A-B Tech Comm College Ethicon In-Service – Sutures / Dermabond Kurt Prewitt Ethicon Products Clinical Representative 1-800-888-9234, x1562

Agenda Ethicon Sutures New Innovations Absorbable and Non-Absorbable Needles New Innovations Vicryl Plus Dermabond ProPen

ETHICON,INC. a Johnson & Johnson Company

ETHICON, INC. Johnson & Johnson began manufacturing suture products in 1887 ETHICON, INC., which stands for Ethical and Confidence, was officially established as a separate division of Johnson & Johnson in 1949 From the earliest materials to that of natural materials-GUT & SILK to newer, less reactive synthetic materials, ETHICON has been at the forefront of technology Johnson & Johnson, then ETHICON, has a long history of suture manufacturing Use this slide to point out that with history comes knowledge & expertise Use this slide to show that throughout the years, ETHICON has a proven history of consistently being on the forefront of technology. ETHICON can be trusted to deliver innovative and quality products

Definitions Suture Ligature or tie Term for material used to align severed body tissue together; to hold in place while healing occurs Ligature or tie A strand of suture material that is used to: Tie off blood vessels Prevent hemorrhage/bleeding Isolate tissue while excising

History of Suture Innovation 2000 BC Ancient Egyptians 460 BC – 1865 AD Cauterize to ligation 1887 Silk and Cat Gut 1930s Commercial manufacturing 1940s Sterilization and uniformity 1950s Individualized packaging 1947 Nylon 1958 MERSILENE*polyester fiber 1969 PROLENE*polypropylene Suture 1974 VICRYL*(polyglactin 910) Suture 1976 ETHIBOND* polyester Suture 1979 Coated VICRYL*(polyglactin 910) 1989 PDS II* (polydioxanone) Suture 1992 ETHIGUARD*blunt point needle 1993 MONOCRYL* (poliglecaprone 25) Suture 1995 VICRYL Rapide* (polyglactin 910) Suture 1996 Dyed MONOCRYL* (poliglecaprone 25) Suture 1998 DERMABOND*Topical Skin Adhesive 2003 Coated VICRYL Plus* Antibacterial (polyglactin 910) Suture 2006 PDS and MONOCRYL Plus* Antibacterial Sutures This slide reviews the history of suture manufacturing Use this slide to point out the innovation and consistency in delivering innovative products to meet the changing demands of the customer and to stay at the forefront of procedural changes Trademark Data on file, ETHICON, Inc.

Wound Closure Materials This section reviews suture materials and competitive suture materials. It is designed to be used in whole or in section. Whether a customer is a plastic surgeon looking for the differences between MONOCRYL* Suture and CAPROSYN Suture or whether it is a CV surgeon that would like to know how ETHIBOND* EXCEL Suture has improved, this section will give the answers and provide enough data and graphs to back up the competitive advantages of the ETHICON Products suture

Suture Materials The following information will review: Critical Wound Healing Period (CWHP) ETHICON Products Absorbable Sutures for Short-term, Short- Medium-term, Medium-term, and Long-term The information in this section; Section B is divided into four parts Critical Wound Healing Period - Wound healing times - Terms & definitions Absorbable Suture - Short-term wound support - Short-medium term support - Medium-term support - Longer-term support Non-absorbable Suture Specialty focus - Plastic Surgery - Cardiovascular Surgery

Critical Wound Healing Period Skin Mucosa Subcutaneous Peritoneum Fascia 5-7 Days 5-7 Days 7-14 Days 7-14 Days 14-28 Days Use this slide to explain how different tissues heal at different times, therefore, there is a need for a variety of suture types, absorbable or non-absorbable, that have different strengths and different sizes. Use this slide to explain that ETHICON Products has the most comprehensive range of quality suture products to match these different healing times 0 5 7 14 21 28 days Tissue Healing Times

