.% SUTURES ARE BRAIDED FOR OPTIMAL
HANDLING PROPERTIES AND FOR GOOD VISIBILITY IN THE SURGICAL FIELD ARE DYED GREEN
3IZE
-%23),%.% SUTURES ARE 530 EXCEPT FOR DIAMETER
-!8)-5- 35452% /6%23):% ). $)!-%4%2 MM &2/- 530
530 35452% 3):% $%3)'.!4)/.
02%#!54)/.3
)N HANDLING THIS OR ANY OTHER SUTURE MATERIAL CARE SHOULD BE TAKEN TO AVOID
DAMAGE FROM HANDLING !VOID CRUSHING OR CRIMPING DAMAGE DUE TO APPLICATION
OF SURGICAL INSTRUMENTS SUCH AS FORCEPS OR NEEDLE HOLDERS 4HE USE OF ADDITION
AL THROWS IS PARTICULARLY APPROPRIATE WHEN KNOTTING MONOFILAMENT SUTURES
!S WITH ANY SUTURE MATERIAL ADEQUATE KNOT SECURITY REQUIRES THE ACCEPTED
SURGICAL TECHNIQUE OF FLAT AND SQUARE TIES WITH ADDITIONAL THROWS AS WARRANTED
BY SURGICAL CIRCUMSTANCE AND THE EXPERIENCE OF THE SURGEON
4O AVOID DAMAGING NEEDLE POINTS AND SWAGE AREAS GRASP THE NEEDLE IN AN AREA
ONE
THIRD TO ONE
HALF OF THE DISTANCE FROM THE SWAGED END TO
THE POINT 2ESHAPING NEEDLES MAY CAUSE THEM TO LOSE STRENGTH AND BE LESS
RESISTANT TO BENDING AND BREAKING 5SERS SHOULD EXERCISE CAUTION WHEN
HANDLING SURGICAL NEEDLES TO AVOID INADVERTENT NEEDLE STICKS $ISCARD USED
NEEDLES IN SHARPS CONTAINERS
-!8)-5- /6%23):% MM
).$)#!4)/.3
-%23),%.% SUTURE IS INDICATED FOR USE IN GENERAL SOFT TISSUE APPROXIMATION
ANDOR LIGATION INCLUDING USE IN CARDIOVASCULAR OPHTHALMIC AND NEUROLOGICAL
PROCEDURES
!$6%23% 2%!#4)/.3
!DVERSE EFFECTS ASSOCIATED WITH THE USE OF THIS DEVICE INCLUDE WOUND
DEHISCENCE CALCULI FORMATION IN URINARY AND BILIARY TRACTS WHEN PROLONGED
CONTACT WITH SALT SOLUTIONS SUCH AS URINE AND BILE OCCURS INFECTION MINIMAL
ACUTE INFLAMMATORY TISSUE REACTION AND TRANSITORY LOCAL IRRITATION AT THE WOUND
SITE "ROKEN NEEDLES MAY RESULT IN EXTENDED OR ADDITIONAL SURGERIES OR RESIDUAL
FOREIGN BODIES )NADVERTENT NEEDLE STICKS WITH CONTAMINATED SURGICAL NEEDLES
MAY RESULT IN THE TRANSMISSION OF BLOODBORNE PATHOGENS
!#4)/.3
-%23),%.% SUTURE ELICITS A MINIMAL ACUTE INFLAMMATORY REACTION IN TISSUE
FOLLOWED BY A GRADUAL ENCAPSULATION OF THE SUTURE BY FIBROUS CONNECTIVE
TISSUE )MPLANTATION STUDIES IN ANIMALS SHOW NO MEANINGFUL DECLINE IN
POLYESTER SUTURE STRENGTH OVER TIME 4HE POLYESTER FIBER SUTURE MATERIAL IS
PHARMACOLOGICALLY INACTIVE
#/.42!).$)#!4)/.3
.ONE KNOWN
(/7 3500,)%$
-%23),%.% SUTURES ARE AVAILABLE AS STERILE BRAIDED GREEN AND UNDYED WHITE
STRANDS IN SIZES
THROUGH METRIC SIZES
IN A VARIETY OF LENGTHS WITH
AND WITHOUT PERMANENTLY ATTACHED NEEDLES
-%23),%.% SUTURES ARE ALSO AVAILABLE IN GREEN MONOFILAMENT IN SIZES
AND
METRIC SIZES
-%23),%.% SUTURES GREEN BRAIDED IN 530 SIZE METRIC SIZE ARE ALSO
AVAILABLE ATTACHED TO #/.42/, 2%,%!3%
REMOVABLE NEEDLES
-%23),%.% SUTURES ARE AVAILABLE IN ONE TWO AND THREE DOZEN BOXES
7!2.).'3
5SERS SHOULD BE FAMILIAR WITH SURGICAL PROCEDURES AND TECHNIQUES INVOLVING
NONABSORBABLE SUTURES BEFORE EMPLOYING -%23),%.% SUTURE FOR WOUND
CLOSURE AS RISK OF WOUND DEHISCENCE MAY VARY WITH THE SITE OF APPLICATION AND
THE SUTURE MATERIAL USED
$O NOT RESTERILIZE $ISCARD OPENED PACKAGES AND UNUSED SUTURES
!S WITH ANY FOREIGN BODY PROLONGED CONTACT OF ANY SUTURE WITH SALT SOLUTIONS
SUCH AS THOSE FOUND IN THE URINARY OR BILIARY TRACTS MAY RESULT IN CALCULUS FOR
MATION !CCEPTABLE SURGICAL PRACTICE SHOULD BE FOLLOWED FOR THE MANAGEMENT
OF INFECTED OR CONTAMINATED WOUNDS
4RADEMARK
%4()#/. ).#
02/$5#4 ).&/2-!4)/.
-%23),%.%
0/,9%34%2 &)"%2 -%3(
.ONABSORBABLE 3YNTHETIC 3URGICAL -ESH
34%2),%
$%3#2)04)/.
-%23),%.%
0OLYESTER &IBER -ESH IS CONSTRUCTED FROM POLYETHYLENE
TEREPHTHALATE THE SAME MATERIAL USED TO MAKE -%23),%.%
0OLYESTER &IBER
3UTURE .ONABSORBABLE 3URGICAL 3UTURE 530 %4()#/. ).# -%23),%.%
0OLYESTER &IBER -ESH AFFORDS EXCELLENT STRENGTH DURABILITY AND SURGICAL
ADAPTABILITY ALONG WITH MAXIMAL POROSITY FOR NECESSARY TISSUE INGROWTH
4HE MESH IS APPROXIMATELY INCHES THICK AND IS A HIGHLY FLEXIBLE AND
COMPLIANT MATERIAL
-%23),%.% MESH IS KNITTED BY A PROCESS WHICH INTERLINKS EACH FIBER JUNCTION
AND WHICH PROVIDES FOR ELASTICITY IN BOTH DIRECTIONS 4HIS CONSTRUCTION PERMITS
THE MESH TO BE CUT INTO ANY DESIRED SHAPE OR SIZE WITHOUT UNRAVELING 4HE FIBER
JUNCTIONS ARE NOT SUBJECT TO THE SAME WORK FATIGUE EXHIBITED BY MORE RIGID
METALLIC MESHES 4HIS BI
DIRECTIONAL ELASTIC PROPERTY ALLOWS ADAPTION TO VARIOUS
STRESSES ENCOUNTERED IN THE BODY
7!2.).'3
-%23),%.% MESH IS PROVIDED BY %4()#/. ).# AS A STERILE PRODUCT 5NUSED
-%23),%.% -ESH WHICH HAS BEEN REMOVED FROM THE PACKAGE MAY BE RESTERIL
IZED NOT MORE THAN ONE TIME BY A CONVENTIONAL STREAM AUTOCLAVING PROCESS
AT CONDITIONS OF & # FOR MINUTES -%23),%.% MESH MAY ALSO BE
FLASH AUTOCLAVED NOT MORE THAN ONE TIME AT CONDITIONS OF & # FOR
MINUTES 2ESTERILIZATION UNDER ANY OTHER CONDITIONS OR BY ANY OTHER MEANS
IS NEITHER RECOMMENDED NOR ENDORSED BY %4()#/. ).#
)F THIS PRODUCT SHOULD BECOME STAINED WITH BLOOD OR SOILED IT SHOULD NOT BE
RESTERILIZED FOR REUSE
02%#!54)/.3
! MINIMUM OF MM INCH OF MESH SHOULD EXTEND BEYOND THE SUTURE LINE
!$6%23% 2%!#4)/.3
.O SIGNIFICANT ADVERSE CLINICAL REACTIONS TO -%23),%.% MESH HAVE BEEN
REPORTED 4HE USE OF NONABSORBABLE -%23),%.% MESH IN A WOUND THAT IS
CONTAMINATED OR INFECTED COULD LEAD TO FISTULA FORMATION ANDOR EXTRUSION OF
THE MESH
!#4)/.3
-%23),%.% MESH IS A NONABSORBABLE MESH USED TO SPAN AND REINFORCE
TRAUMATIC OR SURGICAL WOUNDS TO PROVIDE EXTENDED SUPPORT DURING AND
FOLLOWING WOUND HEALING !NIMAL STUDIES SHOW THAT IMPLANTATION OF
-%23),%.% MESH ELICITS A MINIMUM TO SLIGHT INFLAMMATORY REACTION WHICH IS
TRANSIENT AND IS FOLLOWED BY THE DEPOSITION OF A THIN FIBROUS LAYER OF TISSUE
WHICH CAN GROW THROUGH THE INTERSTICES OF THE MESH THUS INCORPORATING THE
MESH INTO ADJACENT TISSUE 4HE MESH REMAINS SOFT AND PLIABLE AND NORMAL
WOUND HEALING IS NOT NOTICEABLY IMPAIRED 4HE MATERIAL IS NOT ABSORBED NOR IS
IT SUBJECT TO DEGRADATION OR WEAKENING BY THE ACTION OF TISSUE ENZYMES
).$)#!4)/.3 &/2 53%
)T IS RECOMMENDED THAT NONABSORBABLE SUTURES BE PLACED TO MM TO
INCH APART AT A DISTANCE APPROXIMATELY MM INCH FROM EDGE OF THE
MESH 3OME SURGEONS PREFER TO SUTURE AND UNCUT SECTION OF MESH THAT IS
CONSIDERABLY LARGE THAN THE DEFECT INTO POSITION OVER THE WOUND 4HE OPPOSITE
SIDES ARE THEN SUTURED TO ASSURE PROPER CLOSURE UNDER CORRECT TENSION 7HEN
THE MARGIN SUTURES HAVE ALL BEEN PLACED THE EXTRA MESH IS TRIMMED AWAY
(/7 3500,)%$
).$)#!4)/.3
4HIS MESH MAY BE USED FOR THE REPAIR OF HERNIA AND OTHER FASCIAL DEFICIENCIES
THAT REQUIRE THE ADDITION OF A REINFORCING OR BRIDGING MATERIAL TO OBTAIN THE
DESIRED SURGICAL RESULT
#/.42!).$)#!4)/.3
7HEN THIS MESH IS USED IN INFANTS OR CHILDREN WITH FUTURE GROWTH POTENTIAL THE
SURGEON SHOULD BE AWARE THAT THIS PRODUCT WILL NOT STRETCH SIGNIFICANTLY AS THE
PATIENT GROWS
-%23),%.% POLYESTER FIBER MESH IN CONTAMINATED WOUNDS SHOULD BE USED
WITH THE UNDERSTANDING THAT SUBSEQUENT INFECTION MAY REQUIRE REMOVAL OF
THE MATERIAL
-%23),%.% MESH IS AVAILABLE IN SINGLE PACKETS AS STERILE UNDYED WHITE
SHEETS IN TWO SIZES 4HE SIZES AVAILABLE ARE X CM X INCHES AND X
CM X INCHES %ACH SHEET IS MM INCH THICK
4RADEMARK
%4()#/. ).#
#(!04%2
-/./#29,
0OLIGLECAPRONE 3UTURE
39.4(%4)# !"3/2"!",% 35452%
530 %8#%04 &/2 $)!-%4%2
!S THIS IS AN ABSORBABLE SUTURE MATERIAL THE USE OF SUPPLEMENTAL
NONABSORBABLE SUTURES SHOULD BE CONSIDERED BY THE SURGEON IN THE CLOSURE OF
THE SITES WHICH MAY UNDERGO EXPANSION STRETCHING OR DISTENTION OR WHICH MAY
REQUIRE ADDITIONAL SUPPORT
02%#!54)/.3
$%3#2)04)/.
-/./#29,
POLIGLECAPRONE SUTURE IS A MONOFILAMENT SYNTHETIC
ABSORBABLE SURGICAL SUTURE PREPARED FROM A COPOLYMER OF GLYCOLIDE AND
EPSILON
CAPROLACTONE 0OLIGLECAPRONE COPOLYMER HAS BEEN FOUND TO BE
NONANTIGENIC NONPYROGENIC AND ELICITS ONLY A SLIGHT TISSUE REACTION DURING
ABSORPTION
-/./#29, SUTURES ARE 530 EXCEPT FOR DIAMETERS IN THE FOLLOWING SIZES
-!8)-5- 35452% /6%23):% ). $)!-%4%2 MM &2/- 530
530 35452% 3):% $%3)'.!4)/.
-!8)-5- /6%23):% MM
3KIN SUTURES WHICH MUST REMAIN IN PLACE LONGER THAN DAYS MAY CAUSE LOCAL
IZED IRRITATION AND SHOULD BE SNIPPED OFF OR REMOVED AS INDICATED 3UBCUTICULAR
SUTURES SHOULD BE PLACED AS DEEPLY AS POSSIBLE TO MINIMIZE THE ERYTHEMA AND
INDURATION NORMALLY ASSOCIATED WITH ABSORPTION
5NDER SOME CIRCUMSTANCES NOTABLY ORTHOPAEDIC PROCEDURES IMMOBILIZATION OF
JOINTS BY EXTERNAL SUPPORT MAY BE EMPLOYED AT THE DISCRETION OF THE SURGEON
#ONSIDERATION SHOULD BE TAKEN IN THE USE OF ABSORBABLE SUTURES IN TISSUE WITH
POOR BLOOD SUPPLY AS SUTURE EXTRUSION AND DELAYED ABSORPTION MAY OCCUR
)N HANDLING THIS OR ANY OTHER SUTURE MATERIAL CARE SHOULD BE TAKEN TO AVOID
DAMAGE FROM HANDLING !VOID CRUSHING OR CRIMPING DAMAGE DUE TO APPLICATION
OF SURGICAL INSTRUMENTS SUCH AS FORCEPS OR NEEDLE HOLDERS
-/./#29, SUTURE KNOTS MUST BE PROPERLY PLACED TO BE SECURE !DEQUATE KNOT
SECURITY REQUIRES THE ACCEPTED SURGICAL TECHNIQUE OF FLAT AND SQUARE TIES WITH
ADDITIONAL THROWS AS WARRANTED BY SURGICAL CIRCUMSTANCE AND THE EXPERIENCE OF
THE SURGEON 4HE USE OF ADDITIONAL THROWS MAY BE PARTICULARLY APPROPRIATE WHEN
KNOTTING MONOFILAMENTS
!VOID PROLONGED EXPOSURE TO ELEVATED TEMPERATURE
-/./#29, SUTURES ARE INDICATED FOR USE IN GENERAL SOFT TISSUE APPROXIMATION
ANDOR LIGATION BUT NOT FOR USE IN CARDIOVASCULAR OR NEUROLOGICAL TISSUES
MICROSURGERY OR OPHTHALMIC SURGERY
4O AVOID DAMAGING NEEDLE POINTS AND SWAGE AREAS GRASP THE NEEDLE IN AN AREA
ONE
THIRD TO ONE
HALF OF THE DISTANCE FROM THE SWAGED END TO
THE POINT 2ESHAPING NEEDLES MAY CAUSE THEM TO LOSE STRENGTH AND BE LESS
RESISTANT TO BENDING AND BREAKING 5SERS SHOULD EXERCISE CAUTION WHEN
HANDLING SURGICAL NEEDLES TO AVOID INADVERTENT NEEDLE STICKS $ISCARD USED
NEEDLES IN SHARPS CONTAINERS
!#4)/.3
!$6%23% 2%!#4)/.3
).$)#!4)/.3
-/./#29, SUTURE IS A MONOFILAMENT WHICH ELICITS A MINIMAL ACUTE INFLAMMA
TORY REACTION IN TISSUES AND INGROWTH OF FIBROUS CONNECTIVE TISSUE 0ROGRESSIVE
LOSS OF TENSILE STRENGTH AND EVENTUAL ABSORPTION OF -/./#29, SUTURES OCCURS
BY MEANS OF HYDROLYSIS !BSORPTION BEGINS AS A LOSS OF TENSILE STRENGTH
FOLLOWED BY A LOSS OF MASS )MPLANTATION STUDIES IN RATS INDICATE THAT
-/./#29, SUTURE RETAINS APPROXIMATELY TO OF ITS ORIGINAL STRENGTH
DAYS POST IMPLANTATION AND APPROXIMATELY TO OF ITS ORIGINAL TENSILE
STRENGTH AT DAYS POST IMPLANTATION !LL OF THE ORIGINAL TENSILE STRENGTH IS LOST
BY DAYS POST IMPLANTATION 4HE ABSOLUTE STRENGTH REMAINING DAYS POST
IMPLANTATION MEETS OR EXCEEDS THAT HISTORICALLY OBSERVED WITH PLAIN OR CHROMIC
SURGICAL GUT SUTURES !BSORPTION OF -/./#29, ABSORBABLE SYNTHETIC SUTURE IS
ESSENTIALLY COMPLETE BETWEEN AND DAYS
!DVERSE EFFECTS ASSOCIATED WITH THE USE OF SYNTHETIC ABSORBABLE SUTURES INCLUDE
WOUND DEHISCENCE FAILURE TO PROVIDE ADEQUATE WOUND SUPPORT IN CLOSURE OF THE
SITES WHERE EXPANSION STRETCHING OR DISTENSION OCCUR FAILURE TO PROVIDE ADE
QUATE WOUND SUPPORT IN ELDERLY MALNOURISHED OR DEBILITATED PATIENTS OR IN
PATIENTS SUFFERING FROM CONDITIONS WHICH MAY DELAY WOUND HEALING INFECTION
MINIMAL ACUTE INFLAMMATORY TISSUE REACTION LOCALIZED IRRITATION WHEN SKIN
SUTURES ARE LEFT IN PLACE FOR GREATER THAN DAYS SUTURE EXTRUSION AND DELAYED
ABSORPTION IN TISSUE WITH POOR BLOOD SUPPLY CALCULI FORMATION IN URINARY AND
BILIARY TRACTS WHEN PROLONGED CONTACT WITH SALT SOLUTIONS SUCH AS URINE AND BILE
OCCURS AND TRANSITORY LOCAL IRRITATION AT THE WOUND SITE "ROKEN NEEDLES MAY
RESULT IN EXTENDED OR ADDITIONAL SURGERIES OR RESIDUAL FOREIGN BODIES
)NADVERTENT NEEDLE STICKS WITH CONTAMINATED SURGICAL NEEDLES MAY RESULT IN THE
TRANSMISSION OF BLOODBORNE PATHOGENS
!002/8)-!4% /2)').!,
$!93 )-0,!.4!4)/.
