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What's New in Sutures
New materials and needle designs may make wound closure faster, safer and stronger.
Kristin Royer
Publish Date: October 10, 2007   |  Tags:   Supply Management

If you're looking to give your surgeons the ability to close wounds faster, with less trauma and to lower risk of surgical site infections (SSIs), the latest sutures, needles and skin adhesives may help. Here's a review of what's new.

  • Antibacterial sutures. According to the Centers for Disease Control, 2 percent to 3 percent of surgeries result in surgical site infections (SSIs) - about 675,000 SSIs annually. In an attempt to reduce this risk, Ethicon developed its Vicryl Plus antibacterial suture. It's the first and only suture coated with an antibacterial agent, triclosan, to reduce colonization of bacteria on the suture. Triclosan is known to be effective against staphylococcus aureus, staphylococcus epidermidis and methicillin-resistant strains of staphylococcus, says Ethicon.

"When I prepare for surgery, I take precautions, like scrubbing my hands and wearing gloves to protect my patient against bacteria," says Philip S. Barie, MD, an associate professor of surgery at the Medical College of Cornell University. "I now have another tool to add to my routine to help protect my patients from surgical site infection."

However, the manufacturer warns that the Vicryl Plus shouldn't be used in patients with known allergic reactions to triclosan.

  • Quick-dissolve sutures. The quicker a suture is absorbed, the faster your patient recovers. Syneture, formerly US Surgical, released its synthetic, absorbable Caprosyn sutures in 2002. The sutures are made of a polymer called Polyglytone, which Syneture claims degrades faster than many other synthetic suture materials. Caprosyn sutures were designed especially for subcuticular closure in plastic, OB/GYN, general and urology procedures; they hold their strength for 10 days to 14 days and are totally absorbed in 56 days, says Syneture.

A new suture from Surgical Specialties, Monoderm, offers an alternative to Syneture's Caprosyn. The monofilament, synthetic short-term absorbable suture also holds for 14 days, and it's completely dissolved in 91 days. Surgical Specialties claims the suture is ideal for plastic and cosmetic procedures. Monoderm will be available in June, and the company says it will be priced about 10 percent less than its competitors.

  • Specialty sutures. While many sutures can be used for multiple specialties, sometimes a specialty-specific suture is just what you need. Here are two suture products unique to orthopedics and ophthalmology.

Inside A Hospital"s Suture Trial

About a year ago, Marilyn Kennedy, RN, the director of perioperative services of a hospital outpatient surgery department, had a tough decision to make. She had to select a single company to provide her department with all its suture supplies. She had been perfectly content purchasing her suture supplies from two companies in a 60-40 split, but now had to choose one.

The reason? Her New York-based hospital health system joined a group purchasing organization. As part of the GPO, the health system could save a lot of money by purchasing all its suture products from one manufacturer. Here's how Ms. Kennedy set out to streamline her department's suture inventory and standardize her surgeons' use of certain suture products.

' Form a value-analysis group. The group was comprised of the staff members from all areas of the hospital who'd be using the sutures: surgeons, materials managers, administrators and staff. The group met with company reps and began to find sutures and needles that would be comparable to those the surgeons were using.

' Conduct blind studies. "We held an in-service for RNs and department staff," says Ms. Kennedy. "They were trained on the new suture. And we also let the surgeons know we would be trying new sutures, but they wouldn't be told when they were using the new suture."

The hospital quickly became overwhelmed by the trials, though, she says: "We were evaluating too many sutures at once. We weren't capturing all the data from all the specialties and we also wanted to make sure the doctors were comfortable before we switched."

' Take it one specialty at a time. When the trial started, Ms. Kennedy estimated it would take about six months, but she soon realized that was overly ambitious; the hospital has now started over and is taking it one specialty at a time. So far, the hospital has completed trials for plastics, orthopedics and vascular surgery. On average, 60 percent of suture products now come from the company that had been supplying 40 percent. Although one vendor would be ideal, Ms. Kennedy believes this is unrealistic for all specialties. "There are certain needles we use that we haven't found equivalents for yet," she says. She continues to trial products and relay surgeon feedback to her rep to narrow the search.

"The challenge is making sure you are comparing apples to apples," says Ms. Kennedy. "Once you do this, you will greatly reduce the frustration of both surgeons and staff when trying to transition."

- Kristin Royer

Force Fiber, Teleflex Medical's high-strength orthopedic suture, is made of a high-molecular-weight polyethylene fiber, which the company claims offers 47 percent better knot-break strength than the nearest competitor. The non-absorbable suture also offers better tensile strength than polyester and polyblend sutures. Designed for a variety of orthopedic procedures, Force Fiber is ideal for approximation and/or ligation of soft tissues, including the use of allograft tissue for orthopedic procedures, says the company.

The Alcon Closure System offers several needle configurations and sutures, including BioSorb absorbable sutures, which provide smooth passage through tissue and excellent knot-holding qualities, says Alcon. According to the company, the products offer predictable tensile strength and absorption characteristics.

"I use Alcon's sutures because the tensile strength is very consistent," says Steve Charles, MD, a retinal surgeon in Memphis, Tenn. "With some sutures, I can apply the same amount of pressure, and one suture pack will break and another will be fine. I also like the way the suture is secured to the needle. It doesn't seem to come detached as easily as some other products I've tried."

  • Suture needles. The challenge for manufacturers is to design suture needles that penetrate tissue smoothly and hold their sharpness, particularly in cosmetic and dermatological procedures.

Surgical Specialties claims that its Dermaglide needle, released about two years ago, is the sharpest needle available for skin closure and subcuticular closure. Instead of grinding the needle edges, which is the typical manufacturing process, the company etches the edges of the needle with acid. The company says this process creates a more consistently sharp needle, which holds its edge as it is passed through tissue. Dermaglide is available with all types of suture materials and, according to the company, is priced 20 percent to 25 percent less than comparable needles.

The Syneture's DermaX needle has a fourth edge, which, unlike three-dimensional needles, allows four-directional control - horizontal (left/right) and vertical (up/down). According to the company, the four-edged tip is remarkably sharp and smooth, which may enhance the results of cosmetic surgery by providing easier penetration, smoother passage and minimal potential for tissue damage.

Selected New Sutures At A Glance

Alcon Laboratories
Alcon Closure System
(800) TO-ALCON

Surgical Specialties
(800) 523-3332

Vicryl Plus
(877) 384-4266

(800) 722-8772

Surgical Specialties
(800) 523-3332

Teleflex Medical
Force Fiber
(800) 474-0178

Trial and standardize
Before you buy the latest sutures and related products, those we spoke to recommend you include your surgeons in the purchasing decision and ask them to trial the sutures.

According to a recent Outpatient Surgery reader survey (n=116), 80 percent of respondents cited surgeon preference as the No. 1 reason for buying a particular suture. And, yes, you can do this and keep costs down. "Educating physicians to cost and the need to standardize reduced the excessive variety of suture stocked here," says Wendy Harley, the director of nursing at Pasadena ASC in Templeton, Calif. (For more on setting up a suture trial, see "Inside a Hospital's Suture Trial" on page 60.)