The Critical Wound Healing Period Can Depend on Various Factors Age Weight Nutrition Dehydration Blood Supply Immune response Chronic diseases Localized infection Diabetes History of Radiation Therapy Use this slide to discuss- not only does the different tissue layer have an effect on critical wound healing times, but the patient themselves, effect wound healing times Use this slide to talk to the fact that certain factors may decrease or accelerate the rate of time it takes for wound healing to occur Give an example of a diabetic patient that has more friable tissue which will take a longer time to heal and will need a suture to support the wound for longer than normal

Suture Sizes Sizes range from 7 (Largest) to 11-0 (Smallest) Size 7-0 is the size of a human hair Example – General Closure Fascia – Size 1 to 2-0 Fat – Size 2-0 to 4-0 Skin – Size 3-0 to 5-0 Fast Healing Wound Cutting Needles Epidermis Epidermis Dermis Dermis Taper Needles Subcutaneous (Fat) Subcutaneous (Fat) Fascia Fascia Slow Healing

ETHICON Products Box Box clearly distinguishes the type of suture and needle information Code Suture size Product name Suture length Needle size Type of needle Quantity Use this slide to talk about the features that distinguish the ETHICON Products suture box

Suture Types Absorbable Non-Absorbable Natural Synthetic Natural Monofilament Braided Monofilament Braided Suture is divided into different categories Use this slide to give an overview on how suture is categorized Short -term Short-Medium -term Medium -term Longer -term

Suture Summary Absorbable Non-Absorbable Braided Monofilament Braided Vicryl Vicryl Plus Vicryl Rapide Monofilament Monocryl PDS II Plain Gut - Natural Chromic Gut - Natural Fast Absorbing Gut - Natural Braided Silk - Natural Cotton - Natural Nurolon Mersilene Ethibond Excel Monofilament Prolene Ethilon Stainless Steel - Natural

Suture Types Absorbable Natural Synthetic Short -term Monofilament Braided Monofilament Braided This slide begins the absorbable suture products presentation Use this slide as an overview of what is to follow in the presentation on absorbable suture Short -term Short-Medium -term Medium -term Longer -term

Short-term Wound Support Situation in Short-term Wound Support Skin & mucosa Typically emergency procedures Typically areas with increased blood flow Need Benefit Fast-absorbing suture · Good clinical outcomes Rapid loss of strength/mass Good knot formation/snug down Different suture products align with the Critical Wound Healing Period depending on the tissue and patient type Wound healing that requires absorbable suture can be divided into four sections: Short-term wound support Short to medium-term wound support Medium-term wound support Longer-term wound support This slide talks to short-term wound support Use this slide to set up the discussion on what procedures and tissue types are required for short-term wound support and what suture products it needs Procedure Example: Episiotomy & Perineal Repair

ETHICON Products Gut Suture All Gut is not created equal ETHICON Products Surgical Gut sutures are manufactured from almost 100% pure collagen: (i.e. small intestine of sheep or serosa of cattle) Quality in raw material which minimizes tissue reactions. TRU-GAUGING is an exclusive ETHICON process which produces the most uniform diameter possible: No fraying of the suture after tie-down Buffered CHROMICIZING the entire suture is an exclusive ETHICON process which minimizes tissue irritation. Use this slide to explain the key advantages that the ETHICON Products Gut Suture has over the competition TRU-GUAGING: This process ensures a uniform diameter along the entire length of the strand- a difficult thing to do in a natural substance. This eliminates the potential for the suture to fray, ensures a uniform high tensile strength, and ensures a high surface smoothness Buffered CHROMICIZING: This process entirely bathes the collagen strand before and after spinning to form the suture. This allow for uniformity in high tensile strength The following is an example of a demonstration that can be used to emphasize the point: Demonstration: Perform a knot tie down with ETHICON Products chromic gut suture & competitive gut suture See the differences in that the competitive product is more brittle and easily breaks