$!93
$!93
342%.'4( 2%-!).).'
4/
4/
#/.42!).$)#!4)/.3
4HIS SUTURE BEING ABSORBABLE SHOULD NOT BE USED WHERE EXTENDED APPROXI
MATION OF TISSUE UNDER STRESS IS REQUIRED SUCH AS IN FASCIA
(/7 3500,)%$
-/./#29, SUTURES ARE AVAILABLE AS STERILE MONOFILAMENT UNDYED NATURAL
STRANDS IN SIZES
THROUGH METRIC SIZES
IN A VARIETY OF LENGTHS WITH
OR WITHOUT NEEDLES
-/./#29, SUTURES ARE ALSO AVAILABLE IN SIZES
THROUGH METRICSIZES
ATTACHED TO #/.42/, 2%,%!3%
REMOVABLE NEEDLES
-/./#29, SUTURES ARE AVAILABLE IN ONE AND THREE DOZEN BOXES
7!2.).'3
5SERS SHOULD BE FAMILIAR WITH SURGICAL PROCEDURES AND TECHNIQUES INVOLVING
ABSORBABLE SUTURES BEFORE EMPLOYING -/./#29, SUTURE FOR WOUND CLOSURE
AS RISK OF WOUND DEHISCENCE MAY VARY WITH THE SITE OF APPLICATION AND THE
SUTURE MATERIAL USED 0HYSICIANS SHOULD CONSIDER THE IN VIVO PERFORMANCE
UNDER !#4)/.3 SECTION WHEN SELECTING A SUTURE FOR USE IN PATIENTS 4HE USE OF
THIS SUTURE MAY BE INAPPROPRIATE IN ELDERLY MALNOURISHED OR DEBILITATED
PATIENTS OR IN PATIENTS SUFFERING FROM CONDITIONS WHICH MAY DELAY WOUND
HEALING
$O NOT RESTERILIZE $ISCARD OPENED PACKAGES AND UNUSED SUTURES
!S WITH ANY FOREIGN BODY PROLONGED CONTACT OF ANY SUTURE WITH SALT SOLUTIONS
SUCH AS THOSE FOUND IN THE URINARY OR BILIARY TRACTS MAY RESULT IN CALCULUS
FORMATION !S AN ABSORBABLE SUTURE -/./#29, SUTURE MAY ACT TRANSIENTLY AS
A FOREIGN BODY !CCEPTABLE SURGICAL PRACTICE SHOULD BE FOLLOWED FOR THE
MANAGEMENT OF CONTAMINATED OR INFECTED WOUNDS
4RADEMARK
%4()#/. ).#
02/$5#4 ).&/2-!4)/.
-/./#29,
6)/,%4 -/./&),!-%.4
0OLIGLECAPRONE 3UTURE
39.4(%4)# !"3/2"!",% 35452% 530
%8#%04 &/2 $)!-%4%2
$%3#2)04)/.
-/./#29,
POLIGLECAPRONE SUTURE IS A MONOFILAMENT SYNTHETIC
ABSORBABLE SURGICAL SUTURE PREPARED FROM A COPOLYMER OF GLYCOLIDE AND
EPSILON
CAPROLACTONE 0OLIGLECAPRONE COPOLYMER HAS BEEN FOUND TO BE
NONANTIGENIC NONPYROGENIC AND ELICITS ONLY A SLIGHT TISSUE REACTION DURING
ABSORPTION
-/./#29, SUTURES ARE 530 EXCEPT FOR DIAMETERS IN THE FOLLOWING SIZES
-!8)-5- 35452% /6%23):% ). $)!-%4%2 MM &2/- 530
530 35452% 3):% $%3)'.!4)/.
-!8)-5- /6%23):% MM
02%#!54)/.3
3KIN SUTURES WHICH MUST REMAIN IN PLACE LONGER THAN DAYS MAY CAUSE LOCAL
IZED IRRITATION AND SHOULD BE SNIPPED OFF OR REMOVED AS INDICATED 3UBCUTICULAR
SUTURES SHOULD BE PLACED AS DEEPLY AS POSSIBLE TO MINIMIZE THE ERYTHEMA AND
INDURATION NORMALLY ASSOCIATED WITH ABSORPTION
5NDER SOME CIRCUMSTANCES NOTABLY ORTHOPAEDIC PROCEDURES IMMOBILIZATION OF
JOINTS BY EXTERNAL SUPPORT MAY BE EMPLOYED AT THE DISCRETION OF THE SURGEON
#ONSIDERATION SHOULD BE TAKEN IN THE USE OF ABSORBABLE SUTURES IN TISSUE WITH
POOR BLOOD SUPPLY AS SUTURE EXTRUSION AND DELAYED ABSORPTION MAY OCCUR
)N HANDLING THIS OR ANY OTHER SUTURE MATERIAL CARE SHOULD BE TAKEN TO AVOID
DAMAGE FROM HANDLING !VOID CRUSHING OR CRIMPING DAMAGE DUE TO APPLICATION
OF SURGICAL INSTRUMENTS SUCH AS FORCEPS OR NEEDLE HOLDERS
-/./#29, SUTURE KNOTS MUST BE PROPERLY PLACED TO BE SECURE !DEQUATE KNOT
SECURITY REQUIRES THE ACCEPTED SURGICAL TECHNIQUE OF FLAT AND SQUARE TIES WITH
ADDITIONAL THROWS AS WARRANTED BY SURGICAL CIRCUMSTANCE AND THE EXPERIENCE OF
THE SURGEON 4HE USE OF ADDITIONAL THROWS MAY BE PARTICULARLY APPROPRIATE WHEN
KNOTTING MONOFILAMENTS
!VOID PROLONGED EXPOSURE TO ELEVATED TEMPERATURE
4O AVOID DAMAGING NEEDLE POINTS AND SWAGE AREAS GRASP THE NEEDLE IN AN AREA
ONE
THIRD TO ONE
HALF OF THE DISTANCE FROM THE SWAGED END TO THE
POINT 2ESHAPING NEEDLES MAY CAUSE THEM TO LOSE STRENGTH AND BE LESS
RESISTANT TO BENDING AND BREAKING 5SERS SHOULD EXERCISE CAUTION WHEN
HANDLING SURGICAL NEEDLES TO AVOID INADVERTENT NEEDLE STICKS $ISCARD USED
NEEDLES IN SHARPS CONTAINERS
!$6%23% 2%!#4)/.3
).$)#!4)/.3
-/./#29, SUTURES ARE INDICATED FOR USE IN GENERAL SOFT TISSUE APPROXIMATION
ANDOR LIGATION BUT NOT FOR USE IN CARDIOVASCULAR OR NEUROLOGICAL TISSUES
MICROSURGERY OR OPHTHALMIC SURGERY
!#4)/.3
-/./#29, SUTURE IS A MONOFILAMENT WHICH ELICITS A MINIMAL ACUTE INFLAMMA
TORY REACTION IN TISSUES AND INGROWTH OF FIBROUS CONNECTIVE TISSUE 0ROGRESSIVE
LOSS OF TENSILE STRENGTH AND EVENTUAL ABSORPTION OF -/./#29, SUTURES OCCURS
BY MEANS OF HYDROLYSIS !BSORPTION BEGINS AS A LOSS OF TENSILE STRENGTH
FOLLOWED BY A LOSS OF MASS )MPLANTATION STUDIES IN RATS INDICATE THAT
-/./#29, SUTURE RETAINS APPROXIMATELY TO OF ITS ORIGINAL STRENGTH
DAYS POST IMPLANTATION AND APPROXIMATELY TO OF ITS ORIGINAL TENSILE
STRENGTH AT DAYS POST IMPLANTATION %SSENTIALLY ALL OF THE ORIGINAL TENSILE
STRENGTH IS LOST BY DAYS POST IMPLANTATION !BSORPTION OF -/./#29,
ABSORBABLE SYNTHETIC SUTURE IS ESSENTIALLY COMPLETE BETWEEN AND DAYS
!002/8)-!4% /2)').!,
$!93 )-0,!.4!4)/.
$!93
$!93
342%.'4( 2%-!).).'
4/
4/
#/.42!).$)#!4)/.3
4HIS SUTURE BEING ABSORBABLE SHOULD NOT BE USED WHERE EXTENDED APPROXI
MATION OF TISSUE UNDER STRESS IS REQUIRED
7!2.).'3
5SERS SHOULD BE FAMILIAR WITH SURGICAL PROCEDURES AND TECHNIQUES INVOLVING
ABSORBABLE SUTURES BEFORE EMPLOYING -/./#29, SUTURE FOR WOUND CLOSURE
AS RISK OF WOUND DEHISCENCE MAY VARY WITH THE SITE OF APPLICATION AND THE
SUTURE MATERIAL USED 0HYSICIANS SHOULD CONSIDER THE IN VIVO PERFORMANCE
UNDER !#4)/.3 SECTION WHEN SELECTING A SUTURE FOR USE IN PATIENTS 4HE
USE OF THIS SUTURE MAY BE INAPPROPRIATE IN ELDERLY MALNOURISHED OR DEBILITATED
PATIENTS OR IN PATIENTS SUFFERING FROM CONDITIONS WHICH MAY DELAY WOUND
HEALING
$O NOT RESTERILIZE $ISCARD OPENED PACKAGES AND UNUSED SUTURES
!S WITH ANY FOREIGN BODY PROLONGED CONTACT OF ANY SUTURE WITH SALT SOLUTIONS
SUCH AS THOSE FOUND IN THE URINARY OR BILIARY TRACTS MAY RESULT IN CALCULUS
FORMATION !S AN ABSORBABLE SUTURE -/./#29, SUTURE MAY ACT TRANSIENTLY AS
A FOREIGN BODY !CCEPTABLE SURGICAL PRACTICE SHOULD BE FOLLOWED FOR THE
MANAGEMENT OF CONTAMINATED OR INFECTED WOUNDS
!S THIS IS AN ABSORBABLE SUTURE MATERIAL THE USE OF SUPPLEMENTAL
NONABSORBABLE SUTURES SHOULD BE CONSIDERED BY THE SURGEON IN THE CLOSURE OF
THE SITES WHICH MAY UNDERGO EXPANSION STRETCHING OR DISTENTION OR WHICH MAY
REQUIRE ADDITIONAL SUPPORT
!DVERSE EFFECTS ASSOCIATED WITH THE USE OF SYNTHETIC ABSORBABLE SUTURES INCLUDE
WOUND DEHISCENCE FAILURE TO PROVIDE ADEQUATE WOUND SUPPORT IN CLOSURE OF THE
SITES WHERE EXPANSION STRETCHING OR DISTENSION OCCUR FAILURE TO PROVIDE
ADEQUATE WOUND SUPPORT IN ELDERLY MALNOURISHED OR DEBILITATED PATIENTS OR IN
PATIENTS SUFFERING FROM CONDITIONS WHICH MAY DELAY WOUND HEALING INFECTION
MINIMAL ACUTE INFLAMMATORY TISSUE REACTION LOCALIZED IRRITATION WHEN SKIN
SUTURES ARE LEFT IN PLACE FOR GREATER THAN DAYS SUTURE EXTRUSION AND DELAYED
ABSORPTION IN TISSUE WITH POOR BLOOD SUPPLY CALCULI FORMATION IN URINARY AND
BILIARY TRACTS WHEN PROLONGED CONTACT WITH SALT SOLUTIONS SUCH AS URINE AND BILE
OCCURS AND TRANSITORY LOCAL IRRITATION AT THE WOUND SITE "ROKEN NEEDLES MAY
RESULT IN EXTENDED OR ADDITIONAL SURGERIES OR RESIDUAL FOREIGN BODIES
)NADVERTENT NEEDLE STICKS WITH CONTAMINATED SURGICAL NEEDLES MAY RESULT IN THE
TRANSMISSION OF BLOODBORNE PATHOGENS
(/7 3500,)%$
-/./#29, SUTURES ARE AVAILABLE AS STERILE MONOFILAMENT DYED VIOLET
STRANDS IN SIZES
THROUGH METRIC SIZES
IN A VARIETY OF LENGTHS WITH
OR WITHOUT NEEDLES -/./#29, SUTURES ARE ALSO AVAILABLE IN SIZES
THROUGH
METRIC SIZES
ATTACHED TO #/.42/, 2%,%!3%
REMOVABLE NEEDLES
-/./#29, SUTURES ARE AVAILABLE IN ONE AND THREE DOZEN BOXES
4RADEMARK
%4()#/. ).#
#(!04%2
.52/,/.
.9,/. 35452%
./.!"3/2"!",% 352')#!, 35452% 530
$%3#2)04)/.
.52/,/.
