The Science of Sutures presented by: Chantal Souligny-Prud’homme Covidien

SUTURES

The definition of a suture A surgical suture is any material used to approximate tissue during the critical wound healing period. Covidien | November 10, 2018 | Confidential Formerly Tyco Healthcare

Suture Selection Training and experience of surgeon Type of operation Site of operation Healing and strength of tissues Condition of the patient Risk of infection Post-operatives conditions Strand properties Covidien | November 10, 2018 | Confidential Formerly Tyco Healthcare

Suture Strand Reactivity Natural Max Reactivity Gut Silk Synthetic Braided Polysorb* Dexon*II/S … Synthetic monofilaments Caprosyn* Biosyn* Maxon* Reactivity - Minimum Covidien | November 10, 2018 | Confidential Formerly Tyco Healthcare

Strand Gauge/Diameter 11/0 10/0 9/0 8/0 7/0 6/0 5/0 4/0 3/0 2/0 1 2 3 4 5 7 Cardiovascular Surgery Ophthalmology, microsurgery Retention Plastics, emergency General Surgery Gynecology, orthopedics Sternotomy Covidien | November 10, 2018 | Confidential Formerly Tyco Healthcare

Monofilaments One strand Superior tissue passage Reduced knot security Smooth surface Stiffer material Covidien | November 10, 2018 | Confidential Formerly Tyco Healthcare

Multifilaments Multiple strands, braids coatings Surface interstices - capillarity Difficult tissue passage Superior knot security Supple strand Covidien | November 10, 2018 | Confidential Formerly Tyco Healthcare

Absorbable Sutures - Multifilaments Gut Short-term, natural-source multifilament Absorption by enzymatic reaction leading to greater tissue reactivity, inflammatory response Variable absorption period, variable tensile strength out-of-package Excellent knot security Alcohol packed – quick drying Tendency to fray at surface Plain Gut ~ 60 days absorption ~ 7 days strength retention Chromic Gut ~ 90 days absorption ~ 14 days strength retention Chromic salt bath Covidien | November 10, 2018 | Confidential Formerly Tyco Healthcare

Absorbable Sutures - Multifilaments VICRYL RapideTM Short-term synthetic multifilament Absorption by hydrolysis, low reactivity Fixed absorption period ~ 42 days Strength retention period ~ 7 days Excellent knot security Coated to reduce tissue drag Covidien | November 10, 2018 | Confidential Formerly Tyco Healthcare

Absorbable Sutures - Multifilaments DEXONTM ‘S’, POLYSORBTM, VICRYLTM Medium-term synthetic multifilament Absorption by hydrolysis, low reactivity Fixed absorption period ~ 56 - 90 days Strength retention period ~ 28 days Excellent knot security Coated to reduce tissue drag General surgery, orthopedics, gynecology ie: hysterectomy, ligation, skin closure Opthalmic Covidien | November 10, 2018 | Confidential Formerly Tyco Healthcare

Absorbable Sutures - Monofilaments BIOSYNTM, MONOCRYLTM Medium-term synthetic monofilament Absorption by hydrolysis, low reactivity Fixed absorption period ~ 100 days Strength retention period ~ 21 days Good knot security Excellent tissue passage Subcuticular closure (fascia, muscle, fat), general surgery (ie , plastic surgery,(ie Cosmetic work) Covidien | November 10, 2018 | Confidential Formerly Tyco Healthcare

Absorbable Sutures - Monofilaments MAXONTM, PDS IITM Long-term synthetic monofilament Absorption by hydrolysis, low reactivity Fixed absorption period ~ 180 days Strength retention period ~ 42 days Good knot security Excellent tissue passage General surgery (ie Whipple procedure, bowel anastomosis, general closure, mass skin closure, pancreatoduodenectomy )Plastics subcuticular closure,( ie Breast Reduction) Covidien | November 10, 2018 | Confidential Formerly Tyco Healthcare

Absorbable Sutures - Monofilaments CAPROSYNTM Short-term synthetic monofilament Absorption by hydrolysis, low reactivity Fixed absorption period ~ 56 days Strength retention period ~ 10 days Excellent knot security Excellent tissue passage Excellent replacement for gut products gynecology, plastic surgery, subcuticular closure ei: prostatectomy, episiorraphy in highly vascularised areas Covidien | November 10, 2018 | Confidential Formerly Tyco Healthcare

Non Absorbable Sutures - Silk SOFSILKTM, PERMAHAND™ Silk Natural-source non-absorbable multifilament Wax-coated/ Silicone coating Fractures over long-term, high reactivity Excellent knot security Poor tissue passage general surgery-ligatures, ophthalmology, plastic surgery Covidien | November 10, 2018 | Confidential Formerly Tyco Healthcare

Non Absorbable Sutures - Nylon DERMALON BlueTM, MONOSOFTM, ETHILONTM Monofilament, Excellent tissue passage Fractures over long-term, low reactivity Good knot security Also known as polyamide Plastic surgery, general surgery, orthopedics, ophthalmics, general closure SURGILONTM, NUROLONTM Braided, good tissue passage Excellent knot security Excellent replacement for silk Covidien | November 10, 2018 | Confidential Formerly Tyco Healthcare

Non Absorbable Sutures - Polyester TICRONTM, SURGIDAC™, MERSILENETM, ETHIBONDTM Braided, good tissue passage Permanent suture, low reactivity Extremely strong Excellent knot security Excellent replacement for silk Coated and Non-coated Cardic surgery, sternal closure, plication ie: heart valve repair – annuloplasty Covidien | November 10, 2018 | Confidential Formerly Tyco Healthcare

Non Absorbable Sutures - Polypropylene SURGIPROTM, SURGIPRO IITM, PROLENETM Monofilament, excellent tissue passage Permanent suture, low reactivity Extremely strong Nupack packaging cardiovascular, cardiac, general surgery, orthopedics or general closure ie: CABG (anastomosis), femoral popliteal bypass, microsurgery Covidien | November 10, 2018 | Confidential Formerly Tyco Healthcare

Non Absorbable Sutures - Polybutester NOVAFILTM Monofilament, excellent tissue passage Permanent suture, low reactivity Extremely strong, minimal memory Tactile ‘WARNING’ before elongation to breaking point Excellent knot security Elastic material conforms to post-operative edema to ensure proper approximation A&E department, plastic surgery, hand surgery and any specialty requiring skin closure ie: blephroplasty, mamoplasty Covidien | November 10, 2018 | Confidential Formerly Tyco Healthcare

NEEDLES

Needles ATRAUMATICTM vs. eyed (French eyed) Speed, reduced trauma Curvature Deep vs. superficial Straight does not require needle driver ATRUAMATIC Eyed Covidien | November 10, 2018 | Confidential Formerly Tyco Healthcare

Point Geometry Taper point Cutting Point Variations Spatula, lancet Conventional Cutting Reverse Cutting Spatula Point Taper point Taper point Cutting Point Variations Spatula, lancet Trocar, Y, diamond, penetrating point. Covidien | November 10, 2018 | Confidential Formerly Tyco Healthcare

Wound Closure Techniques « Principles of wound closure » Gently manipulate tissues Take small tissue bites Just approximate tissue Use smallest suture possible Assure hemostasis Avoid dead spaces Covidien | November 10, 2018 | Confidential Formerly Tyco Healthcare