Coated VICRYL RAPIDE* (polyglactin 910) Suture SYNTHETIC Predictable absorption Minimal tissue reaction FAST ABSORPTION No foreign body after 6 weeks Superficial sutures brush off after 7-10 days BRAIDED Good handling & knotting Initial strength greater than nylon & gut suture COATING Smooth passage through tissue. Easy knot adjustment For delicate repairs the comfort of a synthetic alternative to gut suture Use this slide to speak to the key features and benefits of VICRYL* RAPIDE Suture Use this slide to highlight the innovation in a fast absorbing braided suture which is easy for the surgeon to handle but has “comfort” for the patient, such as in delicate repairs like episiotomy repair, a stiff or non pliable suture may cause pain or discomfort Trademark * Data on file, ETHICON, INC

Short-Medium-term Wound Support Situation in Short-Medium-term Wound Support Skin, mucosa, subcuticular Typically cosmetic surgery cases Typically areas with increased blood flow Need Benefit High initial strength · Good Clinical Outcomes Good cosmesis Good handling & passage through tissue Good knot formation/snug down Low reactivity This slide talks to the second type of wound support for absorbable suture Short-Medium-term wound support Use this slide to set up the discussion on what the procedure and tissue types are that require short-medium-term wound support and what suture type it needs Give examples of the type of procedures that require short-medium wound support, such as plastic surgery Procedure Example: Plastic Surgery

MONOCRYL* (polyglecaprone 25) Suture SYNTHETIC Predictable absorption Minimal tissue reaction MONOFILAMENT Smooth passage through tissue POLIGLECAPRONE 25 Excellent handling characteristics and pliability Excellent knot security Monofilament pliability unprecedented among synthetic absorbable suture Use this slide to highlight the key features and benefits of the MONOCRYL Suture product Use this slide to emphasize why surgeons prefer it: Because of its unprecedented monofilament pliability Trademark * Data on file, ETHICON, INC

Medium-term Wound Support Situation in Medium-term Wound Support All tissue layers that align with the critical wound healing period of 21-28 days All tissue types Need Benefit Consistent strength around the CWHP · Good clinical outcomes Good handling & passage through tissue Good knot formation/snug down Low reactivity This slide is the third type of wound support in absorbable suture medium-term wound support Use this slide to describe what medium-term wound support means for the surgeon. This is the category where the majority of general surgery procedures will fall Use this slide to explain what is needed from a suture for medium-term wound support Give examples of procedures that fall into this category, such as general closure Procedure Example: General Closure

Coated VICRYL* (polyglactin 910) Suture SYNTHETIC Predictable absorption Minimal tissue reaction ABSORBABLE No foreign body after 56-70 days Strength in the critical wound healing time with new claim of 25% BSR at 28 days BRAIDED Strong good handling & knotting COATING Smooth passage through tissue. Minimal tissue trauma Unique coating enables knot adjustability Unequaled strength from the worlds #1 Suture Use this slide to highlight the key features and benefits of the VICRYL Suture product Use this slide to emphasize why surgeons prefer it: because of its strength, performance and handling Use this slide to speak to the fact that it is the world’s number one suture Trademark Data on file, ETHICON, INC.

The evolution of the World’s # 1 Suture 2003 2003 28 day claim 25% 2000 Vegetable-based calcium stearate 1996 21 day claim 50% 1988 21 day claim improves to 40% 1983 VICRYL Suture 2.0 dpf 21 day claim is 20% This is an example of the timeline of VICRYL Suture Definition of Dpf : This is a textile terminology. Basically, the lower the dpf, the finer the material Vegetable based coating definition: all calcium stearate coating worldwide moves to a non-animal based product Use this slide to discuss the reason why ETHICON Products continues to earn the business. It is because of the dedication to innovation and continuous improvement Use this slide to speak to the innovations that have constantly enhanced VICRYL Suture as a suture since its launch to the market 30 years ago Use this slide to speak to the fact that in the 1980’s VICRYL had a 21-day claim of 30% BSR. Today, the claim is 50% at 21 days. In comparison, POLYSORB Suture, the major competitor to VICRYL is 30% of original BSR at 21- days. Note that VICRYL Suture has an additional claim of 25% at 28 days Use this slide to demonstrate that through VICRYL Suture innovations, ETHICON Products has changed the role of the suture from that of an implant to that of playing an active role with VICRYL Plus Suture, the worlds first antibacterial suture 1979 VICRYL Suture Coating-Polyglactin 370 and calcium stearate 1977 Improved VICRYL Suture 3.5dpf 1974 Uncoated VICRYL Suture launched 5dpf *Trademark Data on file, ETHICON, INC. .