NYLON SUTURE IS A NONABSORBABLE STERILE SURGICAL BRAIDED SUTURE
COMPOSED OF THE LONG
CHAIN ALIPHATIC POLYMERS .YLON OR .YLON
.52/,/. SUTURES ARE DYED BLACK TO ENHANCE VISIBILITY IN TISSUE 4HE SUTURE IS
ALSO AVAILABLE UNDYED CLEAR
.52/,/. SUTURE MEETS ALL REQUIREMENTS ESTABLISHED BY THE 5NITED 3TATES
0HARMACOPOEIA 530 FOR NONABSORBABLE SURGICAL SUTURE
02%#!54)/.3
)N HANDLING THIS OR ANY OTHER SUTURE MATERIAL CARE SHOULD BE TAKEN TO AVOID
DAMAGE FROM HANDLING !VOID CRUSHING OR CRIMPING DAMAGE DUE TO APPLICATION
OF SURGICAL INSTRUMENTS SUCH AS FORCEPS OR NEEDLE HOLDERS
!S WITH ANY SUTURE MATERIAL ADEQUATE KNOT SECURITY REQUIRES THE ACCEPTED
SURGICAL TECHNIQUE OF FLAT AND SQUARE TIES WITH ADDITIONAL THROWS AS WARRANTED
BY SURGICAL CIRCUMSTANCE AND THE EXPERIENCE OF THE SURGEON
4O AVOID DAMAGING NEEDLE POINTS AND SWAGE AREAS GRASP THE NEEDLE IN AN AREA
ONE
THIRD TO ONE
HALF OF THE DISTANCE FROM THE SWAGED END TO THE
POINT 2ESHAPING NEEDLES MAY CAUSE THEM TO LOSE STRENGTH AND BE LESS
RESISTANT TO BENDING AND BREAKING 5SERS SHOULD EXERCISE CAUTION WHEN
HANDLING SURGICAL NEEDLES TO AVOID INADVERTENT NEEDLE STICKS $ISCARD USED
NEEDLES IN SHARPS CONTAINERS
).$)#!4)/.3
.52/,/. SUTURE IS INDICATED FOR USE IN GENERAL SOFT TISSUE
APPROXIMATION ANDOR LIGATION INCLUDING USE IN CARDIOVASCULAR
OPHTHALMIC AND NEUROLOGICAL PROCEDURES
!#4)/.3
.52/,/. SUTURE ELICITS A MINIMAL ACUTE INFLAMMATORY REACTION IN
TISSUE WHICH IS FOLLOWED BY A GRADUAL ENCAPSULATION OF THE SUTURE BY FIBROUS
CONNECTIVE TISSUE 7HILE NYLON IS NOT ABSORBED PROGRESSIVE HYDROLYSIS OF THE
NYLON IN VIVO MAY RESULT IN GRADUAL LOSS OF TENSILE STRENGTH OVER TIME
#/.42!).$)#!4)/.3
$UE TO THE GRADUAL LOSS OF TENSILE STRENGTH WHICH MAY OCCUR OVER PROLONGED
PERIODS IN VIVO NYLON SUTURE SHOULD NOT BE USED WHERE PERMANENT RETENTION OF
TENSILE STRENGTH IS REQUIRED
7!2.).'3
5SERS SHOULD BE FAMILIAR WITH SURGICAL PROCEDURES AND TECHNIQUES INVOLVING
NONABSORBABLE SUTURES BEFORE EMPLOYING .52/,/. SUTURE FOR WOUND CLOSURE
AS RISK OF WOUND DEHISCENCE MAY VARY WITH THE SITE OF APPLICATION AND THE
SUTURE MATERIAL USED
!S WITH ANY FOREIGN BODY PROLONGED CONTACT OF ANY SUTURE WITH SALT SOLUTIONS
SUCH AS THOSE FOUND IN THE URINARY OR BILIARY TRACTS MAY RESULT IN CALCULUS FOR
MATION !CCEPTABLE SURGICAL PRACTICES SHOULD BE FOLLOWED FOR THE MANAGEMENT
OF INFECTED OR CONTAMINATED WOUNDS
$O NOT RESTERILIZE $ISCARD OPENED PACKAGES AND UNUSED SUTURES
!$6%23% 2%!#4)/.3
!DVERSE EFFECTS ASSOCIATED WITH THE USE OF THIS DEVICE INCLUDE WOUND
DEHISCENCE GRADUAL LOSS OF TENSILE STRENGTH OVER TIME CALCULI FORMATION IN
URINARY AND BILIARY TRACTS WHEN PROLONGED CONTACT WITH SALT SOLUTIONS SUCH AS
URINE AND BILE OCCURS INFECTION MINIMAL ACUTE INFLAMMATORY TISSUE REACTION
AND TRANSITORY LOCAL IRRITATION AT THE WOUND SITE "ROKEN NEEDLES MAY RESULT IN
EXTENDED OR ADDITIONAL SURGERIES OR RESIDUAL FOREIGN BODIES )NADVERTENT NEEDLE
STICKS WITH CONTAMINATED SURGICAL NEEDLES MAY RESULT IN THE TRANSMISSION OF
BLOODBORNE PATHOGENS
(/7 3500,)%$
.52/,/. SUTURES ARE AVAILABLE IN 530 SIZES
THROUGH METRIC SIZES
IN A VARIETY OF LENGTHS WITH AND WITHOUT PERMANENTLY ATTACHED NEEDLES
.52/,/. SUTURES ARE AVAILABLE IN 530 SIZES
THROUGH METRIC SIZES
ATTACHED TO #/.42/, 2%,%!3%
REMOVABLE NEEDLES
.52/,/. SUTURES ARE AVAILABLE IN ONE TWO AND THREE DOZEN BOXES
4RADEMARK
%4()#/. ).#
02/$5#4 ).&/2-!4)/.
0$3
)) 0/,9$)/8!./.% 3UTURE
$9%$ AND #,%!2 -/./&),!-%.4
39.4(%4)# !"3/2"!",% 35452%3 530
%8#%04 &/2 $)!-%4%2
$%3#2)04)/.
0$3
)) POLYDIOXANONE MONOFILAMENT SYNTHETIC ABSORBABLE SUTURE IS PREPARED
FROM THE POLYESTER POLY P
DIOXANONE 4HE EMPIRICAL MOLECULAR FORMULA OF THE
POLYMER IS #( X
0OLYDIOXANONE POLYMER HAS BEEN FOUND TO BE NONANTIGENIC NONPYROGENIC AND
ELICITS ONLY A SLIGHT TISSUE REACTION DURING ABSORPTION
0$3 )) SUTURES ARE 530 EXCEPT FOR DIAMETER
-!8)-5- 35452% /6%23):% ). $)!-%4%2 MM &2/- 530
530 35452%
3):% $%3)'.!4)/.
-!8)-5- /6%23):% MM
!#4)/.3
4WO IMPORTANT CHARACTERISTICS DESCRIBE THE IN VIVO PERFORMANCE OF ABSORBABLE
SUTURES FIRST TENSILE STRENGTH RETENTION AND SECOND THE ABSORPTION RATE LOSS
OF MASS 0$3 )) SYNTHETIC ABSORBABLE SUTURE HAS BEEN FORMULATED TO MINIMIZE
THE VARIABILITY OF THESE CHARACTERISTICS AND TO PROVIDE WOUND SUPPORT THROUGH
AN EXTENDED HEALING PERIOD
4HE RESULTS OF IMPLANTATION STUDIES OF 0$3 )) MONOFILAMENT SUTURE IN ANIMALS
INDICATE THAT APPROXIMATELY OF ITS ORIGINAL STRENGTH REMAINS TWO WEEKS
AFTER IMPLANTATION !T FOUR WEEKS POST
IMPLANTATION APPROXIMATELY OF ITS
ORIGINAL STRENGTH IS RETAINED AND AT SIX WEEKS APPROXIMATELY OF THE ORIGI
NAL STRENGTH IS RETAINED
7!2.).'3
4HE SAFETY AND EFFECTIVENESS OF 0$3 )) POLYDIOXANONE SUTURES HAVE NOT BEEN
ESTABLISHED IN NEURAL TISSUE ADULT CARDIOVASCULAR TISSUE OR FOR USE IN MICRO
SURGERY
5NDER CERTAIN CIRCUMSTANCES NOTABLY ORTHOPAEDIC PROCEDURES IMMOBILIZATION
BY EXTERNAL SUPPORT MAY BE EMPLOYED AT THE DISCRETION OF THE SURGEON
$O NOT RESTERILIZE
02%#!54)/.3
4HE 0$3 )) SUTURE KNOTS MUST BE PROPERLY PLACED TO BE SECURE !S WITH OTHER
SYNTHETIC SUTURES KNOT SECURITY REQUIRES THE STANDARD SURGICAL TECHNIQUE OF FLAT
AND SQUARE TIES WITH ADDITIONAL THROWS IF INDICATED BY SURGICAL CIRCUMSTANCE
AND THE EXPERIENCE OF THE OPERATOR
!S WITH ANY SUTURE CARE SHOULD BE TAKEN TO AVOID DAMAGE WHEN HANDLING
!VOID THE CRUSHING OR CRIMPING APPLICATION OF SURGICAL INSTRUMENTS SUCH AS
NEEDLE HOLDERS AND FORCEPS TO THE STRAND EXCEPT WHEN GRASPING THE FREE END OF
THE SUTURE DURING AN INSTRUMENT TIE
#ONJUNCTIVAL AND VAGINAL MUCOSAL SUTURES REMAINING IN PLACE FOR EXTENDED
PERIODS MAY BE ASSOCIATED WITH LOCALIZED IRRITATION AND SHOULD BE REMOVED AS
INDICATED
3UBCUTICULAR SUTURES SHOULD BE PLACED AS DEEPLY AS POSSIBLE IN ORDER TO
MINIMIZE THE ERYTHEMA AND INDURATION NORMALLY ASSOCIATED WITH ABSORPTION
!CCEPTABLE SURGICAL PRACTICE SHOULD BE FOLLOWED WITH RESPECT TO DRAINAGE AND
CLOSURE OF INFECTED WOUNDS
!$6%23% 2%!#4)/.3
$UE TO PROLONGED SUTURE ABSORPTION SOME IRRITATION AND BLEEDING HAS BEEN
OBSERVED IN THE CONJUNCTIVA AND MILD IRRITATION HAS BEEN OBSERVED IN THE
VAGINAL MUCOSA
$/3!'% !.$ !$-).)342!4)/.
5SE AS REQUIRED PER SURGICAL PROCEDURE
(/7 3500,)%$
$ATA OBTAINED FROM IMPLANTATION STUDIES IN RATS SHOW THAT THE ABSORPTION OF
THESE SUTURES IS MINIMAL UNTIL ABOUT THE TH POST
IMPLANTATION DAY !BSORPTION
IS ESSENTIALLY COMPLETE WITHIN SIX MONTHS
0$3 )) SUTURES ARE AVAILABLE AS STERILE MONOFILAMENT DYED VIOLET STRANDS IN
SIZES
THRU METRIC SIZES
AND STERILE MONOFILAMENT DYED BLUE
STRANDS IN SIZE
THRU
METRIC SIZE
IN A VARIETY OF LENGTHS WITH A
VARIETY OF NEEDLES
).$)#!4)/.3
0$3 )) MONOFILAMENT DYED VIOLET SUTURES SIZES THRU METRIC SIZE ARE
ALSO AVAILABLE ATTACHED TO #/.42/, 2%,%!3%
REMOVABLE NEEDLES
0$3 )) MONOFILAMENT SYNTHETIC ABSORBABLE SUTURES ARE INDICATED FOR USE IN ALL
TYPES OF SOFT TISSUE APPROXIMATION INCLUDING USE IN PEDIATRIC CARDIOVASCULAR TIS
SUE WHERE GROWTH IS EXPECTED TO OCCUR AND OPTHALMIC SURGERY 0$3 )) SUTURE IS
NOT INDICATED IN ADULT CARDIOVASCULAR TISSUE MICROSURGERY AND NEURAL TISSUE
4HESE SUTURES ARE PARTICULARLY USEFUL WHERE THE COMBINATION OF AN ABSORBABLE
SUTURE AND EXTENDED WOUND SUPPORT UP TO SIX WEEKS IS DESIRABLE
#/.42!).$)#!4)/.3
4HESE SUTURES BEING ABSORBABLE ARE NOT TO BE USED WHERE PROLONGED BEYOND
SIX WEEKS APPROXIMATION OF TISSUES UNDER STRESS IS REQUIRED ARE NOT TO BE USED
IN CONJUNCTION WITH PROSTHETIC DEVICES IE HEART VALVES OR SYNTHETIC GRAFTS
0$3 )) #LEAR SUTURE STRANDS ARE AVAILABLE IN SIZES THRU METRIC SIZE IN
A VARIETY OF LENGTHS WITH PERMANENTLY ATTACHED NEEDLES
7
4RADEMARK
%4()#/. ).#
#(!04%2
0%2-!
(!.$
3),+ 35452%
./.!"3/2"!",% 352')#!, 35452% 530
$%3#2)04)/.
0%2-!
(!.$
SILK SUTURE IS A NONABSORBABLE STERILE SURGICAL SUTURE
COMPOSED OF AN ORGANIC PROTEIN CALL FIBROIN 4HIS PROTEIN IS DERIVED FROM THE
DOMESTICATED SPECIES "OMBYX MORI B -ORE OF THE FAMILY "OMBYCIDAE
0%2-!
(!.$ SUTURES ARE PROCESSED TO REMOVE THE NATURAL WAXES AND GUMS
0%2-!
(!.$ SUTURE IS DYED BLACK AND COATED WITH A SPECIAL WAS MIXTURE
0%2-!
(!.$ SUTURE IS ALSO AVAILABLE IN ITS NATURAL COLOR 0%2-!
(!.$ 6IRGIN
SILK SUTURE IS AVAILABLE IN WHICH THE SERICIN GUM IS NOT REMOVED AND SERVES TO
HOLD THE FILAMENTS TOGETHER
0%2-!
(!.$ SUTURE MEETS REQUIREMENTS ESTABLISHED BY THE 5NITED 3TATES
0HARMACOPOEIA 530 FOR NONABSORBABLE SURGICAL SUTURE
).$)#!4)/.3
0%2-!
(!.$ SUTURE IS INDICATED FOR USE IN GENERAL SOFT TISSUE APPROXIMATION
ANDOR LIGATION INCLUDING USE IN CARDIOVASCULAR OPHTHALMIC AND NEUROLOGICAL
PROCEDURES
!#4)/.3
02%#!54)/.3
)N HANDLING THIS OR ANY OTHER SUTURE MATERIAL CARE SHOULD BE TAKEN TO AVOID
DAMAGE FROM HANDLING !VOID CRUSHING OR CRIMPING DAMAGE DUE TO APPLICATION
OF SURGICAL INSTRUMENTS SUCH AS FORCEPS OR NEEDLE HOLDERS
!S WITH ANY SUTURE MATERIAL ADEQUATE KNOT SECURITY REQUIRES THE ACCEPTED
SURGICAL TECHNIQUE OF FLAT AND SQUARE TIES WITH ADDITIONAL THROWS AS WARRANTED
BY SURGICAL CIRCUMSTANCE AND THE EXPERIENCE OF THE SURGEON
4O AVOID DAMAGING NEEDLES POINTS AND SWAGE AREAS GRASP THE NEEDLE IN AN
AREA ONE
THIRD TO ONE
HALF OF THE DISTANCE FROM THE SWAGED END TO THE
POINT 2ESHAPING NEEDLES MAY CAUSE THEM TO LOSE STRENGTH AND BE LESS
RESISTANT TO BENDING AND BREAKING G 5SERS SHOULD EXERCISE CAUTION WHEN
HANDLING SURGICAL NEEDLES TO AVOID INADVERTENT NEEDLE STICKS $ISCARD USED
NEEDLES IN SHARPS CONTAINERS
!$6%23% 2%!#4)/.3
!DVERSE EFFECTS ASSOCIATED WITH THE USE OF THIS DEVICE INCLUDE WOUND
DEHISCENCE GRADUAL LOSS OF ALL TENSILE STRENGTH OVER TIME ALLERGIC RESPONSE IN
PATIENTS THAT ARE KNOW TO BE SENSITIVE TO SILK CALCULI FORMATION IN URINARY AND
BILIARY TRACTS WHEN PROLONGED CONTACT WITH SALT SOLUTIONS SUCH AS URINE AND BILE
OCCURS INFECTION ACUTE INFLAMMATORY TISSUE REACTION AND TRANSITORY LOCAL
IRRITATION AT THE WOUND SITE "ROKEN NEEDLES MAY RESULT IN EXTENDED OR
ADDITIONAL SURGERIES OR RESIDUAL FOREIGN BODIES )NADVERTENT NEEDLE STICKS WITH
CONTAMINATED SURGICAL NEEDLES MAY RESULT IN THE TRANSMISSION OF BLOODBORNE
PATHOGENS
0%2-! (!.$ SUTURE ELICITS AN ACUTE INFLAMMATORY REACTION IN TISSUE WHICH IS
FOLLOWED BY A GRADUAL ENCAPSULATION OF THE SUTURE BY FIBROUS CONNECTIVE TISSUE
7HILE SILK SUTURES ARE NOT ABSORBED PROGRESSIVE DEGRADATION OF THE PROTEINA
CEOUS SILK FIBER IN VIVO MAY RESULT IN GRADUAL LOSS OF ALL OF THE SUTURES TENSILE
STRENGTH OVER TIME
(/7 3500,)%$
#/.42!).$)#!4)/.3
0%2-!
(!.$ SUTURES ARE ALSO AVAILABLE IN 530 SIZES
THROUGH METRIC
SIZES
ATTACHED TO #/.42/, 2%,%!3%
REMOVABLE NEEDLES
4HE USE OF THIS SUTURE IS CONTRAINDICATED IN PATIENTS WITH KNOWN SENSITIVITIES OR
ALLERGIES TO SILK
0%2-! (!.$ SUTURES ARE AVAILABLE IN 530 SIZES THROUGH METRIC SIZES
IN A VARIETY OF LENGTHS WITH AND WITHOUT PERMANENTLY ATTACHED NEEDLES
AND ON ,)'!0!+
DISPENSING REELS
0%2-! (!.$ SUTURES ARE AVAILABLE IN ONE TWO AND THREE DOZEN BOXES
$UE TO THE GRADUAL LOSS OF TENSILE STRENGTH WHICH MAY OCCUR OVER PROLONGED
PERIODS IN VIVO SILK SHOULD NOT BE USED WHERE PERMANENT RETENTION OF TENSILE
STRENGTH IS REQUIRED
7!2.).'3
5SERS SHOULD BE FAMILIAR WITH SURGICAL PROCEDURES AND TECHNIQUES INVOLVING
NONABSORBABLE SUTURES BEFORE EMPLOYING 0%2-!
(!.$ SUTURE FOR WOUND
CLOSURE AS RISK OF WOUND DEHISCENCE MAY VARY WITH THE SITE OF APPLICATION AND
THE SUTURE MATERIAL USED
!S WITH ANY FOREIGN BODY PROLONGED CONTACT OF ANY SUTURE WITH SALT SOLUTIONS
SUCH AS THOSE FOUND IN THE URINARY OR BILIARY TRACTS MAY RESULT IN CALCULUS FOR
MATION !CCEPTABLE SURGICAL PRACTICE SHOULD BE FOLLOWED FOR THE MANAGEMENT
OF INFECTED OR CONTAMINATED WOUNDS
$O NOT STERILIZE $ISCARD OPENED PACKAGES AND UNUSED SUTURES
4RADEMARK
%4()#/. ).#
02/$5#4 ).&/2-!4)/.
