CONFIDENTIAL A-B Tech Comm College Ethicon In-Service – Sutures / Dermabond Kurt Prewitt Ethicon...
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Transcript of CONFIDENTIAL A-B Tech Comm College Ethicon In-Service – Sutures / Dermabond Kurt Prewitt Ethicon...
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CONFIDENTIAL
A-B Tech Comm College Ethicon In-Service – Sutures / Dermabond
Kurt PrewittEthicon Products Clinical Representative
1-800-888-9234, x1562
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Agenda
• Ethicon
• Sutures– Absorbable and Non-Absorbable
– Needles
• New Innovations– Vicryl Plus
– Dermabond ProPen
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Definitions
• Suture– 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
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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
History of Suture Innovation
•Trademark
•Data on file, ETHICON, Inc.
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Critical Wound Healing Period
Skin
Mucosa
Subcutaneous
Peritoneum
Fascia
0 5 7 14 21 28 days
5-7 Days
5-7 Days
7-14 Days
7-14 Days
14-28 Days
Tissue Healing Times
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• Age
• Weight
• Nutrition
• Dehydration
• Blood Supply
• Immune response
• Chronic diseases
• Localized infection
• Diabetes
• History of Radiation Therapy
The Critical Wound Healing Period Can Depend on Various Factors
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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
Wound Epidermis
Dermis
Subcutaneous (Fat)
Fascia
Slow Healing
Fast Healing Epidermis
Dermis
Subcutaneous (Fat)
Fascia
Cutting NeedlesTaper
Needles
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Box clearly distinguishes the type of suture and needle information
• Code
• Suture size
• Product name
• Suture length
• Needle size
• Type of needle
• Quantity
ETHICON Products Box
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Suture Types
Absorbable Non-Absorbable
Natural SyntheticNatural Synthetic
Short-Medium -term
Medium -term
Longer -term
Monofilament Braided
Short -term
Monofilament Braided
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Suture Summary
• 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
Absorbable Non-Absorbable
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Suture Types
Absorbable
Natural Synthetic
Short-Medium -term
Medium -term
Longer -term
Short -term
Monofilament Braided Monofilament Braided
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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
Procedure Example: Episiotomy & Perineal Repair
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ETHICON Products Gut SutureAll 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.
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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
•Trademark
* Data on file, ETHICON, INC
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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
Procedure Example: Plastic Surgery
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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
•Trademark
•* Data on file, ETHICON, INC
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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 Procedure Example: General Closure
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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
•Trademark
Data on file, ETHICON, INC.
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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
Procedure Example: Body Contouring
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PDS II * Suture (polydioxanone) sutureSYNTHETIC 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
•Trademark
Data on file, ETHICON, INC.
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Suture Types
Non-Absorbable
SyntheticNatural
Monofilament BraidedMonofilament Braided
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PROLENE* (polypropylene) Suture
SYNTHETIC Minimal tissue reaction even in the presence of infection
MONOFILAMENT Smooth passage through delicate tissue
POLYPROPYLENE Will not fatigue with flexingProvides permanent wound supportUnique knotting properties
MANUFACTURING Highly controlled PROCESS Numerous quality checks
Controlled linear elongationConsistent suture, strand- to-strand
*Trademark
Data on file, ETHICON, INC.
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ETHIBOND EXCEL* (polyester) Suture
SYNTHETIC Minimal tissue reaction
BRAIDED 30% Stronger than leading competitor (size 2/0)Good handling & knotting15% stronger than ever beforeCentral core provides strong suture
POLYESTER Provides permanent wound support
POLYBUTILATE Smooth knot tie-down
COATING Excellent handling propertiesUnmatched polyester knot security
*Trademark
Data on file, ETHICON, INC.
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PERMA-HAND* Silk SutureBRAIDED Excellent handling and knotting
characteristics
WAX COATING Improved surface qualitiesReduces capillarity
INDICATIONS Used in a wide variety of surgical procedures
*Trademark
Data on file, ETHICON, INC.
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ETHILON* (nylon) sutureMONOFILAMENT Smooth, easy passage through tissue
NYLON Less tissue reactionProvides long term wound support
PLIABILIZED Ease of handling
OFFERING Less package memory
INDICATIONS Used in a wide variety of proceduresFine sizes specifically for use in
ophthalmic and microsurgery
*Trademark
Data on file, ETHICON, INC.
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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.
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Cotton and Steel
• Cotton– 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
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Advanced Needle Technology
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ETHICON Products Box
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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
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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
Provides the appropriate penetration performance for surgical indication and maximizes ease of handling during surgery
Focus on Needle Geometry
•Trademark
Data on file, ETHICON, INC..
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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
Geometry-What is Prime?
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Coating - What is MultiPass*?
Proprietary new needle coating
Provides superior needle penetration performance consistency
• Pass after Pass
• Needle to Needle
• Through 30 needle passes
1st pass is not improved 5th, 10th, 20th and 30th are!
•*Trademark
Data on file, ETHICON, INC.
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Needles Shapes
¼ Circle 3/8 Circle ½ Curve
½ Circle 5/8 Circle Straight
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Needles Types
Taper Point Needle
ETHIGUARD* Blunt Point Needle
Conventional Cutting
Reverse Cutting
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Paper Folder 1990
PROLENE* suture Packaging Innovation
• Needles held in place by suture• Needle separation
• Automated process (More Consistent Handling of needles & sutures)
• Enhanced needle separation
• One step opening (no paper tear tab)• Needles held in park• Circulating & scrub nurse verify needle count• Recyclable plastic tray
Door Relay 1992
Zipper Relay 2000
* Trademark
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New Innovations
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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
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CONTRIBUTING FACTORS
• OR
• Procedure
• Technique
• Patient
• Implants
• And others
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ROLE OF THE IMPLANT
• Three Key Factors
– Less Bacteria Required
– Microorganisms Can Colonize and Spread
– Biofilm Formation
• The Key - Preventing Bacteria Colonization
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VICRYL Plus Inhibits Bacterial ColonizationRenders the suture neutralPotentially eliminates it from the SSI Equation
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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
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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
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» 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
Topical Adhesives
•Trademark
Data on file, ETHICON, INC.
.
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» 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: Value Above Price
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A- B Tech Comm College
Thank you for your attention!
Questions ?
Kurt PrewittEthicon Products Clinical Representative
1-800-888-9234, x1562