Longer- term wound support Situation in Longer-term Wound Support Tissue that requires extended support Friable tissue Slow healing tissue/ compromised patients Typically fascia tissue Need Benefit Strength beyond the CWHP of 21 days · Good clinical outcomes Good handling & passage through tissue Good knot formation/snug down Low reactivity This slide talks to the last type of wound support for absorbable suture Longer-term wound support Use this slide to set up the discussion on what the procedures and tissue types are that require longer-term wound support and what suture type it needs Give examples of the type of procedures that require longer-term wound support (ex: post bariatric procedures such as body contouring) Procedure Example: Body Contouring

PDS II * Suture (polydioxanone) suture SYNTHETIC Predictable absorption Minimal tissue reaction MONOFILAMENT Smooth passage through tissue Initial strength greater than nylon & gut suture POLYDIOXANONE Prolonged wound support High initial strength Good handling characteristics Knot security PRODUCT OFFERING Looped suture for speed and security of long incision fascia closure Strongest synthetic absorbable suture for extended wound support Use this slide to highlight the key features and benefits of the PDS II* Suture product Use this slide to emphasize why surgeons prefer it: because PDS II Suture has longer strength claims, it is beneficial for today’s patient as it gives extended wound support and the chance of better clinical outcomes Trademark Data on file, ETHICON, INC.

Suture Materials NON-ABSORBABLE SUTURE SPECIALTY FOCUS This next section will describe the non-absorbable suture range of products and then lead into the specialty focus in Plastic and Cardiovascular Surgery

Suture Types Non-Absorbable Synthetic Natural Monofilament Braided Use this slide to graphically portray the family of non-absorbable suture products and how they are categorized

PROLENE* (polypropylene) Suture SYNTHETIC Minimal tissue reaction even in the presence of infection MONOFILAMENT Smooth passage through delicate tissue POLYPROPYLENE Will not fatigue with flexing Provides permanent wound support Unique knotting properties MANUFACTURING Highly controlled PROCESS Numerous quality checks Controlled linear elongation Consistent suture, strand- to-strand Use this slide to highlight the key features and benefits of the PROLENE Suture product Use this slide to emphasize why surgeons prefer it Use this slide to emphasize the special manufacturing process and quality steps that go into making PROLENE Suture *Trademark Data on file, ETHICON, INC.

ETHIBOND EXCEL* (polyester) Suture SYNTHETIC Minimal tissue reaction BRAIDED 30% Stronger than leading competitor (size 2/0) Good handling & knotting 15% stronger than ever before Central core provides strong suture POLYESTER Provides permanent wound support POLYBUTILATE Smooth knot tie-down COATING Excellent handling properties Unmatched polyester knot security Use this slide to highlight the key features and benefits of the ETHIBOND EXCEL Suture product Use this slide to emphasize the improvements that have been made to ETHIBOND EXCEL Suture : now it is 15% stronger *Trademark Data on file, ETHICON, INC.

PERMA-HAND* Silk Suture BRAIDED Excellent handling and knotting characteristics WAX COATING Improved surface qualities Reduces capillarity INDICATIONS Used in a wide variety of surgical procedures Use this slide to highlight the key features and benefits of the PERMA-HAND Silk Suture product *Trademark Data on file, ETHICON, INC.

ETHILON* (nylon) suture MONOFILAMENT Smooth, easy passage through tissue NYLON Less tissue reaction Provides long term wound support PLIABILIZED Ease of handling OFFERING Less package memory INDICATIONS Used in a wide variety of procedures Fine sizes specifically for use in ophthalmic and microsurgery Use this slide to highlight the key features and benefits of the ETHILON suture product *Trademark Data on file, ETHICON, INC.