02/,%.%
0/,902/09,%.% 35452%
./.!"3/2"!",% 352')#!, 35452% 530
%XCEPT FOR SIZE
DIAMETER
AND (%-/
3%!,
.EEDLE 3UTURE !TTACHMENT
$%3#2)04)/.
02/,%.%
POLYPROPYLENE SUTURE CLEAR OR PIGMENTED IS A NONABSORBABLE
STERILE SURGICAL SUTURE COMPOSED OF AN ISOTACTIC CRYSTALLINE STEREOISOMER OF
POLYPROPYLENE A SYNTHETIC LINEAR POLYOLEFIN 4HE SUTURE IS PIGMENTED BLUE TO
ENHANCE VISIBILITY
3IZE
02/,%.% SUTURES ARE 530 EXCEPT FOR DIAMETER
-!8)-5- 35452% /6%23):% ). $)!-%4%2 MM &2/- 530
530 35452% 3):% $%3)'.!4)/.
-!8)-5- /6%23):% MM
02/,%.% SUTURE AVAILABLE AS (%-/ 3%!,
NEEDLE SUTURE IS A NEEDLE SUTURE
COMBINATION IN WHICH THE DIAMETER OF THE NEEDLE SWAGE AREA HAS BEEN REDUCED
TO FACILITATE ATTACHMENT OF FINER WIRE DIAMETER NEEDLES 4HE DIAMETER OF THE
SUTURE STRAND AND THE NEEDLE WIRE HAVE BEEN MORE CLOSELY ALIGNED TO REDUCE THE
DEGREE OF NEEDLE HOLE BLEEDING (%-/ 3%!, NEEDLE SUTURE DIFFERS FROM 530
IN NEEDLE ATTACHMENT REQUIREMENTS ONLY
).$)#!4)/.3
02/,%.% SUTURE IS INDICATED FOR USE IN GENERAL SOFT TISSUE APPROXIMATION
ANDOR LIGATION INCLUDING USE IN CARDIOVASCULAR OPHTHALMIC AND NEUROLOGICAL
PROCEDURES
!#4)/.3
02/,%.% SUTURE ELICITS A MINIMAL ACUTE INFLAMMATORY REACTION IN TISSUE WHICH
IS FOLLOWED BY GRADUAL ENCAPSULATION OF THE SUTURE BY FIBROUS CONNECTIVE TISSUE
02/,%.% SUTURE IS NOT ABSORBED NOR IS IT SUBJECT TO DEGRADATION OR WEAKENING
BY THE ACTION OF TISSUE ENZYMES !S A MONOFILAMENT 02/,%.% SUTURE 530
RESISTS INVOLVEMENT IN INFECTION AND HAS BEEN SUCCESSFULLY EMPLOYED IN CON
TAMINATED AND INFECTED WOUNDS TO ELIMINATE OR MINIMIZE LATER SINUS FORMATION
AND SUTURE EXTRUSION 4HE LACK OF ADHERENCE TO TISSUES HAS FACILITATED THE USE OF
02/,%.% SUTURE AS A PULL
OUT SUTURE
#/.42!).$)#!4)/.3
.ONE KNOWN
7!2.).'3
5SERS SHOULD BE FAMILIAR WITH SURGICAL PROCEDURES AND TECHNIQUES INVOLVING
NONABSORBABLE SUTURES BEFORE EMPLOYING 02/,%.% SUTURE FOR WOUND CLOSURE
AS RISK OF WOUND DEHISCENCE MAY VARY WITH THE SITE OF APPLICATION AND THE
SUTURE MATERIAL USED
$O NOT RESTERILIZE $ISCARD OPENED PACKAGES AND UNUSED SUTURES
!S WITH ANY FOREIGN BODY PROLONGED CONTACT OF ANY SUTURE WITH SALT SOLUTIONS
SUCH AS THOSE FOUND IN THE URINARY OR BILIARY TRACTS MAY RESULT IN CALCULUS FOR
MATION !CCEPTABLE SURGICAL PRACTICE MUST BE FOLLOWED FOR THE MANAGEMENT OF
INFECTED OR CONTAMINATED WOUNDS
02%#!54)/.3
)N HANDLING THIS SUTURE MATERIAL CARE SHOULD BE TAKEN TO AVOID DAMAGE FROM
HANDLING !VOID CRUSHING OR CRIMPING DAMAGE DUE TO APPLICATION OF SURGICAL
INSTRUMENTS SUCH AS FORCEPS OR NEEDLE HOLDERS
!DEQUATE KNOT SECURITY REQUIRES THE ACCEPTED SURGICAL TECHNIQUE OF FLAT SQUARE
TIES OF SINGLE SUTURE STRANDS 4HE USE OF ADDITIONAL THROWS IS PARTICULARLY APPRO
PRIATE WHEN KNOTTING POLYPROPYLENE SUTURES
4O AVOID DAMAGING NEEDLE POINTS AND SWAGE AREAS GRASP THE NEEDLE IN AN AREA
ONE
THIRD TO ONE
HALF OF THE DISTANCE FROM THE SWAGED END TO THE
POINT 2ESHAPING NEEDLES MAY CAUSE THEM TO LOSE STRENGTH AND BE LESS RESIST
ANT TO BENDING AND BREAKING 5SERS SHOULD EXERCISE CAUTION WHEN HANDLING SUR
GICAL NEEDLES TO AVOID INADVERTENT NEEDLE STICKS $ISCARD USED NEEDLES IN
SHARPS CONTAINERS
!$6%23% 2%!#4)/.3
!DVERSE EFFECTS ASSOCIATED WITH THE USE OF THIS DEVICE INCLUDE WOUND
DEHISCENCE CALCULI FORMATION IN URINARY AND BILIARY TRACTS WHEN PROLONGED
CONTACT WITH SALT SOLUTIONS SUCH AS URINE AND BILE OCCURS INFECTION MINIMAL
ACUTE INFLAMMATORY TISSUE REACTION AND TRANSITORY LOCAL IRRITATION AT THE WOUND
SITE "ROKEN NEEDLES MAY RESULT IN EXTENDED OR ADDITIONAL SURGERIES OR RESIDUAL
FOREIGN BODIES )NADVERTENT NEEDLE STICKS WITH CONTAMINATED SURGICAL NEEDLES
MAY RESULT IN THE TRANSMISSION OF BLOODBORNE PATHOGENS
(/7 3500,)%$
02/,%.% SUTURES PIGMENTED ARE AVAILABLE AS STERILE STRANDS IN 530 SIZES
THROUGH
METRIC SIZES
AND
THROUGH METRIC SIZES
02/,%.% SUTURES CLEAR ARE AVAILABLE AS STERILE STRANDS IN 530 SIZES
THROUGH METRIC SIZES
3IZE
METRIC SIZE 02/,%.% SUTURES PIG
MENTED AND CLEAR ARE 530 EXCEPT FOR DIAMETER !LL 02/,%.% SUTURES ARE AVAIL
ABLE IN A VARIETY OF LENGTHS WITH PERMANENTLY ATTACHED NEEDLES
02/,%.% SUTURES PIGMENTED AND CLEAR ARE ALSO AVAILABLE AS STERILE STRANDS IN
530 SIZES THROUGH METRIC SIZES
ATTACHED TO #/.42/, 2%,%!3%
REMOVABLE NEEDLES
02/,%.% SUTURES PIGMENTED AND CLEAR ARE ALSO AVAILABLE AS STERILE STRANDS IN
530 SIZES THROUGH
ATTACHED TO 4&% PLEDGETS MEASURING X X
MM X MM X MM
02/,%.% SUTURES PIGMENTED AND CLEAR ARE ALSO AVAILABLE IN STERILE STRANDS AS
(%-/
3%!,
NEEDLE SUTURES IN THE FOLLOWING SIZES
02/,%.% 3UTURE (%-/
3%!,
530 3IZE
.EEDLE 3UTURE
(%-/
3%!, .EEDLE 3UTURE ,IMITS
ON .EEDLE !TTACHMENT
!VG +GF
-IN
)NDIVIDUAL +GF
-IN
(3
(3
(3
530 ,IMITS ON .EEDLE !TTACHMENT
530 3IZE
!VG +GF
-IN
)NDIVIDUAL +GF
-IN
02/,%.% SUTURES ARE AVAILABLE IN ONE TWO AND THREE DOZEN BOXES
4RADEMARK
%4()#/. ).#
#(!04%2
02/,%.%
0/,902/09,%.%
(%2.)! 3934%.ONABSORBABLE 3YNTHETIC 3URGICAL -ESH
$%3#2)04)/.
4HE 02/,%.%
0OLYPROPYLENE (ERNIA 3YSTEM IS A STERILE PRE
SHAPED THREE
DIMENSIONAL DEVICE CONSTRUCTED OF AN ONLAY PATCH CONNECTED BY A MESH
CYLINDER TO A CIRCULAR UNDERLAY PATCH 4HE MATERIAL IS UNDYED 02/,%.%
0OLYPROPYLENE -%3( CONSTRUCTED OF KNITTED NONABSORBABLE POLYPROPYLENE
FILAMENTS
!#4)/.30%2&/2-!.#%
4HE 02/,%.% (ERNIA 3YSTEM IS A NONABSORBABLE MESH USED TO REINFORCE OR
BRIDGE INGUINAL HERNIA DEFICIENCIES TO PROVIDE EXTENDED SUPPORT DURING AND
FOLLOWING WOUND HEALING !NIMAL STUDIES SHOW THAT IMPLANTATION OF 02/,%.%
-ESH ELICITS A MINIMUM TO SLIGHT INFLAMMATORY REACTION WHICH IS TRANSIENT AND IS
FOLLOWED BY THE DEPOSITION OF A THIN FIBROUS LAYER OF TISSUE WHICH CAN GROW THROUGH
THE INTERSTICES OF THE MESH THUS INCORPORATING THE MESH INTO ADJACENT TISSUE
4HE MESH REMAINS SOFT AND PLIABLE AND NORMAL WOUND HEALING IS NOT NOTICEABLY
IMPAIRED 4HE MATERIAL IS NEITHER ABSORBED NOR IS IT SUBJECT TO DEGRADATION OR
WEAKENING BY THE ACTION OF TISSUE ENZYMES
).3425#4)/.3 &/2 53%
&OR INDIRECT HERNIA A HIGH DISSECTION OF THE NECK OF THE HERNIA SAC TO UTILIZE THE
POTENTIAL OF THE PREPERITONEAL SPACE CAN BE PERFORMED TO INSERT THE 02/,%.%
(ERNIA 3YSTEM 4HE CIRCULAR OR BOTTOM UNDERLAY PORTION OF THE 02/,%.% (ERNIA
3YSTEM IS FOLDED AND IS INSERTED THROUGH THE INTERNAL RING ALLOWING THE MESH TO
EXPAND TO THE UNDERLAY POSITION 3URGICAL MANIPULATION MAY BE USED TO
FACILITATE THE EXPANSION OF THE DEVICE TO THE UNDERLAY POSITION .O SUTURES ARE
NECESSARY IN THE BOTTOM UNDERLAY PATCH 4HE TOP ONLAY PATCH WHICH IS DESIGNED
TO COVER THE POSTERIOR WALL FLOOR OF THE CANAL IS THEN MODIFIED AS NEEDED TO
ACCOMMODATE THE CORD STRUCTURES )F ONE END OF THE OVAL ONLAY PATCH IS LONGER
THAN THE OTHER THE 02/,%.% (ERNIA 3YSTEM IS POSITIONED SO THAT THE LONGER
END COVERS THE POSTERIOR WALL FLOOR OF THE CANAL AND OVERLAPS THE PUBLIC
TUBERCLE
&OR DIRECT HERNIA THE DEFECT IS CIRCUMSCRIBED AT ITS BASE THE CONTENTS FULLY
REDUCED AND THE PREPERITONEAL SPACE IS ACTUALIZED PRIOR TO THE INSERTION OF THE
02/,%.% (ERNIA 3YSTEM 4HE CIRCULAR OR BOTTOM UNDERLAY PORTION OF THE
02/,%.% (ERNIA 3YSTEM IS FOLDED AND IS INSERTED THROUGH THE DEFECT OR THE
INTERNAL RING ALLOWING THE MESH TO EXPAND TO THE UNDERLAY POSITION 4HE
UNDERLAY PORTION SHOULD EXPAND UNDER THE DEFECT IN THE FLOOR OF THE CANAL
3URGICAL MANIPULATION MAY BE USED TO FACILITATE THE EXPANSION OF THE DEVICE TO
THE UNDERLAY POSITION 3UTURES OR CLIPS MAY BE USED TO SECURE THE TOP ONLAY
PATCH IN PLACE
34%2),)49
4HE 02/,%.% (ERNIA 3YSTEM IS STERILIZED BY %THYLENE /XIDE $O NOT RESTERILIZE
$O NOT USE IF PACKAGE IS OPENED OR DAMAGED $ISCARD OPEN UNUSED PRODUCT
).$)#!4)/.3
4HIS PRODUCT IS INDICATED FOR THE REPAIR OF INDIRECT AND DIRECT INGUINAL HERNIA
DEFECTS
34/2!'%
2ECOMMENDED STORAGE CONDITIONS BELOW # & AWAY FROM MOISTURE AND
DIRECT HEAT $O NOT USE AFTER EXPIRY DATE
7!2.).'3
4HE 02/,%.% (ERNIA 3YSTEM IS PROVIDED BY %4()#/. ).# AS A STERILE
PRODUCT 4HIS DEVICE IS FOR SINGLE USE ONLY $O NOT RESTERILIZE $ISCARD OPENED
PACKAGES AND UNUSED PRODUCT
7HEN THIS DEVICE IS USED IN INFANTS OR CHILDREN WITH FUTURE GROWTH POTENTIAL THE
SURGEON SHOULD BE AWARE THAT THIS PRODUCT WILL NOT STRETCH SIGNIFICANTLY AS THE
PATIENT GROWS
4HE 02/,%.% (ERNIA 3YSTEM SHOULD ONLY BE USED IN CONTAMINATED WOUNDS
WITH THE UNDERSTANDING THAT SUBSEQUENT INFECTION MAY REQUIRE REMOVAL OF THE
DEVICE
02%#!54)/.3
3UTURES OR CLIPS IF NECESSARY SHOULD BE PLACED SUCH THAT A MINIMUM OF MM
OF MESH SHOULD EXTEND BEYOND THE SUTURE LINE
!$6%23% 2%!#4)/.3
0OTENTIAL ADVERSE REACTIONS ARE THOSE TYPICALLY ASSOCIATED WITH SURGICALLY
IMPLANTABLE MATERIALS WHICH INCLUDE INFECTION POTENTIATION INFLAMMATION
ADHESION FORMATION FISTULA FORMATION AND EXTRUSION
(/7 3500,)%$
4HE 02/,%.% (ERNIA 3YSTEM IS AVAILABLE STERILE UNDYED IN SEVERAL SIZES
#!54)/.
&EDERAL 53! ,AW RESTRICTS THIS DEVICE TO SALE BY OR ON THE ORDER OF A
PHYSICIAN
4RADEMARK
%4()#/. ).#
02/$5#4 ).&/2-!4)/.
02/,%.%
0/,902/09,%.% -%3(
./.!"3/2"!",% 39.4(%4)# 352')#!, -%3(
34%2),%
02%#!54)/.3
! MINIMUM OF MM OF MESH SHOULD EXTEND BEYOND THE SUTURE LINE
!$6%23% 2%!#4)/.3
$%3#2)04)/.
02/,%.%
POLYPROPYLENE MESH IS CONSTRUCTED OF KNITTED FILAMENTS OF EXTRUDED
POLYPROPYLENE IDENTICAL IN COMPOSITION TO THAT USED IN 02/,%.%
0OLYPROPYLENE 3UTURE .ONABSORBABLE 3URGICAL 3UTURES 530 %4()#/.
