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Sutures have been around for centuries. In fact, despite the sophistication of modern medicine, suturing today is essentially the same procedure used in the time of the Roman Empire-the surgeon uses a surgical needle and thread to close the wound. Today, modern advances in sutures and suture alternatives have given surgeons the ability to close wounds faster and with less trauma, as well as customize their wound-closure methods depending on the procedure, healing time, and the patient's condition. Here we'll review some of the advances in wound-closure products.
Sutures
The AxyaLoop, from Axya, is a polypropylene suture that is designed to eliminate the need to bundle and tie the suture into a knot, which saves time. The suture works in conjunction with the AxyaWeld, a device consisting of an ultrasonic generator, a reusable handpiece, and a disposable welding component. The instrument relies on conventional needle passing techniques to position the suture. It differs from needle-only suturing in one way: the surgeon uses the instrument like a knot pusher, but rather than taking multiple throws to create a loop, the device welds the edges of the sutures together. The device can be used for minimally-invasive and open surgical procedures. It is especially recommended for orthopedic procedures and shoulder surgeries, primarily for the repair of rotator cuff tears but also for tendon repairs and soft-tissue repair. The primary disadvantage of these sutures is that they must be used in conjunction with the welding device. Call (978) 232-9997 or visit http://www.axya.com.
Ethicon manufactures a comprehensive array of absorbable and non-absorbable sutures. Within the line of synthetic absorbable sutures are a variety of options geared toward either long-term or short-term absorption cycles. These include the coated Vicryl Rapide. This polyglactin suture is designed for short-term (7 to 10 day) wound support for superficial closure of skin and mucosa, including episiotomy repair, skin lacerations caused by casts, repair of mucosa in the mouth after oral surgery, and skin repair after the removal of small lesions. This type of suture is not intended for use in ligation, ophthalmology, cardiovascular surgery, or neurological procedures. Other absorbables in the company's line include Monocryl (a longer-lasting pliable suture intended for soft tissue); coated Vicryl (similar to Monocryl, but also suitable for ophthalmic procedures); PDS II (effective for up to 6 week wound support for all types of soft-tissue approximation); and Panacryl (up to 6 month wound support, useful for orthopedic procedures, including tendon and ligament repairs). For more information, call (817) 858-7133 or visit http://www.ethiconinc.com.
The CloseSure Procedure Kit, from Inlet Medical, is a single-use kit specifically designed for closing laparoscopic trocar wounds. The kit includes a suture knot passer for laparoscopic suturing and abdominal wall vessel ligation. It also includes suture guides for uniform and secure closure of laparoscopic incisions. The company claims that it promotes faster overall closure (about 1.5 minutes) than traditional methods and enables leak-proof closures. For more information, call (800) 969-0269 or visit http://www.inletmedical.com.
The needle-less Touche Grasper, from Onux, is a battery-powered device that delivers, ties, and cuts sutures automatically. A disposable suture cartridge is attached to the back of the grasper. The surgeon grips the tissue to be sutured within the jaws of the grasper. A grasping lever is used for precise positioning. The surgeon then pushes the button to deliver the suture, flips a switch to tie the knot, and activates a trigger to cut it. For more information, call (603) 926-6200 or visit http://www.onuxmedical.com.
U.S. Surgical manufactures traditional absorbable and non-absorbable sutures, including the SofSilk, SurgiGut, PolySorb, and SurgiPro product lines. The company also produces non-needle products, including pre-cut sutures. For more information, call (800) 722-8722 or visit http://www.ussurg.com.
Staples
Surgical stapling has been around since the 1970s. It is generally considered to be faster and less reactive than suturing. In recent years, manufacturers have developed disposable staplers with absorbable staples or tacks that eliminate the need for staple removal (these are only appropriate for certain procedures, however). Also, staplers with circular as well as linear configurations now make stapling an option for a wider range of tissue.
Staples are widely used in procedures such as gastric bypass surgery, laparoscopic procedures such as bladder neck suspension, and in inpatient procedures such as mastectomy. However, sutures remain the more widely used method overall, in part because sutures provide more options for subcuticular closure (although this is now possible with disposable staples deployed from a stapler with twin gripper blades).
U.S. Surgical is also a major player in the surgical staple market. They offer a wide array of circular and linear stapling devices.
3-M offers a line of disposable stapling devices, staples, and staple removers. For more information, call (800) 228-3957 or visit http://www.3m.com/us/healthcare.