Specialty Focus Plastic Surgery Cardiovascular Surgery Focus on.. MONOCRYL suture ETHILON suture Cardiovascular Surgery PROLENE suture ETHIBOND EXCEL suture These next set of slides will emphasize suture material as it relates to specialty focus. Specialties are broken up into two areas: Plastic & CV Each specialty discussed will focus on two product areas: MONOCRYL suture and ETHILON suture for Plastic PROLENE suture and ETHIBOND suture for CV *Trademark Data on file, ETHICON, INC.

Plastic Surgery Situation in plastic surgery Need Benefit Cosmetic results Aesthetic outcomes Consistent performance (suturing is signature) Varying degrees of tissue strength/ length of incisions Need Benefit Low reactivity · Good clinical outcomes Pliability & smooth passage through tissue Good cosmesis Monofilament preferred This slide highlights what is important in Plastic Surgery and what is critical to a good outcome and to the surgeons’ needs Use this slide to set up the discussion of choosing the suture for this specialty area: For example, talk about the need for aesthetic outcomes and therefore a monofilament will be more appropriate

MONOCRYL* Suture Advantages for Plastic Surgery Ease of passage through tissue Monofilament Pliability/ surgical hand Excellent cosmesis Good knot security & tie down Attached to P, PS and PC series needles Some of the best surgical needles in the world Use this slide to talk about the reasons why MONOCRYL suture meets the needs of the plastic surgeon and is the suture of choice for this specialty focus Trademark Data on file, ETHICON, INC.

ETHILON* Suture Pliabilized: Enhances handling in cosmetic surgery Good cosmesis Attached to PS and PC series needles Use this slide to discuss the role of a non-absorbable product and how ETHILON Suture meets the needs of the plastic surgeon. Trademark Data on file, ETHICON, INC.

NUROLON* Nylon Suture Specially made for neurological surgery Handles like silk Higher strength and less tissue reaction than silk T*Trademark Data on file, ETHICON, INC.

Cotton and Steel Cotton Steel Natural cellulose multifilament fiber Weakest of non-absorbable materials, but gains strength when wet Used for ligating and suturing No advantages over silk Steel Inert with high tensile strength Used for sternum closure, orthopedics, neurosurgery May be used in presence of infection Difficult to handle and tie. May damage tissue. Be Careful! Keep straight, double glove, use wire cutters

Cardiovascular Surgery Situation in C.A.B.G. More diseased vessels Typically smaller vessels Harder to access Often suturing on beating heart Need Benefit Smooth passage through tissue · Good Clinical Outcomes Good knot tensile strength · Preferred performance & handling Good knot formation/snug down Low reactivity Consistent performance This slide highlights what is important in cardiovascular C.A.B.G. surgery and what is critical to a good outcome and to the surgeons needs Use this slide to set up the discussion of the type of suture that is needed in this specialty area: For example, talk about the need for consistency and, therefore, a good quality, consistently performing suture that will be required such as PROLENE suture

PROLENE* Suture Used in 9 out of every 10 CABG procedures Controlled linear elongation – the “early warning system” manufactured into every strand Unique knotting properties – plastic knot deformity Smooth tissue passage Rigorous manufacturing process to ensure truly consistent sutures Special raw material certification process 35 years of market leadership Use this slide to talk about the reason why PROLENE suture meets the needs of the cardiovascular surgeon and is the suture of choice for this specialty focus Use this slide to talk to the unique advantages of PROLENE suture and why that is important to the CV surgeon Use this slide to discuss the leadership position that PROLENE suture has in that 9 out of 10 CABG procedures use PROLENE suture due to its QUALITY, CONSISTENCY and INNOVATION Trademark Data on file, ETHICON, INC.

Manufacturing Process Special Material Certification Process Raw material goes through rigorous evaluation and selection process Product is stored under tightest of conditions until use Meticulous extrusion process to turn raw material into strands of suture Numerous quality checks at every manufacturing stage Results in product which has unrivalled quality and consistency This slide describes the unique and rigorous manufacturing process that PROLENE suture goes through. Use this slide to discuss why it is critical that these quality steps take place in the manufacture of PROLENE suture, a suture that is used to save a person’s life, and why the importance of the end product being consistent all of the time *Trademark Data on file, ETHICON, INC.