).# 4HE MESH IS APPROXIMATELY INCHES THICK 4HIS MATERIAL WHEN USED
AS A SUTURE HAS BEEN REPORTED TO BE NON REACTIVE AND TO RETAIN ITS STRENGTH
INDEFINITELY IN CLINICAL USE
02/,%.% MESH IS KNITTED BY A PROCESS WHICH INTERLINKS EACH FIBER JUNCTION AND
WHICH PROVIDES FOR ELASTICITY IN BOTH DIRECTIONS 4HIS CONSTRUCTION PERMITS THE
MESH TO BE CUT INTO ANY DESIRED SHAPE OR SIZE WITHOUT UNRAVELING 4HE FIBER JUNC
TIONS ARE NOT SUBJECT TO THE SAME WORK FATIGUE EXHIBITED BY MORE RIGID METALLIC
MESHES 4HIS BI DIRECTIONAL ELASTIC PROPERTY ALLOWS ADAPTION TO VARIOUS STRESSES
ENCOUNTERED IN THE BODY
0OTENTIAL ADVERSE REACTIONS ARE THOSE TYPICALLY ASSOCIATED WITH SURGICALLY
IMPLANTABLE MATERIALS WHICH INCLUDE INFECTION POTENTIATION INFLAMMATION
ADHESION FORMATION FISTULA FORMATION AND EXTRUSION
).3425#4)/.3 &/2 53%
)T IS RECOMMENDED THAT NONABSORBABLE SUTURES BE PLACED MM TO MM
TO APART AT A DISTANCE APPROXIMATELY MM FROM EDGE OF THE
MESH 3OME SURGEONS PREFER TO SUTURE AN UNCUT SECTION OF MESH THAT IS
CONSIDERABLY LARGER THAN THE DEFECT INTO POSITION OVER THE WOUND 4HE OPPOSITE
SIDES ARE THEN SUTURED TO ASSURE PROPER CLOSURE UNDER CORRECT TENSION 7HEN
THE MARGIN SUTURES HAVE ALL BEEN PLACED THE EXTRA MESH IS TRIMMED AWAY
(/7 3500,)%$
!#4)/.3
02/,%.% MESH IS A NONABSORBABLE MESH USED TO SPAN AND REINFORCE TRAUMAT
IC OR SURGICAL WOUNDS TO PROVIDE EXTENDED SUPPORT DURING AND FOLLOWING WOUND
HEALING !NIMAL STUDIES SHOW THAT IMPLANTATION OF 02/,%.% MESH ELICITS A MIN
IMUM TO SLIGHT INFLAMMATORY REACTION WHICH IS TRANSIENT AND IS FOLLOWED BY THE
DEPOSITION OF A THIN FIBROUS LAYER OF TISSUE WHICH CAN GROW THROUGH THE INTER
STICES OF THE MESH THUS INCORPORATING THE MESH INTO ADJACENT TISSUE 4HE MESH
REMAINS SOFT AND PLIABLE AND NORMAL WOUND HEALING IS NOT NOTICEABLY IMPAIRED
4HE MATERIAL IS NOT ABSORBED NOR IS IT SUBJECT TO DEGRADATION OR WEAKENING BY
THE ACTION OF TISSUE ENZYMES
).$)#!4)/.3
4HIS MESH MAY BE USED FOR THE REPAIR OF HERNIA AND OTHER FASCIAL DEFICIENCIES
THAT REQUIRE THE ADDITION OF A REINFORCING OR BRIDGING MATERIAL TO OBTAIN THE
DESIRED SURGICAL RESULT
#/.42!).$)#!4)/.3
7HEN THIS MESH IS USED IN INFANTS OR CHILDREN WITH FUTURE GROWTH POTENTIAL THE
SURGEON SHOULD BE AWARE THAT THIS PRODUCT WILL NOT STRETCH SIGNIFICANTLY AS THE
PATIENT GROWS
02/,%.% MESH IN CONTAMINATED WOUNDS SHOULD BE USED WITH THE UNDERSTAND
ING THAT SUBSEQUENT INFECTION MAY REQUIRE REMOVAL OF THE MATERIAL
7!2.).'3
02/,%.% MESH IS PROVIDED BY %4()#/. ).# AS A STERILE PRODUCT
2ESTERILIZATION OF THE DEVICE IS ./4 RECOMMENDED (OWEVER TESTING HAS
DEMONSTRATED THAT REPROCESSING OF UNUSED 02/,%.% MESH WHICH HAS BEEN
REMOVED FROM THE PACKAGE WILL NOT BE ADVERSELY AFFECTED WHEN EXPOSED NOT
MORE THAN ONE TIME TO CONVENTIONAL STEAM AUTOCLAVE CONDITIONS OF &
# FOR MINUTES 2EPROCESSING UNDER ANY OTHER CONDITION OR BY ANY
OTHER MEANS IS NEITHER RECOMMENDED NOR ENDORSED BY %4()#/. ).#
02/,%.% MESH SHOULD NOT BE FLASH AUTOCLAVED
)F THIS PRODUCT SHOULD BECOME STAINED WITH BLOOD OR SOILED IT SHOULD NOT BE
RESTERILIZED FOR REUSE
7HEN REPROCESSED AS OUTLINED ABOVE IT IS THE RESPONSIBILITY OF THE END
USER TO
ASSURE STERILITY OF THE PRODUCT VIA A VALIDATED STERILIZATION PROCESS AS %4()#/.
).# HAS NO CONTROL OVER ENVIRONMENTAL CONDITIONS THE PRODUCT MAY ENCOUNTER
PRIOR TO
DURING
OR AFTER REPROCESSING
02/,%.% MESH IS AVAILABLE IN SINGLE PACKETS AS STERILE UNDYED CLEAR SHEETS
IN SEVEN SIZES 4HE SIZES AVAILABLE ARE CM X CM X CM X CM
X CM X CM X CM X CM X CM X CM
X CM X CM X AND CM X CM X %ACH SHEET IS
APPROXIMATELY MM THICK
2
4RADEMARK
%4()#/. ).#
#(!04%2
02/./6!
0/,9 (%8!&,5/2/02/09
,%.%
6$& 35452%
./.!"3/2"!",% 352')#!, 35452% 530
%8#%04 &/2 3):%
$)!-%4%2
$%3#2)04)/.
02/./6!
SUTURE CLEAR OR PIGMENTED IS A NONABSORBABLE STERILE SURGICAL
SUTURE MADE FROM A POLYMER BLEND OF POLYVINYLIDENE FLUORIDE AND POLY
VINYLIDENE FLUORIDE
CO
HEXAFLUOROPROPYLENE 4HE SUTURE IS PIGMENTED BLUE TO
ENHANCE VISIBILITY
3IZE
02/./6! SUTURES ARE 530 EXCEPT FOR DIAMETER
-!8)-5- 35452% /6%23):% ). $)!-%4%2 MM &2/- 530
530 35452% 3):% $%3)'.!4)/.
-!8)-5- /6%23):% MM
).$)#!4)/.3
02/./6! SUTURE IS INDICATED FOR USE IN GENERAL SOFT TISSUE APPROXIMATION
ANDOR LIGATION INCLUDING USE IN CARDIOVASCULAR OPHTHALMIC AND NEUROLOGICAL
PROCEDURES
02%#!54)/.3
)N HANDLING THIS SUTURE MATERIAL CARE SHOULD BE TAKEN TO AVOID DAMAGE FROM
HANDLING !VOID CRUSHING OR CRIMPING DAMAGE DUE TO APPLICATION OF SURGICAL
INSTRUMENTS SUCH AS FORCEPS OR NEEDLE HOLDERS
!DEQUATE KNOT SECURITY REQUIRES THE ACCEPTED SURGICAL TECHNIQUE OF FLAT SQUARE
TIES OF SINGLE SUTURE STRANDS 4HE USE OF ADDITIONAL THROWS IS PARTICULARLY
APPROPRIATE WHEN KNOTTING MONOFILAMENT SUTURES
4O AVOID DAMAGING NEEDLE POINTS AND SWAGE AREAS GRASP THE NEEDLE IN AN AREA
ONE
THIRD TO ONE
HALF OF THE DISTANCE FROM THE SWAGED END TO THE
POINT 2ESHAPING NEEDLES MAY CAUSE THEM TO LOSE STRENGTH AND BE LESS
RESISTANT TO BENDING AND BREAKING 5SERS SHOULD EXERCISE CAUTION WHEN
HANDLING SURGICAL NEEDLES TO AVOID INADVERTENT NEEDLE STICKS $ISCARD USED
NEEDLES IN SHARPS CONTAINERS
!$6%23% 2%!#4)/.3
!DVERSE EFFECTS ASSOCIATED WITH THE USE OF THIS DEVICE INCLUDE WOUND DEHIS
CENCE CALCULI FORMATION IN URINARY AND BILIARY TRACTS WHEN PROLONGED CONTACT
WITH SALT SOLUTIONS SUCH AS URINE AND BILE OCCURS INFECTION MINIMAL TO MILD
INFLAMMATORY TISSUE REACTION AND TRANSITORY LOCAL IRRITATION AT THE WOUND SITE
"ROKEN NEEDLES MAY RESULT IN EXTENDED OR ADDITIONAL SURGERIES OR RESIDUAL FOR
EIGN BODIES )NADVERTENT NEEDLE STICKS WITH CONTAMINATED SURGICAL NEEDLES MAY
RESULT IN THE TRANSMISSION OF BLOODBORNE PATHOGENS
(/7 3500,)%$
!#4)/.3
02/./6! SUTURE ELICITS A MINIMAL TO MILD INFLAMMATORY REACTION IN TISSUE
WHICH IS FOLLOWED BY GRADUAL ENCAPSULATION OF THE SUTURE BY FIBROUS CONNECTIVE
TISSUE 02/./6! SUTURE IS NOT ABSORBED NOR IS IT SUBJECT TO DEGRADATION OR
WEAKENING BY THE ACTION OF TISSUE ENZYMES !S A MONOFILAMENT 02/./6!
SUTURE 530 RESISTS INVOLVEMENT IN INFECTION AND HAS BEEN SUCCESSFULLY
EMPLOYED IN CONTAMINATED AND INFECTED WOUNDS TO ELIMINATE OR MINIMIZE LATER
SINUS FORMATION AND SUTURE EXTRUSION &URTHERMORE THE LACK OF ADHERENCE TO
TISSUES HAS FACILITATED THE USE OF 02/./6! SUTURE AS A PULL
OUT SUTURE
#/.42!).$)#!4)/.3
02/./6! SUTURES PIGMENTED ARE AVAILABLE AS STERILE STRANDS IN 530 SIZES
THROUGH METRIC SIZES AND THROUGH METRIC SIZES
02/./6! SUTURES CLEAR ARE AVAILABLE AS STERILE STRANDS IN 530 SIZES
THROUGH METRIC SIZES 3IZE METRIC SIZE 02/./6! SUTURES PIG
MENTED AND CLEAR ARE 530 EXCEPT FOR DIAMETER !LL 02/./6! SUTURES ARE
AVAILABLE IN A VARIETY OF LENGTHS WITH PERMANENTLY ATTACHED NEEDLES
02/./6! SUTURES PIGMENTED AND CLEAR ARE ALSO AVAILABLE AS STERILE STRANDS IN
530 SIZES THROUGH METRIC SIZES ATTACHED TO #/.42/, 2%,%!3%
REMOVABLE NEEDLES
02/./6! SUTURES ARE AVAILABLE IN ONE TWO AND THREE DOZEN BOXES
.ONE KNOWN
7!2.).'3
5SERS SHOULD BE FAMILIAR WITH SURGICAL PROCEDURES AND TECHNIQUES INVOLVING
NONABSORBABLE SUTURES BEFORE EMPLOYING 02/./6! SUTURE FOR WOUND CLOSURE
AS RISK OF WOUND DEHISCENCE MAY VARY WITH THE SITE OF APPLICATION AND THE
SUTURE MATERIAL USED
$O NOT RESTERILIZE $ISCARD OPENED PACKAGES AND UNUSED SUTURES
!S WITH ANY FOREIGN BODY PROLONGED CONTACT OF ANY SUTURE WITH SALT SOLUTIONS
SUCH AS THOSE FOUND IN THE URINARY OR BILIARY TRACTS MAY RESULT IN CALCULUS FOR
MATION !CCEPTABLE SURGICAL PRACTICE MUST BE FOLLOWED FOR THE MANAGEMENT OF
INFECTED OR CONTAMINATED WOUNDS
4RADEMARK
%4()#/. ).#
02/$5#4 ).&/2-!4)/.
02/8)-!4%
3+). 34!0,%2
).$)#!4)/.3
4HE 3KIN 3TAPLER HAS APPLICATION FOR ROUTINE SKIN CLOSURE IN A WIDE VARIETY OF
SURGICAL PROCEDURES
#/.42!).$)#!4)/.3
7HEN IT IS NOT POSSIBLE TO MAINTAIN AT LEAST A MM DISTANCE FROM THE STAPLED
SKIN TO UNDERLYING BONES VESSELS OR INTERNAL ORGANS THE USE OF STAPLES FOR SKIN
CLOSURE IS CONTRAINDICATED
$%6)#% $%3#2)04)/.
4HE 3KIN 3TAPLER IS A STERILE SINGLE PATIENT USE INSTRUMENT DESIGNED TO DELIVER
RECTANGULAR STAINLESS STEEL STAPLES FOR ROUTINE WOUND CLOSURE
).3425#4)/.3 &/2 53%
6ERIFY COMPATIBILITY OF ALL INSTRUMENTS AND ACCESSORIES PRIOR TO USING THE
INSTRUMENT
5SING STERILE TECHNIQUE REMOVE THE INSTRUMENT FROM THE PACKAGE
4O AVOID DAMAGE DO NOT FLIP THE INSTRUMENT INTO THE STERILE FIELD
3UGGESTED %VERSION 4ECHNIQUES 7ITH TWO TISSUE FORCEPS PICK UP EACH
WOUND EDGE INDIVIDUALLY AND APPROXIMATE THE EDGES )LLUSTRATION
/R WITH ONE TISSUE FORCEPS PULL SKIN EDGES TOGETHER UNTIL EDGES EVERT
)LLUSTRATION
/R APPLY TENSION TO EITHER END OF THE INCISION SUCH THAT THE TISSUE EDGES
BEGIN TO APPROXIMATE THEMSELVES /NE FORCEPS CAN BE USED TO ENSURE THAT
THE EDGES ARE EVERTED )LLUSTRATION
0OSITION THE INSTRUMENT WITH MODERATE PRESSURE OVER THE EVERTED SKIN
EDGES 4HE INSTRUMENT SHOULD BE HELD AT A ANGLE TO THE SKIN )LLUSTRATION
3QUEEZE THE TRIGGER UNTIL THE TRIGGER MOTION IS HALTED THEN RELEASE THE
TRIGGER AND MOVE THE INSTRUMENT OFF THE INCISION IN ANY DIRECTION
)LLUSTRATION
!LTERNATE 2ELEASE )F DESIRED BEFORE RELEASING THE TRIGGER LIFT UP ON THE
INSTRUMENT 4HIS WILL HELP TO EVERT THE SKIN EDGES WHICH CAN THEN BE MORE
EASILY GRASPED WITH THE TISSUE FORCEPS 2ELEASE THE TRIGGER AFTER THE
FORCEPS ARE IN PLACE AND REPEAT THE SEQUENCE TO FIRE THE NEXT STAPLE
)LLUSTRATION
!LTERNATE 4ECHNIQUE 4HE INSTRUMENT CAN ALSO BE PRECOCKED PARTIALLY FIRED
SO THAT THE STAPLE POINTS ARE VISIBLE AT THE NOSE OF THE INSTRUMENT 4HIS FEA
TURE IN CONJUNCTION WITH THE CLEAR NOSE AND ALIGNMENT ARROW ENSURES PRE
CISE STAPLE PLACEMENT IN THE SKIN )LLUSTRATION
.OTE )F DESIRED AFTER THE INSTRUMENT HAS BEEN PRECOCKED ONE LEG OF THE
STAPLE CAN BE HOOKED ONTO ONE SIDE OF THE TISSUE 4HIS WILL AID IN DRAWING
THE TISSUE TOGETHER 4HIS TECHNIQUE MAY BE SUITABLE FOR ATTACHING SKIN GRAFTS
UNDER MODERATE TENSION )LLUSTRATION
7!2.).'3 !.$ 02%#!54)/.3
s
$ISPOSE OF ALL OPENED PRODUCTS WHETHER USED OR UNUSED $O .OT
2ESTERILIZE THE INSTRUMENT 2ESTERILIZATION MAY COMPROMISE THE INTEGRITY OF
THE INSTRUMENT WHICH MAY RESULT IN UNINTENDED INJURY
(/7 3500,)%$
4HE 02/8)-!4% 3KIN 3TAPLER IS SUPPLIED STERILE AND PRELOADED FOR SINGLE
PATIENT USE $ISCARD AFTER USE
&/2-%$ 34!0,% $)-%.3)/.3
2EGULAR STAPLES HAVE AN APPROXIMATE DIAMETER OF MM SPAN OF MM
AND LEG LENGTH OF MM
7IDE STAPLES HAVE AN APPROXIMATE DIAMETER OF MM SPAN OF MM AND
LEG LENGTH OF MM
00
4RADEMARK
%4()#/. %.$/ 352'%29 ).#
#(!04%2
02/8)-!4%
3+). 34!0,%2 %842!#4/2
).$)#!4)/.3
4HE 02/8)-!4% 3KIN 3TAPLE %XTRACTOR HAS APPLICATION FOR ROUTINE SKIN CLOSURE
IN A WIDE VARIETY OF SURGICAL PROCEDURES
#/.42!).$)#!4)/.3
7HEN IT IS NOT POSSIBLE TO MAINTAIN AT LEAST A MM DISTANCE FROM THE STAPLED
SKIN TO UNDERLYING BONES VESSELS OR INTERNAL ORGANS THE USE OF STAPLES FOR SKIN
CLOSURE IS CONTRAINDICATED
$%6)#% $%3#2)04)/.
