Wednesday, October 21, 2015

Atraumatic Suture Needles

This is a scan of a flashcard that I created for myself as a whippersnapperrn. It has held up well over the years, just a bit of yellowing and the tape is starting to deteriorate.  Whenever I wanted to learn something quickly, I made flash cards. Suture needle flashcards had the added incentive to master  names quickly because of the hazard of being stuck with one of the needles when grabbing the card out of your pocket. I know from personal experience that the  Straight Milliner intestinal needle really inflicts a painful and embarrassingly bloody wound. Traumatic needles indeed. Take my word for it, you do not want to see the flash card I made for the different scalpel blades!  It still has a split thickness sample of skin on the #11 blade from the back of my hand. I really learned those blade numbers in  lickety-split  fashion.

After learning the different suture needle names it was time to learn how to thread them. Surgeons could be a persnickety lot and it took considerable time to learn the correct length to cut the suture and position the needle in a  driver at the preferred angle. Suture always came in 48 inch lengths and I could cut it down to either 12 inch or 16 inch lengths in the blink of an eye. Needles and suture material were always packaged separately.

French needles were really easy to thread, just pull the thread through the open back of the needle. Presto! You did it. There is nothing more satisfying than to feel that suture material snap into a French needle for that quick hand-off to a waiting surgeon. It was definitely more fun than threading a needle with a standard eye.

Just when I when I completely mastered handling suture needles, a new product was introduced at our hospital, atraumatic needles. When I first heard this term (atraumatic needle) I thought it was some kind of practical joke. In my experience suture needles were not a major source of trauma in surgery. Trauma came from aggressive retraction where tissues were stretched out like  candy at a taffy pull. How about hacking away at tissue as if you were attempting to open one of those clear plastic clamshell containers? Hey, That's a gall bladder, not a high end HDMI cable! How about using a chisel or curette on an actual living tissue? Now that is trauma and has nothing to do with suture needles. Pulling an extra strand of suture material through tissue, no matter how friable, is really small potatoes compared with other events occurring in the OR.

Atraumatic needles had the end of the suture attached or swadged  directly to the needle. This eliminated the drag from the suture attachment site and extra strand of suture being pulled through  the tissue. A noble accomplishment, but not up to all the hype and ballyhoo that came with their introduction. If you really want to go for the Nobel Prize, think about inventing an atraumatic Balfour Retractor or an atraumatic rib spreader.  Atraumatic needles and  their accompanying  hype were akin to an elephant giving birth to a flea.

Look Ma, No Eyes!

Swage sounds like one of those made up words that pharmaceutical companies developed  to give their product some panache. It does sound more sophisticated than calling them suture needles without eyes or other visible means of  attachment.

There were two methods of swaging suture to a needle. Drill swaging involved boring a hole into the end of the needle, shoving the suture material into the hole and crimping the end of the needle. Channel swaging involved casting the needle with a valley-like depression at the end and positioning suture in the channel and crimping. Channel swaged needles were few and far between and I saved a couple of them. Dexon a new-fangled absorbable suture came channel swaged.

All this atraumatic  foolishness has inspired another great idea. I am off to the  Oldfoolrn  product development institute to work on an atraumatic pillow. Stay tuned!


  1. I made myself a few flashcards in my time, too! I'm glad I'm not the only one!

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