Adhesives
Adhesives come in two categories: tapes and glues. Synthetic adhesives, particularly tapes with hypoallergenic adhesives, are among the least reactive wound closure materials. Medical-grade adhesive products may work best in closing wounds that are fairly shallow with straight (rather than jagged) edges that come together easily. Three examples:
Dermabond, from Ethicon, is a topical adhesive used in lieu of sutures for easily approximated wound edges. The company claims that the post-operative cosmetic results of the adhesive are superior to stitches in facial and plastic surgery, and says that a surgeon can apply the adhesive 2 to 3 times faster than sutures. Dermabond is not suitable for use below the skin or in areas of skin tension (such as the knee or elbow) unless the joint will be immobilized as it heals.
Steri-Strip adhesive tapes, from 3-M, are available in both reinforced and non-reinforced strengths. 3-M claims that the product is completely atraumatic and more cost-effective than sutures. The product is also said to create improved cosmetic results, reduce potential for infection and produce quicker development of tensile strength.
Suture Strip and Suture Strip Plus, from Derma Sciences, are adhesive strips that can be used in lieu of sutures. The adhesive is said to be pressure sensitive and ideal for primary wound closure of surface tissue as well as more traumatic surface wounds, such as skin tears. Suture Strips have less flex than the Plus adhesives. Both are latex-free and water-resistant. For more information, call (800) 825-4325, or visit http://www.dermasciences.com.
Zippers
Zippering, which is said to offer similar benefits to adhesives, is one of the relative newcomers in wound closure. The technique is designed to save time, reduce tissue reactivity and infection potential, and eliminate the possibility of needlestick accidents. To apply the zipper, the surgeon approximates the wound edges close to the zipper. The teeth of the zipper are aligned with the wound, but never actually "grab" the wound itself.
The Medi-Zip surgical zipper, from Atrax, adheres to the patient by means of two adhesive strips. The surgeon applies the first strip, and then manually elongates the wound, placing the teeth of the zipper about 1/2 cm away from the edge of the wound. The length of the zipper extends at least 1 to 2 cm beyond the length of the wound. The surgeon then applies the other adhesive strip and closes the zipper by gently pulling on a holding tab at the bottom of the device. The wound should then "seal" along its edges as the zipper slides closed. Atrax claims the zipper is non-invasive, faster, and safer to apply and remove than sutures or staples and potentially conducive to promoting reduced post-operative scarring. For more information, call (866)-JUSTZIP (587-8947) or visit http://www.medizip.com.
Sutures
The AxyaLoop, from Axya, is a polypropylene suture that is designed to eliminate the need to bundle and tie the suture into a knot, which saves time. The suture works in conjunction with the AxyaWeld, a device consisting of an ultrasonic generator, a reusable handpiece, and a disposable welding component. The instrument relies on conventional needle passing techniques to position the suture. It differs from needle-only suturing in one way: the surgeon uses the instrument like a knot pusher, but rather than taking multiple throws to create a loop, the device welds the edges of the sutures together. The device can be used for minimally-invasive and open surgical procedures. It is especially recommended for orthopedic procedures and shoulder surgeries, primarily for the repair of rotator cuff tears but also for tendon repairs and soft-tissue repair. The primary disadvantage of these sutures is that they must be used in conjunction with the welding device. Call (978) 232-9997 or visit http://www.axya.com.
Ethicon manufactures a comprehensive array of absorbable and non-absorbable sutures. Within the line of synthetic absorbable sutures are a variety of options geared toward either long-term or short-term absorption cycles. These include the coated Vicryl Rapide. This polyglactin suture is designed for short-term (7 to 10 day) wound support for superficial closure of skin and mucosa, including episiotomy repair, skin lacerations caused by casts, repair of mucosa in the mouth after oral surgery, and skin repair after the removal of small lesions. This type of suture is not intended for use in ligation, ophthalmology, cardiovascular surgery, or neurological procedures. Other absorbables in the company's line include Monocryl (a longer-lasting pliable suture intended for soft tissue); coated Vicryl (similar to Monocryl, but also suitable for ophthalmic procedures); PDS II (effective for up to 6 week wound support for all types of soft-tissue approximation); and Panacryl (up to 6 month wound support, useful for orthopedic procedures, including tendon and ligament repairs). For more information, call (817) 858-7133 or visit http://www.ethiconinc.com.