4HE 02/8)-!4% 3KIN 3TAPLE %XTRACTOR IS A STERILE SINGLE PATIENT USE STAINLESS
STEEL DEVICE SPECIFICALLY DESIGNED TO COMPLETELY OPEN SKIN STAPLES FOR REMOVAL
4HE FUNCTION OF THE 3KIN 3TAPLE %XTRACTOR IS TO REMOVE 0ROXIMATE 2EGULAR OR
7IDE 3KIN 3TAPLES FROM SKIN WOUNDS
)LLUSTRATION AND .OMENCLATURE
3AFETY #AP
*AWS
5PPER (ANDLE
,OWER (ANDLE
).3425#4)/.3 &/2 53%
6ERIFY COMPATIBILITY OF ALL INSTRUMENTS AND ACCESSORIES PRIOR TO USING THE DEVICE
5SING STERILE TECHNIQUE REMOVE THE DEVICE FROM THE PACKAGE 4O AVOID
DAMAGE DO NOT FLIP THE DEVICE INTO THE STERILE FIELD
2EMOVE THE SAFETY CAP FROM THE DEVICE
3LIDE LOWER JAW OF EXTRACTOR UNDER REGULAR OR WIDE STAPLE UNTIL STAPLE IS
SECURED IN SLOT IN LOWER JAW )LLUSTRATION
3QUEEZE DOWN WITH THUMB TO OPEN STAPLE UNTIL HANDLES ARE FIRMLY
TOUCHING )LLUSTRATION
%NSURE STAPLE IS COMPLETELY OPENED BEFORE LIFTING EXTRACTOR FROM SKIN
.EVER PULL UP BEFORE EXTRACTOR IS FULLY CLOSED )LLUSTRATION
7ARNINGS AND 0RECAUTIONS
s
$ISPOSE OF ALL OPENED PRODUCTS WHETHER USED OR UNUSED $O .OT
2ESTERILIZE THE DEVICE 2ESTERILIZATION MAY COMPROMISE THE INTEGRITY OF THE
DEVICE WHICH MAY RESULT IN UNINTENDED INJURY
)NSTRUMENTS OR DEVICES WHICH COME INTO CONTACT WITH BODILY FLUIDS MAY
REQUIRE SPECIAL DISPOSAL HANDLING TO PREVENT BIOLOGICAL CONTAMINATION
(/7 3500,)%$
4HE 02/8)-!4% 3KIN 3TAPLE %XTRACTOR IS SUPPLIED STERILE FOR SINGLE PATIENT USE
$ISCARD AFTER USE
00
4RADEMARK
%4()#/. %.$/ 352'%29 ).#
02/$5#4 ).&/2-!4)/.
02/8)-!4% 0,53 -$
-5,4)
$)-%.4)/.!, 2%,%!3% 3+). 34!0,%2
).$)#!4)/.3
4HE 02/8)-!4% 0,53 -$ 3KIN 3TAPLER HAS APPLICATION FOR ROUTINE SKIN CLOSURE
IN A WIDE VARIETY OF SURGICAL PROCEDURES
#/.42!).$)#!4)/.3
7HEN IT IS NOT POSSIBLE TO MAINTAIN AT LEAST A MM DISTANCE FROM THE STAPLED
SKIN TO UNDERLYING BONES VESSELS OR INTERNAL ORGANS THE USE OF STAPLES FOR SKIN
CLOSURE IS CONTRAINDICATED
$%6)#% $%3#2)04)/.
4HE 02/8)-!4% 0,53 -$ 3KIN 3TAPLER IS A STERILE SINGLE PATIENT USE
INSTRUMENT DESIGNED TO DELIVER RECTANGULAR STAINLESS STEEL STAPLES FOR ROUTINE
WOUND CLOSURE
).3425#4)/.3 &/2 53%
6ERIFY COMPATIBILITY OF ALL INSTRUMENTS AND ACCESSORIES PRIOR TO USING THE INSTRU
MENT REFER TO 7ARNINGS AND 0RECAUTIONS
5SING STERILE TECHNIQUE REMOVE THE INSTRUMENT FROM THE PACKAGE
4O AVOID DAMAGE DO NOT FLIP THE INSTRUMENT INTO THE STERILE FIELD
%VERT AND APPROXIMATE SKIN EDGES AS DESIRED 3EVERAL TECHNIQUES ARE
SUGGESTED
A 7ITH ONE TISSUE FORCEP PULL SKIN EDGES TOGETHER UNTIL EDGES EVERT
)LLUSTRATION
/2
B 7ITH TWO TISSUE FORCEPS PICK UP EACH WOUND EDGE INDIVIDUALLY AND
APPROXIMATE THE EDGES )LLUSTRATION
/2
C !PPLY TENSION TO EITHER END OF THE INCISION SUCH THAT THE TISSUE EDGES
BEGIN TO APPROXIMATE THEMSELVES /NE FORCEP CAN BE USED TO ENSURE THAT
THE EDGES ARE EVERTED
0OSITION THE INSTRUMENT OVER THE EVERTED SKIN EDGES ALIGNING THE
INSTRUMENT ARROW WITH THE INCISION )LLUSTRATION
3QUEEZE THE TRIGGER UNTIL THE TRIGGER MOTION IS HALTED 2ELEASE THE TRIGGER
AND REMOVE THE INSTRUMENT FROM THE FIRED STAPLE )LLUSTRATION
7!2.).'3 !.$ 02%#!54)/.3
s
$ISPOSE OF ALL OPENED INSTRUMENTS WHETHER USED OR UNUSED $O .OT
2ESTERILIZE THE INSTRUMENT 2ESTERILIZATION MAY COMPROMISE THE INTEGRITY OF
THE STAPLER WHICH MAY RESULT IN UNINTENDED INJURY
(/7 3500,)%$
4HE 02/8)-!4% 0,53 -$ 3KIN 3TAPLER IS SUPPLIED STERILE AND PRELOADED FOR
SINGLE PATIENT USE $ISCARD AFTER USE
&/2-%$ 34!0,% $)-%.3)/.3
2EGULAR STAPLES HAVE A DIAMETER OF MM A SPAN OF MM AND A LEG LENGTH
OF MM
7IDE STAPLES HAVE A DIAMETER OF MM A SPAN OF MM AND A LEG LENGTH
OF MM
#AUTION &EDERAL 53! LAW RESTRICTS THIS DEVICE TO SALE BY OR ON THE ORDER
OF A PHYSICIAN
00
4RADEMARK
%4()#/. %.$/ 352'%29 ).#
#(!04%2
352')#!, '54 35452%
!"3/2"!",% 352')#!, 35452%3 530
$%3#2)04)/.
3URGICAL GUT SUTURE IS AN ABSORBABLE STERILE SURGICAL SUTURE COMPOSED OF
PURIFIED CONNECTIVE TISSUE MOSTLY COLLAGEN DERIVED FROM EITHER THE SEROSAL
LAYER OF BEEF BOVINE OR THE SUBMUCOSAL FIBROUS LAYER OF SHEEP OVINE
INTESTINES 3URGICAL GUT SUTURES ARE AVAILABLE IN PLAIN OR CHROMIC #HROMIC GUT
IS PROCESSED TO PROVIDE GREATER RESISTANCE TO ABSORPTION 3URGICAL GUT IS
PACKAGED IN TUBING FLUID "LUE DYED CHROMIC GUT SUTURE IS ALSO AVAILABLE
3URGICAL GUT SUTURE MEETS ALL REQUIREMENTS ESTABLISHED BY THE 5NITED 3TATES
0HARMACOPOEIA 530 FOR ABSORBABLE SURGICAL SUTURES
).$)#!4)/.3
3URGICAL GUT SUTURE IS INDICATED FOR USE IN GENERAL SOFT TISSUE APPROXIMATION
ANDOR LIGATION INCLUDING USE IN OPHTHALMIC PROCEDURES BUT NOT FOR USE IN
CARDIOVASCULAR AND NEUROLOGICAL TISSUES
!#4)/.3
7HEN SURGICAL GUT SUTURE IS PLACED IN TISSUE A MODERATE TISSUE INFLAMMATION
OCCURS WHICH IS CHARACTERISTIC OF FOREIGN BODY RESPONSE TO A SUBSTANCE 4HIS IS
FOLLOWED BY A LOSS OF TENSILE STRENGTH AND A LOSS OF SUTURE MASS AS THE PROTE
OLYTIC ENZYMATIC DIGESTIVE PROCESS DISSOLVES THE SURGICAL GUT 4HIS PROCESS
CONTINUES UNTIL THE SUTURE IS COMPLETELY ABSORBED -ANY VARIABLE FACTORS MAY
AFFECT THE RATE OF ABSORPTION 3OME OF THE MAJOR FACTORS WHICH CAN AFFECT TENSILE
STRENGTH LOSS AND ABSORPTION RATES ARE
4YPE OF SUTURE
PLAIN GUT GENERALLY ABSORBS MORE RAPIDLY THAN CHROMIC GUT
)NFECTION
SURGICAL GUT IS ABSORBED MORE RAPIDLY IN INFECTED TISSUE
THAN IN NON
INFECTED TISSUE
4ISSUE SITES
SURGICAL GUT WILL ABSORB MORE RAPIDLY IN TISSUE WHERE
INCREASED LEVELS OF PROTEOLYTIC ENZYMES ARE PRESENT AS IN THE SECRE
TIONS EXHIBITED IN THE STOMACH CERVIX AND VAGINA
#/.42!).$)#!4)/.3
4HIS SUTURE BEING ABSORBABLE SHOULD NOT BE USED WHERE EXTENDED APPROXI
MATION OF TISSUE IS REQUIRED
4HE USE OF THIS SUTURE IS CONTRAINDICATED IN PATIENTS WITH KNOWN SENSITIVITIES OR
ALLERGIES TO COLLAGEN OR CHROMIUM AS GUT IS A COLLAGEN BASED MATERIAL AND
CHROMIC GUT IS TREATED WITH CHROMIC SALT SOLUTIONS
7!2.).'3
5SERS SHOULD BE FAMILIAR WITH SURGICAL PROCEDURES AND TECHNIQUES INVOLVING GUT
SUTURE BEFORE USING SURGICAL GUT SUTURE FOR WOUND CLOSURE AS THE RISK OF WOUND
DEHISCENCE MAY VARY WITH THE SITE OF APPLICATION AND THE SUTURE MATERIAL USED
0HYSICIANS SHOULD CONSIDER THE IN VIVO PERFORMANCE WHEN SELECTING A SUTURE
4HE USE OF THIS SUTURE MAY BE INAPPROPRIATE IN ELDERLY MALNOURISHED OR DEBIL
ITATED PATIENTS OR IN PATIENTS SUFFERING FROM CONDITIONS WHICH MAY DELAY WOUND
HEALING !S THIS IS AN ABSORBABLE MATERIAL THE USE OF SUPPLEMENTAL NONAB
SORBABLE SUTURES SHOULD BE CONSIDERED BY THE SURGEON IN THE CLOSURE OF SITES
WHICH MAY UNDERGO EXPANSION STRETCHING OR DISTENTION OR WHICH MAY REQUIRE
ADDITIONAL SUPPORT
!S WITH ANY FOREIGN BODY PROLONGED CONTACT OF ANY SUTURE WITH SALT SOLUTIONS
SUCH AS THOSE FOUND IN THE URINARY OR BILIARY TRACTS MAY RESULT IN CALCULUS FOR
MATION !S AN ABSORBABLE SUTURE SURGICAL GUT MAY ACT TRANSIENTLY AS A FOREIGN
BODY !CCEPTABLE SURGICAL PRACTICE SHOULD BE FOLLOWED FOR THE MANAGEMENT OF
CONTAMINATED OR INFECTED WOUNDS
$O NOT RESTERILIZE $ISCARD OPEN PACKAGES AND UNUSED SUTURES
#ERTAIN PATIENTS MAY BE HYPERSENSITIVE TO COLLAGEN OR CHROMIUM AND MIGHT
EXHIBIT AN IMMUNOLOGICAL REACTION RESULTING IN INFLAMMATION TISSUE GRANULATION OR
FIBROSIS WOUND SUPPURATION AND BLEEDING AS WELL AS SINUS FORMATION
02%#!54)/.3
)N HANDLING THIS OR ANY OTHER SUTURE MATERIAL CARE SHOULD BE TAKEN TO AVOID
DAMAGE FROM HANDLING !VOID CRUSHING OR CRIMPING DAMAGE DUE TO APPLICATION
OF SURGICAL INSTRUMENTS SUCH AS FORCEPS OR NEEDLE HOLDERS 3URGICAL GUT SUTURES
REQUIRE THE ACCEPTED SURGICAL TECHNIQUE OF FLAT AND SQUARE TIES WITH
ADDITIONAL THROWS AS WARRANTED BY SURGICAL CIRCUMSTANCE AND THE EXPERIENCE OF
THE SURGEON
5NDER SOME CIRCUMSTANCES NOTABLY ORTHOPAEDIC PROCEDURES IMMOBILIZATION OF
JOINTS BY EXTERNAL SUPPORT MAY BE EMPLOYED AT THE DISCRETION OF THE SURGEON
4HE SURGEON SHOULD AVOID UNNECESSARY TENSION WHEN RUNNING DOWN KNOTS TO
REDUCE THE OCCURRENCE OF SURFACE FRAYING AND WEAKENING OF THE STRAND
!VOID PROLONGED EXPOSURE TO ELEVATED TEMPERATURES
4O AVOID DAMAGING NEEDLE POINTS AND SWAGE AREAS GRASP THE NEEDLE IN AN AREA
ONE
THIRD TO ONE
HALF OF THE DISTANCE FROM THE SWAGED END TO THE
POINT 2ESHAPING NEEDLES MAY CAUSE THEM TO LOSE STRENGTH AND BE LESS
RESISTANT TO BENDING AND BREAKING 5SERS SHOULD EXERCISE CAUTION WHEN
HANDLING SURGICAL NEEDLES TO AVOID INADVERTENT NEEDLE STICKS $ISCARD USED
NEEDLES IN SHARPS CONTAINERS
!$6%23% 2%!#4)/.3
!DVERSE EFFECTS ASSOCIATED WITH THE USE OF THIS DEVICE INCLUDE WOUND DEHIS
CENCE VARIABLE RATES OF ABSORPTION OVER TIME DEPENDING ON SUCH FACTORS AS THE
TYPE OF SUTURE USED THE PRESENCE OF INFECTION AND THE TISSUE SITE FAILURE TO PRO
VIDE ADEQUATE WOUND SUPPORT IN CLOSURE OF SITES WHERE EXPANSION STRETCHING
OR DISTENSION OCCUR ETC UNLESS ADDITIONAL SUPPORT IS SUPPLIED THROUGH THE USE
OF NONABSORBABLE SUTURE MATERIAL FAILURE TO PROVIDE ADEQUATE WOUND SUPPORT
IN ELDERLY MALNOURISHED OR DEBILITATED PATIENTS OR IN PATIENTS SUFFERING FROM
CANCER ANEMIA OBESITY DIABETES INFECTION OR OTHER CONDITIONS WHICH MAY
DELAY WOUND HEALING ALLERGIC RESPONSE IN PATIENTS WITH KNOWN SENSITIVITIES TO
COLLAGEN OR CHROMIUM WHICH MAY RESULT IN AN IMMUNOLOGICAL REACTION RESULTING
IN INFLAMMATION TISSUE GRANULATION OR FIBROSIS WOUND SUPPURATION AND BLEED
ING AS WELL AS SINUS FORMATION INFECTION MODERATE TISSUE INFLAMMATORY
RESPONSE CHARACTERISTIC OF FOREIGN BODY RESPONSE CALCULI FORMATION IN URINARY
AND BILIARY TRACTS WHEN PROLONGED CONTACT WITH SALT SOLUTIONS SUCH AS URINE AND
BILE OCCURS AND TRANSITORY LOCAL IRRITATION AT THE WOUND SITE "ROKEN NEEDLES
MAY RESULT IN EXTENDED OR ADDITIONAL SURGERIES OR RESIDUAL FOREIGN BODIES
)NADVERTENT NEEDLE STICKS WITH CONTAMINATED SURGICAL NEEDLES MAY RESULT IN THE
TRANSMISSION OF BLOODBORNE PATHOGENS
(/7 3500,)%$
3URGICAL GUT SUTURES ARE AVAILABLE IN 530 SIZES
THROUGH METRIC SIZES
IN A VARIETY OF LENGTHS WITH AND WITHOUT PERMANENTLY ATTACHED NEEDLES
AND ON ,)'!0!+
DISPENSING REELS 3URGICAL GUT SUTURES ARE ALSO AVAILABLE IN
530 SIZES THROUGH METRIC SIZES
ATTACHED TO #/.42/, 2%,%!3%
REMOVABLE NEEDLES 4HE SUTURE IS SUPPLIED STERILE IN ONE TWO AND THREE
DOZEN BOXES
4RADEMARK
%4()#/. ).#
02/$5#4 ).&/2-!4)/.
352')#!, 34!).,%33 34%%, 35452%
./.!"3/2"!",% 352')#!, 35452%3 530
$%3#2)04)/.