Size 8-0 PROLENE* Suture 8-0 suture is frequently used for IMA-LAD anastomosis and also fine distal vein grafts 8-0 PROLENE suture is a true 8-0, in that it falls within the USP specifications for 8-0 suture sizing Both 8-0 SURGIPRO II and DEKLENE II are significantly oversized – up to 20% - and fall within the specifications for a 7-0 suture 7-0 PROLENE suture is significantly stronger than both the 8-0 SURGIPRO II and 8-0 DEKLENE II This slide speaks to the one size of PROLENE suture size 8-0 that is primarily used for one type of procedure in CV Use this slide to speak to the advantages that 8-0 PROLENE suture has compared to the competition Use this slide to speak to the oversizing of the competition, to the extent that the maximum overage falls in the range of the next largest suture Ask the question: Isn’t it more appropriate to use the correct suture size for the tissue type? Use this slide to speak to the strength of PROLENE suture compared to that of the competition Trademark Data on file, ETHICON, INC. Competitive Trademark – Syneture

Valve Surgery Need High tensile strength Smooth passage through tissue Excellent handling Secure knot tie down Consistent tissue reaction This slide highlights what is important in cardiovascular valve surgery and what is critical to a good outcome and to the surgeons needs Use this slide to set up the discussion of what type of suture is needed in this specialty area: For example, talk about the need for excellent handling and therefore the need for a smoothly coated suture will be required such as ETHIBOND Excel suture suture

ETHIBOND Excel* Suture 30% stronger than TICRON at size 2-0 Unique braiding construction provides strong supple consistent suture Proprietary coating allows for smooth tissue passage and smooth knot tie-down (no chattering) Superior knot security Use this slide to talk about the reason why ETHIBOND Excel suture meets the needs of the cardiovascular surgeon and is the suture of choice for this specialty focus Use this slide to talk to the unique advantages of ETHIBOND suture and why that is important to the CV surgeon Trademark Data on file, ETHICON, INC. Competitive Trademark – Syneture

The following charts explain the range of suture products and the product attributes for ETHICON Products and its competitors Trademark*

Advanced Needle Technology This section covers ETHICON Products needles and introduces our advanced needle technology (i.e.: geometry, coating and alloy)as the key advantage over the competition Illustrations and data in the form of graphs and pictures are presented

ETHICON Products Box Use this slide to talk about the features that distinguish the ETHICON Products suture box

Advanced Needle Technology ETHICON Products Advanced Needle Technology Superior Alloy A.N.T. Use this slide as a visual to explain that ETHICON Products believes that all three areas combine to give the customer the most advanced needle technology in their suture products Superior Geometry Superior Coating

The Anatomy of the Ideal Surgical Needle Three key factors make up the ideal needle: Alloy Geometry – tip and body Coating The combination of these attributes is ETHICON’s Advanced Needle Technology This slide sets up the discussion of the ideal needle and the elements that are required for an ideal needle Use this slide to introduce the concept that the combination of the ETHICON Products exclusives in geometry, coating and alloy gives the customer advanced needle technology in our suture products

Focus on Needle Geometry Provides the appropriate penetration performance for surgical indication and maximizes ease of handling during surgery GEOMETRY TIP BODY Various designs for surgical indication PRIME* cutting – for skin closure BV Taper – vascular anastomosis ETHIGUARD* Blunt – safety needles CS Ultima* – spatulated ophthalmic V-Series – penetrating taper tough tissue Designed for ease of use Needle Ribs – stability in needle holder BV – rounded geometry for arming flexibility 12:1 taper ratio – smooth passage, improved penetration Laser Drilled – smooth needle – suture transition This slide explains the details of the geometry of ETHICON Products needles The geometry is composed of the tip and the body of the needle Use this slide to review the exclusive tip and body designs currently on ETHICON Products needles. Use this slide to discuss why these are important for ease of handling during surgery Trademark Data on file, ETHICON, INC..

