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Making Ends Meet

Thu, 02/15/2007 - 7:35am
Among the most basic and important skills a surgeon has is the ability to close a wound, whether it be caused by accident or during surgery. This has been the case since the dawn of surgery as a profession. Once the work has been done and the patient treated, the closure of the surgical site can be almost as critical to the patient’s outcome as the success of the surgery itself. After all, even with the stunning advancements in antisepsis and barrier protection, the skin is still the human being’s greatest protection against infection.

Of course, in this day and age, the structural integrity of the wound closure is not the only concern, especially in the eyes of the patient. The cosmetic results of whatever wound closure technique is employed are also very important. Fortunately, wound closure technology has been advancing throughout the years, providing surgeons with a broad arsenal of tools and techniques that can help them safely and effectively approximate the wound edges and close them with little scarring.

Incisive Surgical’s INSORB® Subcuticular Skin Stapler is a sterile, single patient use
device that is pre-loaded
with 20 absorbable
staples.
While suturing, once the standard wound closure technique across the board, is still utilized extensively, there are a number of new devices and technologies that allow surgeons to customize their approach to each wound closure application. From adhesives to staples, there are a number of innovative medical devices being developed that provide effective wound closure with excellent cosmetic results, thus benefiting both the surgeon and the patient.

One innovative device for skin closure is the INSORB® Subcuticular Skin Stapler developed by Incisive Surgical, Inc. This sterile, single patient use device is designed to close incisions that are six centimeters or longer in length for a broad range of surgical procedures. The device utilizes absorbable staples is made of PLA/PGA and is pre-loaded with 20 staples, sufficient to close an incision up to 17 cm in length.

In this respect, the INSORB Stapler represents an innovative new skin closure modality designed to combine the cosmesis of absorbable sutures with the rapid closure times associated with metal skin staplers, while eliminating the cost, pain and inconvenience of metal staple removal post-operatively. It also eliminates the percutaneous insult and provides a secure, everted closure.

The INSORB Stapler can also be used with Incisive Surgical’s INSORB|1 Forceps, which allows a single clinician to close the wound. The preferential spring tension on the forceps allows the clinician to pick up the dermis on one side of the incision and then the other side with one hand and introduce the stapler with the other hand.

The 3M™ Steri-Strip™ S Surgical Skin Closure is a wound closure device designed to treat incisions painlessly.
Another wound closure product supplier is 3M™, offering a variety of adhesive skin closures and surgical skin closures, as well as skin staplers and removers. Their full line of Steri-Strip™ Adhesive Skin Closures makes wound closure fast and simple while reducing the risk of infection. Plus, the non-invasive technique reduces tissue trauma and improves patient comfort. The Precise™ Disposable Skin Stapler product line is convenient, easy to use and provides high quality performance, versatility and reliability, while the Precise™ Disposable Skin Staple Remover easily removes staples in the same direction they were implanted, making removal simple with little pain.

Perhaps the most innovative of 3M’s skin closure products is the Steri-Strip™ S Surgical Skin Closure, a non-invasive, adhesive-based wound closure device designed to treat low-tension lacerations and surgical incisions painlessly and without the use of needles. It is constructed of soft polyurethane pads and interlaced polyester filaments to provide a strong, secure skin closure on wounds of almost any length. The device’s unique, interlaced design makes it easy to align and secure wound edges without any additional anesthetic and provides quick skin closures with good cosmetic results. The Steri-Strip S Surgical Skin Closures are available in widths from 10 mm to 100 mm and they can be combined to achieve the length needed or to close a curved wound.

A leader in surgical technology, Ethicon Endo-Surgery offers several skin stapling options, each designed with unique features to meet the ergonomic and access needs of surgeons. The Proximate® RH Skin Stapler features a 360-degree rotating head, a clear cartridge, and a tapered instrument design for visibility and access. It is designed with a pistol grip handle and smooth firing strokes to provide a comfortable fit, accurate staple placement and one-handed firing. The staples in the device are a strong rectangular shape, allowing them to resist opening and to provide high quality cosmetic results.

Ethicon Endo-Surgery skin staplers are easy to use and have been integrated into a wide range of surgical procedures.
Ethicon Endo-Surgery also offers the Proximate® PX Skin Stapler which features a pistol grip design for a comfortable fit and a positive ratchet mechanism for easy staple placement. The Proximate® MD Skin Stapler offers a kick-off spring design for a multi-directional release and an ergonomic design for small hands. It also features an alignment indicator for improved visibility.

All of Ethicon Endo-Surgery’s skin staplers are easy to use and have been integrated into a wide range of surgical procedures. They fire small thin staples directly into the skin without the use of a needle and provide good cosmetic results for the patient. In additions, each of the devices utilizes staples that are coated with a lubricant to enable easy staple extraction.

The Syneture division of US Surgical, a Tyco Healthcare Company, offers a comprehensive line of sutures and needles that can be used in a broad range of wound closure, open and MIS procedures across all surgical specialties. Syneture offers an extensive variety of sutures and needle technologies for cardiovascular procedures, including the enhanced SURGIPRO™ II suture for greater consistency. It provides reduced tissue drag and fraying while tying and delivers improved durability and handling, smooth tissue passage and enhanced knot run-down.

The enhanced SURGIPRO™ II suture from Syneture provides reduced tissue drag and fraying while tying.

In addition to an extensive line of Monofilament Synthetic Absorbable and Braided Synthetic Absorbable Sutures including the CAPROSYN™, BIOSYN™ and POLYSORB™ product lines as well as others, Syneture also offers its innovative needle technology. The PROTECT-POINT™ Blunt Taper and Blunt Point Suture Needles for soft tissue procedures can help prevent accidental needlesticks during surgery. The needles are designed to reduce tissue penetration force in tough tissue like muscle and fascia while still providing superior glove penetration protection, which can help reduce the risk of injury and infection.

For topical skin closure, Syneture markets INDERMIL® Tissue Adhesive, which offers fast, effective wound closure with less trauma and excellent cosmesis comparable to sutures. It is approved as a microbial barrier as long as the film remains intact and its single application reduces OR time and increases efficiency.

To improve safety, Syneture provides education and training to ensure the surgical staff is educated on the proper use and handling of all new technology or devices brought into the OR or Surgi-Center. They also offer a number of accredited programs to educate health care clinicians on the Scientific Basis of Wound Closure and CEU courses for nurses and clinicians on the benefits of using PROTECT-POINT Blunt Taper and Blunt Point Needles. National training and educational programs are also offered to Residents and Fellows to introduce or enhance their knowledge of wound closure and minimally invasive procedures. US Surgical’s Autosuture division also offers a number of solutions for wound closure including surgical staplers for internal wound closure and skin staplers. One such product, the ENDO GIA™ Universal stapler recently received clearance in the U.S. for liver resection. All ENDO GIA, as well as MULTIFIRE GIA™, staplers have a new knife blade with each single use loading unit. The knife blade is protected to minimize risk of injury.

The ENDO GIA™ Universal Stapler from US Surgical’s Autosuture Division.

Autosuture offers SUDs (single use devices) for optimal function and quality right out of the sterile package. While most of their products are intuitive and therefore easily integrated into procedures, training on the proper handling and use of devices can be provided through Auto-suture’s CSS, Certified Surgical Specialist.

As one can see, there is quite a broad range of device and technology choices available for surgical wound closure. And with device development continuing to advance, there stand to be many more choices on the horizon.

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