3URGICAL STAINLESS STEEL SUTURE IS A NONABSORBABLE STERILE SURGICAL SUTURE
COMPOSED OF , STAINLESS STEEL 3URGICAL STAINLESS STEEL SUTURE IS AVAILABLE AS
A MONOFILAMENT AND MULTIFILAMENT SUTURE
3URGICAL STAINLESS STEEL SUTURE MEETS ALL REQUIREMENTS ESTABLISHED BY THE 5NITED
3TATES 0HARMACOPOEIA 530 FOR NONABSORBABLE SURGICAL SUTURES 3URGICAL
STAINLESS STEEL SUTURE IS ALSO LABELED WITH THE "3 GAUGE CLASSIFICATIONS
02%#!54)/.3
)N HANDLING THIS OR ANY OTHER SUTURE MATERIAL CARE SHOULD BE TAKEN TO AVOID
DAMAGE FROM HANDLING SUCH AS KINKING OR EXCESSIVE TWISTING
4O AVOID DAMAGING NEEDLE POINTS AND SWAGE AREAS GRASP THE NEEDLE IN AN AREA
ONE
THIRD TO ONE
HALF OF THE DISTANCE FROM THE SWAGED END TO THE
POINT 2ESHAPING NEEDLES MAY CAUSE THEM TO LOSE STRENGTH AND BE LESS
RESISTANT TO BENDING AND BREAKING 5SERS SHOULD EXERCISE CAUTION WHEN
HANDLING SURGICAL NEEDLES TO AVOID INADVERTENT NEEDLE STICKS $ISCARD USED
NEEDLES IN SHARPS CONTAINERS
!$6%23% 2%!#4)/.3
3URGICAL STAINLESS STEEL SUTURE IS INDICATED FOR USE IN ABDOMINAL WOUND CLOSURE
HERNIA REPAIR STERNAL CLOSURE AND ORTHOPAEDIC PROCEDURES INCLUDING CERCLAGE
AND TENDON REPAIR
!DVERSE EFFECTS ASSOCIATED WITH THE USE OF THIS DEVICE INCLUDE WOUND DEHIS
CENCE ALLERGIC RESPONSE IN PATIENTS WITH KNOWN SENSITIVITIES TO , STAINLESS
STEEL OR CONSTITUENT METALS SUCH AS CHROMIUM AND NICKEL INFECTION MINIMAL
ACUTE INFLAMMATORY TISSUE REACTION PAIN EDEMA AND LOCAL IRRITATION AT THE
WOUND SITE "ROKEN NEEDLES MAY RESULT IN EXTENDED OR ADDITIONAL SURGERIES OR
RESIDUAL FOREIGN BODIES )NADVERTENT NEEDLE STICKS WITH CONTAMINATED SURGICAL
NEEDLES MAY RESULT IN THE TRANSMISSION OF BLOODBORNE PATHOGENS
!#4)/.3
(/7 3500,)%$
3URGICAL STAINLESS STEEL SUTURE ELICITS A MINIMAL ACUTE INFLAMMATORY REACTION IN
TISSUE AND IS NOT ABSORBED
3URGICAL STAINLESS STEEL SUTURES ARE AVAILABLE IN SIZES THROUGH
METRIC
SIZES
IN A VARIETY OF LENGTHS WITH AND WITHOUT PERMANENTLY ATTACHED NEE
DLES IN ONE TWO AND THREE DOZEN BOXES
).$)#!4)/.3
#/.42!).$)#!4)/.3
4HE USE OF THIS SUTURE IS CONTRAINDICATED IN PATIENTS WITH KNOWN SENSITIVITIES OR
ALLERGIES TO , STAINLESS STEEL OR CONSTITUENT METALS SUCH AS CHROMIUM AND
NICKEL
7!2.).'3
5SERS SHOULD BE FAMILIAR WITH SURGICAL PROCEDURES AND TECHNIQUES INVOLVING
NONABSORBABLE STAINLESS STEEL SUTURES BEFORE EMPLOYING FOR WOUND CLOSURE AS
THE RISK OF WOUND DEHISCENCE MAY VARY WITH THE SITE OF APPLICATION AND THE
SUTURE MATERIAL USED
!CCEPTABLE SURGICAL PRACTICE MUST BE FOLLOWED FOR THE MANAGEMENT OF CONTAM
INATED OR INFECTED WOUNDS
4RADEMARK
%4()#/. ).#
#(!04%2
6)#29,
+NITTED -ESH
$%3#2)04)/.
6)#29,
POLYGLACTIN KNITTED MESH IS PREPARED FROM A SYNTHETIC ABSORBABLE
COPOLYMER OF GLYCOLIDE AND LACTIDE DERIVED RESPECTIVELY FROM GLYCOLIC AND LAC
TIC ACIDS 4HIS KNITTED MESH IS PREPARED FROM UNCOATED UNDYED FIBER IDENTICAL IN
COMPOSITION TO THAT USED IN 6)#29, POLYGLACTIN SYNTHETIC ABSORBABLE
SUTURE WHICH HAS BEEN FOUND TO BE INERT NONANTIGENIC NONPYROGENIC AND TO
ELICIT ONLY A MILD TISSUE REACTION DURING ABSORPTION
6)#29, KNITTED MESH IS INTENDED FOR USE AS A BUTTRESS TO PROVIDE TEMPORARY SUP
PORT DURING THE HEALING PROCESS
!#4)/.3
4WO IMPORTANT CHARACTERISTICS DESCRIBE THE IN VIVO FUNCTION AND BEHAVIOR OF
6)#29, KNITTED MESH REINFORCED WOUND STRENGTH AND THE RATE OF ABSORPTION
LOSS OF MASS
4HE DEHISCENCE FORCE OF HEALING ABDOMINAL WOUNDS IN RATS CLOSED WITH SIZE
ABSORBABLE SUTURES WAS COMPARED WITH CORRESPONDING WOUNDS CLOSED WITH SIZE
ABSORBABLE SUTURES AND REINFORCED WITH 6)#29, KNITTED MESH )N THIS ANIMAL
MODEL THE STRENGTH OF THE INCISION WHEN SUPPORTED BY THE MESH WAS SIGNIFI
CANTLY GREATER THAN THE SUTURED INCISIONAL WOUND %XPLANTED 6)#29, KNITTED
MESH WHICH BEFORE IMPLANTATION HAD AN INITIAL AVERAGE BURST STRENGTH OF
LBS WAS FOUND TO HAVE OF ITS ORIGINAL BURST STRENGTH REMAINING AFTER
FOURTEEN DAYS IN VIVO
3UBCUTANEOUS IMPLANTATION STUDIES IN RATS INDICATE THAT THE ABSORPTION OF
6)#29, MESH MATERIAL IS MINIMAL UNTIL ABOUT SIX WEEKS POST IMPLANTATION AND
ESSENTIALLY COMPLETE BETWEEN AND DAYS
7!2.).'3
$/ ./4 2%34%2),):%
4HE SAFETY AND EFFECTIVENESS OF 6)#29, KNITTED MESH IN NEURAL TISSUE AND IN CAR
DIOVASCULAR TISSUE HAS NOT BEEN ESTABLISHED
02%#!54)/.3
.ONE
!$6%23% 2%!#4)/.3
.O SIGNIFICANT CLINICAL ADVERSE REACTIONS TO THE MESH HAVE BEEN REPORTED
$)2%#4)/.3 &/2 53%
)T IS RECOMMENDED THAT ABSORBABLE OR NONABSORBABLE SUTURES BY PLACED TO
INCH TO MM APART AT A DISTANCE APPROXIMATELY INCH MM FORM THE
EDGE OF THE MESH 3OME SURGEONS PREFER TO SUTURE A MESH LARGER THAN THE
DEFECT INTO POSITION OVER THE DEFECT 4HE EDGES ARE THEN SUTURED TO ASSURE A
PROPER CLOSURE UNDER CORRECT TENSION 7HEN ALL MARGIN SUTURES HAVE BEEN
PLACED THE EXCESS MESH IS TRIMMED AWAY LEAVING AT LEAST INCH OF MESH
EXTENDING BEYOND THE SUTURE LINE
(/7 3500,)%$
6)#29, KNITTED MESH IS AVAILABLE IN SINGLE PACKETS AS A STERILE UNDYED FABRIC
MESH IN SINGLE SHEET SIZES OF APPROXIMATELY X INCHES AND X INCHES
X CENTIMETERS AND X CENTIMETERS
).$)#!4)/.3
6)#29, KNITTED MESH MAY BE USED WHEREVER TEMPORARY WOUND OR ORGAN SUPPORT
IS REQUIRED PARTICULARLY IN INSTANCES IN WHICH COMPLIANT AND STRETCHABLE SUPPORT
MATERIAL IS DESIRED AND CONTAINMENT OF WOUND TRANSUDATE IS NOT REQUIRED
6)#29, KNITTED MESH MAY BE CUT TO THE SHAPE OR SIZE DESIRED FOR EACH SPECIFIC
APPLICATION
#/.42!).$)#!4)/.3
"ECAUSE 6)#29, KNITTED MESH IS ABSORBABLE IT SHOULD NOT BE USED WHERE
EXTENDED WOUND OR ORGAN SUPPORT IS REQUIRED
4RADEMARK
%4()#/. ).#
02/$5#4 ).&/2-!4)/.
6)#29,
7OVEN -ESH
7!2.).'3
$%3#2)04)/.
4HE SAFETY AND EFFECTIVENESS OF 6)#29, WOVEN MESH IN NEURAL TISSUE AND IN CAR
DIOVASCULAR TISSUE HAS NOT BEEN ESTABLISHED
6)#29,
POLYGLACTIN WOVEN MESH IS PREPARED FROM A SYNTHETIC ABSORBABLE
COPOLYMER OF GLYCOLIDE AND LACTIDE DERIVED RESPECTIVELY FROM GLYCOLIC AND LAC
TIC ACIDS 4HIS TIGHTLY WOVEN MESH IS PREPARED FROM UNCOATED UNDYED FIBER
IDENTICAL IN COMPOSITION TO THAT USED IN 6)#29,
POLYGLACTIN SYNTHETIC
ABSORBABLE SUTURE WHICH HAS BEEN FOUND TO BE INERT NONANTIGENIC NONPYRO
GENIC AND TO ELICIT ONLY A MILD TISSUE REACTION DURING ABSORPTION
$/ ./4 2%34%2),):%
02%#!54)/.3
.ONE
6)#29, WOVEN MESH IS INTENDED FOR USE AS A BUTTRESS TO PROVIDE TEMPORARY SUP
PORT DURING THE HEALING PROCESS
!$6%23% 2%!#4)/.3
!#4)/.3
$)2%#4)/.3 &/2 53%
4WO IMPORTANT CHARACTERISTICS DESCRIBE THE IN VIVO FUNCTION AND BEHAVIOR OF
6)#29, WOVEN MESH REINFORCED WOUND STRENGTH AND THE RATE OF ABSORPTION
LOSS OF MASS
4HE DEHISCENCE FORCE OF HEALING ABDOMINAL WOUNDS IN RATS CLOSED WITH SIZE
ABSORBABLE SUTURES WAS COMPARED WITH CORRESPONDING WOUNDS CLOSED WITH SIZE
ABSORBABLE SUTURES AND REINFORCED WITH 6)#29, WOVEN MESH )N THIS ANIMAL
MODEL THE STRENGTH OF THE INCISION WHEN SUPPORTED BY THE MESH WAS SIGNIFI
CANTLY GREATER THAN THE SUTURED INCISIONAL WOUND %XPLANTED 6)#29, WOVEN
MESH WHICH BEFORE IMPLANTATION HAD AN INITIAL AVERAGE BURST STRENGTH OF
APPROXIMATELY LBS WAS FOUND TO HAVE APPROXIMATELY OF ITS ORIGINAL
BURST STRENGTH REMAINING AFTER FOURTEEN DAYS IN VIVO
3UBCUTANEOUS IMPLANTATION STUDIES IN RATS INDICATE THAT THE ABSORPTION OF
6)#29, MESH MATERIAL IS MINIMAL UNTIL ABOUT SIX WEEKS POST IMPLANTATION AND
ESSENTIALLY COMPLETE BETWEEN AND DAYS
).$)#!4)/.3
6)#29, WOVEN MESH MAY BE USED WHEREVER TEMPORARY WOUND OR ORGAN SUPPORT
IS REQUIRED 4HE WOVEN MESH STRUCTURE IS LESS POROUS THAN 6)#29, KNITTED MESH
)T IS INDICATED IN INSTANCES IN WHICH CONTAINMENT OF WOUND TRANSUDATE IS DESIR
ABLE 6)#29, WOVEN MESH MAY BE CUT TO THE SHAPE OR SIZE DESIRED FOR EACH SPE
CIFIC APPLICATION
#/.42!).$)#!4)/.3
"ECAUSE 6)#29, WOVEN MESH IS ABSORBABLE IT SHOULD NOT BE USED WHERE
EXTENDED WOUND OR ORGAN SUPPORT IS REQUIRED
.ONE KNOWN
)T IS RECOMMENDED THAT ABSORBABLE OR NONABSORBABLE SUTURES BE PLACED TO
INCH TO MM APART AT A DISTANCE AT LEAST INCH MM FROM THE EDGE OF
THE MESH 3OME SURGEONS PREFER TO SUTURE A MESH LARGER THAN THE DEFECT INTO
POSITION OVER THE DEFECT 4HE EDGES ARE THEN SUTURED TO ASSURE PROPER CLOSURE
UNDER CORRECT TENSION 7HEN ALL MARGIN SUTURES HAVE BEEN PLACED THE EXCESS
MESH IS TRIMMED AWAY LEAVING AT LEAST INCH OF MESH EXTENDING BEYOND THE
SUTURE LINE
(/7 3500,)%$
6)#29, WOVEN MESH IS AVAILABLE IN SINGLE PACKETS AS A STERILE UNDYED FABRIC
MESH IN SINGLE SHEET SIZES OF APPROXIMATELY X INCHES AND X INCHES
X CENTIMETERS AND X CENTIMETERS
4RADEMARK
%4()#/. ).#
CHAPTER 9
INDEX
).$%8
!"$/-%.
ABDOMINAL CAVITY
ABDOMINAL WALL
FASCIA
MUSCLE TISSUE
PERITONEUM
SKIN
SUBCUTANEOUS FAT
SUBCUTICULAR TISSUE
TRANSVERSALIS FASCIA
#/!4%$ 6)#29, 2!0)$%
0/,9',!#4). 35452%
!,)-%.4!29 42!#4
ESOPHAGUS
ORAL CAVITY
PHARYNX
UPPER ALIMENTARY TRACT
"
"),)!29 42!#4
GALLBLADDER
"/.%
ANCHOR
STERNUM
"2!).
CEREBROSPINAL FLUID
DURA MATER
GALEA
PERIPHERAL NERVE REPAIR
SKULL
#!2$)/6!3#5,!2 352'%29
HEART VALVES
PLEDGETS
STERNUM
#/!4%$ 6)#29,
0/,9',!#4). 35452%
#/!4%$ 6)#29,
0,53
0/,9',!#4). 35452%
&
'
(
)
$%!$ 30!#%
$%2-!"/.$
4/0)#!, 3+). !$(%3)6%
/#49, #9!./!#29,!4%
$)33%#4)/.
%4()"/.$
%8#%, 0/,9%34%2
35452%
%4(),/.
.9,/. 35452%
%9%
CONJUNCTIVA
CORNEA
OCULAR MUSCLES
SCLERA
&%-!,% '%.)4!, 42!#4
'!342/).4%34).!, 42!#4
COLON
RECTUM
SMALL INTESTINE
STOMACH
()'( 6)3#/3)49 $%2-!"/.$
4/0)#!, 3+). !$(%3)6%
/#49, #9!./!#29,!4%
).#)3)/.
).&,!--!4/29 2%30/.3%
#(!04%2
,
-
+./4 3%#52)49
+./4 4%.3),% 342%.'4(
+./4 49).'
ENDOSCOPIC
MONOFILAMENT SUTURES
MULTIFILAMENT SUTURES
TECHNIQUES
DEEP TIE
INSTRUMENT TIE
SQUARE KNOT
SURGEONS KNOT
,)'!452%3
FREE TIE
,)'!0!+
DISPENSING REEL
STICK TIE
-%23),%.%
0/,9%34%2 &)"%2 -%3(
-%23),%.%
0/,9%34%2 &)"%2 342)0
-%23),%.%
0/,9%34%2 &)"%2 35452%
-%3(
3EE ALSO -%23),%.%
POLYESTER
FIBER MESH 02/,%.%
0OLYPROPYLENE (ERNIA 3YSTEM
02/,%.%
POLYPROPYLENE MESH
6)#29,
POLYGLACTIN
KNITTED MESH 6)#29,
POLYGLACTIN PERIODONTAL
MESH 6)#29,
POLYGLACTIN
WOVEN MESH
-)#2/352'%29
-/./#29,
0/,)',%#!02/.%
35452%
.%#2/4)# 4)335%
.%%$,%
ANATOMY
BODY
EYE
POINT
APPLICATIONS
SHAPE
COMPOUND CURVED
CURVED
HALF
CURVED
SKI
STRAIGHT
"UNNELL
+EITH
SHARPNESS
STABILITY
STRENGTH
%4(!,,/9
NEEDLE ALLOY
SWAGE
#/.42/, 2%,%!3%
NEEDLE
TYPES
BLUNT POINT
%4()'5!2$
BLUNT
POINT NEEDLE
CUTTING
CONVENTIONAL CUTTING
0# 02)-%
NEEDLE
STERNOTOMY
REVERSE CUTTING
-)#2/
0/).4
NEEDLE
/3
SIDE
CUTTING
#3 5,4)-!