Geometry-What is Prime? Less mass than typical reverse cutting needle = improved penetration and control An exclusive needle tip design that provides Precise placement Smoother repeated passage Better control Less tissue trauma This slide talks about the GEOMETRY of the ETHICON Products plastic needles, in particular the PRIME geometry. Use this slide as a visual to show what prime geometry looks like Use this slide to explain why prime geometry is important for penetration and control in delicate tissue Use this slide to explain the key benefits to the plastic surgeon of prime geometry needles

Coating - What is MultiPass*? Proprietary new needle coating Provides superior needle penetration performance consistency Pass after Pass Needle to Needle Through 30 needle passes This slide talks about the COATING part of the ETHICON Products plastic needles Certain plastic needles will have the new MultiPass needle coating technology Use this slide to explain how well MultiPass needle coating performs Use this slide to explain that smooth consistency in multiple penetrations is advantageous to the plastic surgeon because of the types of procedures that they perform Example: Body contouring with long incisions will require a needle to pass through tissue consistently, pass after pass 1st pass is not improved 5th, 10th, 20th and 30th are! *Trademark Data on file, ETHICON, INC.

Needles Shapes ¼ Circle 3/8 Circle ½ Curve ½ Circle 5/8 Circle Straight

Needles Types Taper Point Needle ETHIGUARD* Blunt Point Needle Conventional Cutting Reverse Cutting

SPECIALTY FOCUS Plastic – cosmetic skin closure C.V. – vascular anastomosis & valve surgery The competitive needle section is broken up into two parts -Plastic -CV (Vascular and Valve) Within these specialty areas, the slides will describe what Advanced Needle Technology is used for each specialty and then give a comparison to the competition. There is a multitude of data in the form of graphs and charts that support our competitive claims

Focus on Plastic Surgery Procedures are changing Growth of body contouring Cosmetic procedures are increasing Cosmetic outcomes more important than ever across all specialties Need Requires consistent needle pass >30x Requires resistance to bending Requires penetration performance pass after pass This slide talks about the specialty area of plastic surgery, the changing demographics and the requirements to address these changing needs Use this slide to set up the reasons why the ETHICON Products Advanced Needle Technology meets the new changing needs of the plastic surgeon

Focus on Plastic Surgery Needles What does Advanced Needle Technology deliver in plastic surgery? Alloy – ETHALLOY* alloy Geometry – PRIME* geometry Coating – MultiPass* needle coating Use this slide to describe the Advance Needle technology of the ETHICON Products plastic needles. Trademark Data on file, ETHICON, INC..

ETHICON Products Packaging ETHICON Products continuously innovates packaging in consideration of: Less environmental waste Easy and safe access Smooth dispensing Package memory Use this slide to talk about why ETHICON Products considers packaging to be a critical component of the final product that a customer uses

PROLENE* suture Packaging Innovation Paper Folder 1990 Needles held in place by suture Needle separation Door Relay 1992 One step opening (no paper tear tab) Needles held in park Circulating & scrub nurse verify needle count Recyclable plastic tray Zipper Relay 2000 Automated process (More Consistent Handling of needles & sutures) Enhanced needle separation * Trademark

ETHICON Products Box Box clearly distinguishes the type of suture and needle information Code Suture size Product name Suture length Needle size Type of needle Quantity Use this slide to talk about the features that distinguish the ETHICON Products suture box

New Innovations This section covers new innovations in wound closure that ETHICON Products has recently added to its product offering It sets the stage for the active suture platform and the surgical adhesive platform that affects wound management

Surgical Site Infection (SSI) FACTS 27 Million Procedures in the US 2%-3% Infection Rates 675,000 SSIs 66% Confined to Incision Staph a, Staph e, MRSA, MRSE

CONTRIBUTING FACTORS OR Procedure Technique Patient Implants And others

ROLE OF THE IMPLANT Three Key Factors Less Bacteria Required Microorganisms Can Colonize and Spread Biofilm Formation The Key - Preventing Bacteria Colonization