The CloseSure Procedure Kit, from Inlet Medical, is a single-use kit specifically designed for closing laparoscopic trocar wounds. The kit includes a suture knot passer for laparoscopic suturing and abdominal wall vessel ligation. It also includes suture guides for uniform and secure closure of laparoscopic incisions. The company claims that it promotes faster overall closure (about 1.5 minutes) than traditional methods and enables leak-proof closures. For more information, call (800) 969-0269 or visit http://www.inletmedical.com.
The needle-less Touche Grasper, from Onux, is a battery-powered device that delivers, ties, and cuts sutures automatically. A disposable suture cartridge is attached to the back of the grasper. The surgeon grips the tissue to be sutured within the jaws of the grasper. A grasping lever is used for precise positioning. The surgeon then pushes the button to deliver the suture, flips a switch to tie the knot, and activates a trigger to cut it. For more information, call (603) 926-6200 or visit http://www.onuxmedical.com.
U.S. Surgical manufactures traditional absorbable and non-absorbable sutures, including the SofSilk, SurgiGut, PolySorb, and SurgiPro product lines. The company also produces non-needle products, including pre-cut sutures. For more information, call (800) 722-8722 or visit http://www.ussurg.com.
Staples
Surgical stapling has been around since the 1970s. It is generally considered to be faster and less reactive than suturing. In recent years, manufacturers have developed disposable staplers with absorbable staples or tacks that eliminate the need for staple removal (these are only appropriate for certain procedures, however). Also, staplers with circular as well as linear configurations now make stapling an option for a wider range of tissue.
Staples are widely used in procedures such as gastric bypass surgery, laparoscopic procedures such as bladder neck suspension, and in inpatient procedures such as mastectomy. However, sutures remain the more widely used method overall, in part because sutures provide more options for subcuticular closure (although this is now possible with disposable staples deployed from a stapler with twin gripper blades).
U.S. Surgical is also a major player in the surgical staple market. They offer a wide array of circular and linear stapling devices.
3-M offers a line of disposable stapling devices, staples, and staple removers. For more information, call (800) 228-3957 or visit http://www.3m.com/us/healthcare.
Adhesives
Adhesives come in two categories: tapes and glues. Synthetic adhesives, particularly tapes with hypoallergenic adhesives, are among the least reactive wound closure materials. Medical-grade adhesive products may work best in closing wounds that are fairly shallow with straight (rather than jagged) edges that come together easily. Three examples:
Dermabond, from Ethicon, is a topical adhesive used in lieu of sutures for easily approximated wound edges. The company claims that the post-operative cosmetic results of the adhesive are superior to stitches in facial and plastic surgery, and says that a surgeon can apply the adhesive 2 to 3 times faster than sutures. Dermabond is not suitable for use below the skin or in areas of skin tension (such as the knee or elbow) unless the joint will be immobilized as it heals.
Steri-Strip adhesive tapes, from 3-M, are available in both reinforced and non-reinforced strengths. 3-M claims that the product is completely atraumatic and more cost-effective than sutures. The product is also said to create improved cosmetic results, reduce potential for infection and produce quicker development of tensile strength.
Suture Strip and Suture Strip Plus, from Derma Sciences, are adhesive strips that can be used in lieu of sutures. The adhesive is said to be pressure sensitive and ideal for primary wound closure of surface tissue as well as more traumatic surface wounds, such as skin tears. Suture Strips have less flex than the Plus adhesives. Both are latex-free and water-resistant. For more information, call (800) 825-4325, or visit http://www.dermasciences.com.
Zippers
Zippering, which is said to offer similar benefits to adhesives, is one of the relative newcomers in wound closure. The technique is designed to save time, reduce tissue reactivity and infection potential, and eliminate the possibility of needlestick accidents. To apply the zipper, the surgeon approximates the wound edges close to the zipper. The teeth of the zipper are aligned with the wound, but never actually "grab" the wound itself.
The Medi-Zip surgical zipper, from Atrax, adheres to the patient by means of two adhesive strips. The surgeon applies the first strip, and then manually elongates the wound, placing the teeth of the zipper about 1/2 cm away from the edge of the wound. The length of the zipper extends at least 1 to 2 cm beyond the length of the wound. The surgeon then applies the other adhesive strip and closes the zipper by gently pulling on a holding tab at the bottom of the device. The wound should then "seal" along its edges as the zipper slides closed. Atrax claims the zipper is non-invasive, faster, and safer to apply and remove than sutures or staples and potentially conducive to promoting reduced post-operative scarring. For more information, call (866)-JUSTZIP (587-8947) or visit http://www.medizip.com.
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