NEEDLE
3!"2%,/#
NEEDLE
SPATULA
4' 0,53
NEEDLE
).$%8
TAPER POINT
-!9/
4!0%2#54
4!0%2#54 NEEDLE
TROCAR POINT
.%%$,%(/,$%2
ARMING
JAWS
.%52/352'%29
.52/,/.
"2!)$%$ .9,/.
35452%
/
0
/0(4(!,-)# 352'%29
/24(/0!%$)# 352'%29
0!2%.#(9-!4/53 /2'!.3
KIDNEY
LIVER
SPLEEN
0$3
)) 0/,9$)/8!./.% 35452%
0%2-! (!.$
3),+ 35452%
0,!34)# 352'%29
02)-!29 35452% ,).%
BURIED SUTURES
CONTINUOUS SUTURES
#ONNELL 4ECHNIQUE
#USHING 4ECHNIQUE
,EMBERT 4ECHNIQUE
DEEP SUTURES
INTERRUPTED SUTURES
INTERRUPTED HORIZONTAL
MATTRESS SUTURE
INTERRUPTED VERTICAL
MATTRESS SUTURE
PURSE STRING SUTURES
RUNNING STITCHES
SUBCUTICULAR SUTURES
02/,%.%
0/,902/09,%.% (%2.)!
3934%-
02/,%.%
0/,902/09,%.% -%3(
02/,%.%
0/,902/09,%.% 35452%
02/./6!
0/,9
(%8!&,5/2/02/09,%.% 6$&
35452%
02/8) 342)0
3+). #,/352%3
2
3
2%30)2!4/29 42!#4
BRONCHIAL STUMP CLOSURE
THORACIC CAVITY
2%4%.4)/. 35452% $%6)#%3
3%#/.$!29 35452% ,).%
CONTINUOUS SUTURES
INTERRUPTED SUTURES
RAILROAD TRACK SCAR
RETENTION SUTURES
3+).
34)4#( 0,!#%-%.4
34)4#(%3 !.$ 490%3
#ONNELL 4ECHNIQUE
#USHING 4ECHNIQUE
(ALSTED 4ECHNIQUE
HORIZONTAL MATTRESS TECHNIQUE
,EMBERT 4ECHNIQUE
OVER
AND
OVER TECHNIQUE
PURSE
STRING TECHNIQUE
RUNNING TECHNIQUE
#(!04%2
SUBCUTICULAR TECHNIQUE
VERTICAL MATTRESS TECHNIQUE
352')#!, '54 35452%
CHROMIC
#(2/-)#):).' PROCESS
COLLAGEN PURE
FAST ABSORBING
PLAIN
425
'!5').' PROCESS
TUBING FLUID
352')#!, 3),+ 35452%
3EE ALSO 0%2-!
(!.$
SILK SUTURE
352')#!, 34!).,%33 34%%,
35452%
35452%
ABSORBABLE SUTURE
3EE ALSO #OATED 6)#29,
POLYGLACTIN SUTURE
#OATED 6)#29, 2!0)$%
POLYGLACTIN SUTURE
-/./#29,
POLIGLECAPRONE SUTURE
0$3
))
POLYDIOXANONE SUTURE
SURGICAL GUT SUTURE
ALLOY SUTURE
WIRE GAUGE EQUIVALENTS
3EE ALSO SURGICAL STAIN
LESS STEEL SUTURE
TEMPORARY CARDIAC
PACING WIRE
ANTIBACTERIAL SUTURE
6)#29,
POLYGLACTIN
PLUS SUTURE
CHARACTERISTICS
ABSORPTION PROFILE
HYDROLYSIS
ABSORPTION RATE
BRAIDED STRANDS
BREAKING STRENGTH
IN VIVO STRENGTH
BURST STRENGTH
MONOFILAMENT STRANDS
MULTIFILAMENT STRANDS
SIZE
TENSILE STRENGTH
TISSUE REACTION
LABELING
EXPIRATION DATE
&OOD AND $RUG
!DMINISTRATION &$!
LOT NUMBER
PACKAGE INSERT
PRODUCT CODE
MANUFACTURE
NONABSORBABLE SUTURE
3EE ALSO %4()"/.$
%8#%,
POLYESTER SUTURE
%4(),/.
NYLON SUTURE
-%23),%.%
POLYESTER
FIBER SUTURE .52/,/.
BRAIDED NYLON SUTURE
02/,%.%
POLYPROPYLENE
SUTURE 02/./6!
POLYHEXAFLUOROPROPY
LENE 6$& SUTURE SURGICAL
SILK SUTURE
NYLON SUTURE
3EE ALSO %4(),/.
NYLON
SUTURE .52/,/.
BRAIDED NYLON SUTURE
PACKAGING
4RADEMARK
).$%8
DISPENSER BOXES
ENVIRONMENTALLY CONSCIOUS
PRIMARY PACKETS
OVERWRAP
PEELABLE FOIL
SINGLE STRAND AND MULTI
STRAND PACKAGING PACKETS
%
0!#+
PROCEDURE
KIT
%!39 !##%33
PACKAGING
%4()
0!#+
PRE
CUT
SUTURE
'%.4,% "%.$
PACKAGE
,!"92).4(
PACKAGE
LOOPED SUTURE
2%,!9
SUTURE
DELIVERY SYSTEM
35450!+
PRE
CUT
STERILE SUTURE
STORAGE RACKS
)6 POLE RACKS
MODULAR STORAGE
RACKS
POLYESTER FIBER SUTURE
3EE ALSO %4()"/.$
%8#%,
POLYESTER SUTURE
POLYPROPYLENE SUTURE
3EE ALSO 02/,%.%
POLYPROPYLENE SUTURE
STERILIZATION
35452% #544).'
35452% (!.$,).'
STERILE BARRER
STERILE FIELD
STERILE TECHNIQUE
STERILE TRANSFER
STERILE STERILIZATION
35452% 02%0!2!4)/.
35452% 2%-/6!,
35452% 4%#(.)15%3
DOUBLE LAYER CLOSURE
INVERTED CLOSURE TECHNIQUE
SINGLE LAYER CLOSURE
3MAED *ONES FAR AND
NEAR TECHNIQUE
3EE ALSO LIGATURES PRIMARY SUTURE
LINE SECONDARY SUTURE LINE
4!0%3
SKIN CLOSURE TAPES
UMBILICAL TAPE
3EE ALSO -%23),%.%
POLYESTER
FIBER STRIP 02/8) 342)0
SKIN
CLOSURES
4%.$/. 352'%29
"UNNELL 4ECHNIQUE
PERIOSTEUM
4)335% !$(%3)6%3
3EE ALSO $%2-!"/.$
4OPICAL
3KIN !DHESIVE /CTYL
#YANOACRYLATE
4)335% 342%.'4(
BREAKING STRENGTH
BURST STRENGTH
TENSILE STRENGTH
52).!29 42!#4 352'%29
#(!04%2
6!3#5,!2 352'%29
HEART VALVES
6%33%,3
PEDIATRIC
6)#29,
0/,9',!#4).
+.)44%$ -%3(
6)#29,
0/,9',!#4).
0%2)/$/.4!, -%3(
6)#29,
0/,9',!#4). 35452%
6)#29,
0/,9',!#4). 0,53
35452%
6)#29,
0/,9',!#4).
7/6%. -%3(
7/5.$ #,!33)&)#!4)/.
CLEAN
CLEAN
CONTAMINATED
CONTAMINATED
DIRTY AND INFECTED
7/5.$ #/-0,)#!4)/.3
DEHISCENCE
DEHYDRATION
EDEMA
EPITHELIALIZATION
INFECTION
WOUND DISRUPTION
7/5.$ (%!,).'
COLLAGEN FORMATION
DEHYDRATION
PRIMARY INTENTION
SECOND INTENTION
DELAYED PRIMARY CLOSURE
4RADEMARK
./4%3
./4%3
./4%3
TO
NEEDLES
V I E W T H E E - C ATA L O G G O T O T H E
H E A LT H C A R E P R O F E S S I O N A L
SECTION OF
W W W. E T H I C O N . C O M
ADHESIVES
SURGICAL MESH
ETHICON, INC. , PO BOX 151, SOMERVILLE, NJ 08876-0151
* TRADEMARK
SM
ETHICON, INC.
2005, ETHICON, INC.
WOUND C LOSURE M ANUAL
SUTURES
WOUND HEALING
W O U N D C L O S U R E M A N UA L
S-ar putea să vă placă și
- Hidden Figures: The American Dream and the Untold Story of the Black Women Mathematicians Who Helped Win the Space RaceDe la EverandHidden Figures: The American Dream and the Untold Story of the Black Women Mathematicians Who Helped Win the Space RaceEvaluare: 4 din 5 stele4/5 (895)
- The Subtle Art of Not Giving a F*ck: A Counterintuitive Approach to Living a Good LifeDe la EverandThe Subtle Art of Not Giving a F*ck: A Counterintuitive Approach to Living a Good LifeEvaluare: 4 din 5 stele4/5 (5794)
- Shoe Dog: A Memoir by the Creator of NikeDe la EverandShoe Dog: A Memoir by the Creator of NikeEvaluare: 4.5 din 5 stele4.5/5 (537)
- Grit: The Power of Passion and PerseveranceDe la EverandGrit: The Power of Passion and PerseveranceEvaluare: 4 din 5 stele4/5 (588)
- The Yellow House: A Memoir (2019 National Book Award Winner)De la EverandThe Yellow House: A Memoir (2019 National Book Award Winner)Evaluare: 4 din 5 stele4/5 (98)
- The Little Book of Hygge: Danish Secrets to Happy LivingDe la EverandThe Little Book of Hygge: Danish Secrets to Happy LivingEvaluare: 3.5 din 5 stele3.5/5 (400)
- Never Split the Difference: Negotiating As If Your Life Depended On ItDe la EverandNever Split the Difference: Negotiating As If Your Life Depended On ItEvaluare: 4.5 din 5 stele4.5/5 (838)
- Elon Musk: Tesla, SpaceX, and the Quest for a Fantastic FutureDe la EverandElon Musk: Tesla, SpaceX, and the Quest for a Fantastic FutureEvaluare: 4.5 din 5 stele4.5/5 (474)
- A Heartbreaking Work Of Staggering Genius: A Memoir Based on a True StoryDe la EverandA Heartbreaking Work Of Staggering Genius: A Memoir Based on a True StoryEvaluare: 3.5 din 5 stele3.5/5 (231)
- The Emperor of All Maladies: A Biography of CancerDe la EverandThe Emperor of All Maladies: A Biography of CancerEvaluare: 4.5 din 5 stele4.5/5 (271)
- Devil in the Grove: Thurgood Marshall, the Groveland Boys, and the Dawn of a New AmericaDe la EverandDevil in the Grove: Thurgood Marshall, the Groveland Boys, and the Dawn of a New AmericaEvaluare: 4.5 din 5 stele4.5/5 (266)
- The Hard Thing About Hard Things: Building a Business When There Are No Easy AnswersDe la EverandThe Hard Thing About Hard Things: Building a Business When There Are No Easy AnswersEvaluare: 4.5 din 5 stele4.5/5 (345)
- On Fire: The (Burning) Case for a Green New DealDe la EverandOn Fire: The (Burning) Case for a Green New DealEvaluare: 4 din 5 stele4/5 (74)
- The World Is Flat 3.0: A Brief History of the Twenty-first CenturyDe la EverandThe World Is Flat 3.0: A Brief History of the Twenty-first CenturyEvaluare: 3.5 din 5 stele3.5/5 (2259)
- Team of Rivals: The Political Genius of Abraham LincolnDe la EverandTeam of Rivals: The Political Genius of Abraham LincolnEvaluare: 4.5 din 5 stele4.5/5 (234)
- The Unwinding: An Inner History of the New AmericaDe la EverandThe Unwinding: An Inner History of the New AmericaEvaluare: 4 din 5 stele4/5 (45)
- The Gifts of Imperfection: Let Go of Who You Think You're Supposed to Be and Embrace Who You AreDe la EverandThe Gifts of Imperfection: Let Go of Who You Think You're Supposed to Be and Embrace Who You AreEvaluare: 4 din 5 stele4/5 (1090)
- The Sympathizer: A Novel (Pulitzer Prize for Fiction)De la EverandThe Sympathizer: A Novel (Pulitzer Prize for Fiction)Evaluare: 4.5 din 5 stele4.5/5 (121)
- Her Body and Other Parties: StoriesDe la EverandHer Body and Other Parties: StoriesEvaluare: 4 din 5 stele4/5 (821)
- Gaucher DiseaseDocument27 paginiGaucher DiseaseWahida PutriÎncă nu există evaluări
- اسئلة تنافسي تمريض صحة مجتمع ٢٠١٩ PDFDocument10 paginiاسئلة تنافسي تمريض صحة مجتمع ٢٠١٩ PDFbilal hadiÎncă nu există evaluări
- AASMRespiratory Events ScoringDocument19 paginiAASMRespiratory Events ScoringAdam GirardoÎncă nu există evaluări
- Part C-35 MCQS/ 7 PP: MCQ PaediatricsDocument6 paginiPart C-35 MCQS/ 7 PP: MCQ Paediatricswindows3123100% (1)
- Chemistry ProjectDocument13 paginiChemistry ProjectPranjal GiriÎncă nu există evaluări
- Pernicious Anaemia and B12 2020Document42 paginiPernicious Anaemia and B12 2020viraaj pawarÎncă nu există evaluări
- Ethics AssignmentDocument3 paginiEthics Assignmenttonydickpatakesseh100% (4)
- Tanzania STG 052013-Copy 1544379670122Document220 paginiTanzania STG 052013-Copy 1544379670122Waqar WikiÎncă nu există evaluări
- Learners and Safety and Emergency CardDocument6 paginiLearners and Safety and Emergency CardAsielyn SamsonÎncă nu există evaluări
- Goodman and Gilman's The Pharmacological Basis of TherapeuticsDocument105 paginiGoodman and Gilman's The Pharmacological Basis of TherapeuticsDiky PratamaÎncă nu există evaluări
- Diabetic RetinopathyDocument36 paginiDiabetic RetinopathyRaúl Plasencia SaliniÎncă nu există evaluări
- Wheezing, Bronchiolitis, and BronchitisDocument12 paginiWheezing, Bronchiolitis, and BronchitisMuhd AzamÎncă nu există evaluări
- Destination 2Document4 paginiDestination 2oldhastonian0% (1)
- Ijarbs 14Document12 paginiIjarbs 14amanmalako50Încă nu există evaluări
- ICU ReadingDocument24 paginiICU Reading駱品全Încă nu există evaluări
- Abdomen PE ChecklistDocument6 paginiAbdomen PE ChecklistJulienne Sanchez-SalazarÎncă nu există evaluări
- Topic:: Relationship Between Theory and The Science and Practice of NursingDocument6 paginiTopic:: Relationship Between Theory and The Science and Practice of NursingAhmad anasÎncă nu există evaluări
- Acute Care PT For Covid 19 PatientsDocument17 paginiAcute Care PT For Covid 19 PatientsSelvi SoundararajanÎncă nu există evaluări
- Animal Testing Should Be BannedDocument7 paginiAnimal Testing Should Be BannedImelda WongÎncă nu există evaluări
- Nursing Care Plan Cesarean DeliveryDocument2 paginiNursing Care Plan Cesarean DeliveryLei Ortega50% (4)
- Us HealthcareDocument49 paginiUs HealthcareJerald FernandezÎncă nu există evaluări
- EICT Patient Information Leaflet - Edgbaston - Aug 19Document4 paginiEICT Patient Information Leaflet - Edgbaston - Aug 19el esÎncă nu există evaluări
- Drug StudyDocument2 paginiDrug StudyJi Vista MamigoÎncă nu există evaluări
- Idrrmu Written Exam ReviewerDocument132 paginiIdrrmu Written Exam ReviewerDaniel Adrian FalaminianoÎncă nu există evaluări
- FwprogrammeDocument38 paginiFwprogrammeSujatha J Jayabal87% (15)
- Hyper para Thyroid Is MDocument3 paginiHyper para Thyroid Is MAriefÎncă nu există evaluări
- Dka in PedsDocument11 paginiDka in PedsMohamed YasserÎncă nu există evaluări
- 322-Article Text-1656-1-10-20230630Document11 pagini322-Article Text-1656-1-10-20230630Bunga nurmala septiaÎncă nu există evaluări
- Factors Affecting Patient Safety Culture in A Tertiary Care Hospital in Sri Lanka 1Document8 paginiFactors Affecting Patient Safety Culture in A Tertiary Care Hospital in Sri Lanka 1wawanÎncă nu există evaluări