VICRYL Plus Inhibits Bacterial Colonization Renders the suture neutral Potentially eliminates it from the SSI Equation

INVENTING VICRYL PLUS §         Added IRGACARE MP* to the suture coating §         Irgacare MP* is the medical grade of Triclosan §         It is one of the purest forms of Triclosan §         Triclosan is not an antibiotic §         Triclosan has been used in consumer products for over 30 years

§         WHAT IS TRICLOSAN IN TODAY? INVENTING VICRYL PLUS §         COMERICIAL PRODUCTS §         IT IS SAFE. IT’S EFFECTIVE §         IT’S THE RIGHT CHOICE FOR ETHICON

FACTS TO REMEMBER VICRYL Plus Antibacterial Suture Creates a Zone of Inhibition VICRYL Plus Suture is Bacteriocidal VICRYL Plus Suture Is Effective Against Staph a, Staph e, MRSA, MRSE VICRYL Plus Suture Is Designed to Be Used Everywhere You Use VICRYL Suture

FACTS TO REMEMBER Medical Implants, Such As Sutures, Do Not Cause Infection SSI Common Contributing Factors Patient Profile Surgical Technique Surgical Environment The Procedure Itself Medical Implants

Topical Adhesives . Competes with sutures and staples for skin closure Strong as 4-0 suture within 3 minutes Microbial barrier Cosmesis An occlusive dressing Fast and easy Patient satisfaction and comfort Close incisions up to 69 cm Patient friendly – Shower immediately, min post-op care Trademark Data on file, ETHICON, INC. .

Not all adhesives are created equal DERMABOND INDERMIL Flexible – 8-carbon side chain 2X wound burst strength 4X breaking strength High viscosity – Stays put May not require a bandage Patient showers immediately No refrigeration required Clinically proven to close incisions up to 69 cm Brittle – 4-carbon side chain Lower closure strength Lower breaking strength Low viscosity Bandage required for 48 hours No showering for 48 hours Refrigeration required Clinically proven to close incisions up to 8 cm

Value of ETHICON Products Suture Economics of conversion Suture in-services, PROF ED, grand rounds, education focus Inventory Management Quality, consistency, innovation It is more than just Suture! In order to maintain a leadership role and to remain the wound closure company of choice, ETHICON Products will deliver QUALITY, CONSISTENCY and INNOVATION to the customer. Use this slide to discuss the other reasons why ETHICON Products should remain the wound closure company of choice Economics of conversion Education that ETHICON Products provides to customers and health care professionals Partnering with inventory management (SMART REPORTS, FSA and representative management) to reduce hospital costs Cost of converting to competitive product

ETHICON Value Above Price New procedures: critical products released to improve procedural outcomes. Quality hospital programs to reduce cost. Physician signatures/letters supporting ETHICON Products. ETHICON Products provides more than just product to the customer ETHICON Products is about innovation in new products to advance patient care ETHICON Products is about partnering with the customer to manage inventory ETHICON Products is about support to the customers that use our products and trust in the QUALITY, CONSISTENCY and INNOVATION of our products

ETHICON Products: Value Above Price Over 300 sales reps hired and trained to service all hospital customers. Clinicians trained on new products / procedures. Suture utilization/standardization programs. (i.e., Inventory programs, returns, in-services) Key customer events (ie: symposiums, plant educational events, key customer visits). ETHICON Products delivers follow-up service beyond the product This comes in the form of a highly trained sales force that can act as sales consultants to the customer This comes in the training and education that ETHICON Products provides to the nurses, surgeons and other health care professionals This comes in the partnership with the hospital to manage inventory levels in order to keep costs down This comes in the multitude of healthcare initiatives and programs that ETHICON invests in every year such as symposiums, conventions, plant tours and key customer visits

Thank you for your attention! A- B Tech Comm College Thank you for your attention! Questions ? Kurt Prewitt Ethicon Products Clinical Representative 1-800-888-9234, x1562