Surgical Needles

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 Review

 Why do we need Surgical Needles?

 Ideally surgical needles should possess

what 3 characteristics?

 What are the 3 basic components of a

needle?
The anatomy of the ideal surgical needle is
made of 3 key factors
 Alloy

 Geometry

 Coating

 The combination of these 3 attributes is

ETHICON* Advanced Needle Technology

 ETHICON* is the only company to design and

manufacture their own needles
The various metal alloys used determines the basic
characteristics of the needle

– ETHICON* stainless steel alloy:

needles are heat treated to give them the maximum possible
strength and ductility.

– ETHALLOY* needle alloy:

exclusive patented alloy developed for unsurpassed strength in
precision needles. Used in CV, ophthalmic, plastic, and
microsurgical procedures. It is produced economically without
sacrificing ductility or corrosion resistance.
 Why is the strength of a surgical
needle so important?

 Tissue trauma can be induced if a needle bends during

penetration and compromises tissue apposition. Therefore,
greater needle strength equals potentially less tissue trauma

 A weak needle that bends or breaks (ductility) can compromise

the surgeon's control and damage surrounding tissue during the
procedure

 In addition, loss of control in needle placement could result in an

inadvertent needlestick
 Geometry
 Needle Point:
- the point extends from the extreme tip of the needle to
the maximum cross-section of the body
- each needle point is designed and produced to the
required degree of sharpness to smoothly penetrate
specific types of tissue

 Body:
- the body of the needle is the portion which is grasped
by the needleholder during the surgical procedure
- the body of the needle should be as close as possible
to the diameter of the suture material to minimize
bleeding and leakage
 Needle Coating

 Most ETHICON needles have a micro-thin coating comprised of

silicone or similar lubricants which significantly and
measurably improves ease of needle penetration

 This coating serves 2 important functions:

– It reduces the force needed to make the initial penetration

through tissue.

– It reduces the drag force on the needle body as it passes

repeatedly through tissue.
Anatomy of a surgical needle

Chord Length

Needle Point Cord

length zone where needle &
suture is armed

Needle radius
Diameter

Needle length
arc length
Why do we need so
many different
types of
surgical needles?
Needle organization
Needle Point Geometry
Taper Needles

 Oval or flattened body tapers

to a sharp point
Pierce and spread tissue
without cutting it
 Have a12:1 taper ratio
Used when the smallest
possible hole possible and
minimal tissue cutting is desired
 SH, CT, MO
 Tissues where Taper Needles are
routinely used
 Fascia/muscle connective tissue / strong
 Peritoneum membrane / elastic easy to penetrate
 Stomach membrane
 Bowel easy to tear /high microbial content
 Tendon / rectum dense
 Organs friable
– i.e. Liver/spleen
 Vessels can be dense due to calcification
 Galea difficult to penetrate
 Uterus / vaginal cuff dense/ difficult to penetrate
 The differences in Taper Needles are
defined by the diameter of the body
Examples

 Fine gauge are known SH = ½ circle 26mm Taper Point –

Ferguson type
as Ferguson Submucosa, Mucosa, Serosa, Fat

CT-1 = ½ circle 36mm Taper point -

 Medium gauge are known Morrison type
Vaginal wall, Fascia, Fat
as Morrison

MO – 4 = ½ circle 36.4mm Taper Point –

Mayo type
Transversalis fascia,Vaginal cuff & uterus
 Heavy Gauge are known
OS – orthopaedic surgery needles are
as Mayo also known as a Mayo type even though
they are a cutting needle
 “Plus” taper Series

 Flat round body needle

 Provides a surf effect
 Benefit: controlled, tissue layer
related, easy tissue penetration
 RB Plus, SH Plus Series

Additional Visi Black Option

 Benefit: no light reflection in
MIS procedures, Headlight
 JRB, JSH Series
Needle Point Geometry
Blunt Needles

Dissect friable tissue

rather than cutting it
 Taper body with a
rounded, blunt point that
will not cut through
tissue
BP, SHB, CTB , BT
Series
 Blunt Point Needles are often used by
surgeons for safety reasons

• Maybe used for suturing fascia, intestines, liver, kidneys,

spleen

• Used in obstetric and gynaecological procedures when

working in deep cavities which are prone to space and
visibility limitations

• Blunt point needles for general closure are especially

helpful when performing procedures on at-risk patients.
Needle Point Geometry
Taper Needles

 Combine the features of the

reverse cutting edge tip and
taper point needles
 Three cutting edges extend
approximately 1/32" back from
the point
 All three edges are sharpened
to provide uniform cutting action
 V and CC Series
 Tissues where Tapercut needles are used

• Initially designed for use in cardiovascular surgery on

sclerotic or calcified tissue
• Now widely used for suturing dense, fibrous connective
tissues eg; fascia, periosteum, and tendon where
separation of parallel connective tissue fibres could
occur with a conventional cutting
• Also referred to as a trocar point
• The point itself not to exceed the diameter of the suture
material
• The taper body portion provides smooth passage
through tissue and eliminates the danger of cutting into
the surrounding tissue.
Point Geometry
Cutting Needles

• Cutting needles have at least two

opposing cutting edges.
• Sharpened to cut through
tough, difficult-to-penetrate tissue.
• Ideal for skin sutures that must pass
through dense, irregular, and
relatively thick
connective dermal tissue
Reverse Cutting

In addition to the two

cutting edges, reverse
cutting needles have a third
cutting edge on the outside
convex curvature of the
needle.
The shape changes from
a triangular cutting blade to
that of a flattened body
 FS, CP, OS Series
 Tissues where Reverse Cutting needles are used

• These needles were created specifically for tough,

difficult-to penetrate tissue
skin
tendon sheath
oral mucosa
• Reverse cutting needles are used in orthopaedic
surgery, ophthalmic and cosmetic surgery where
minimal trauma, early regeneration of tissue, and little
scar formation are primary concerns
 Reverse Cutting Needles vs Conventional Cutting
Needles

• The reverse cutting needle is as sharp as the

conventional cutting needle

• Reverse cutting needles have more strength than

similar-sized conventional cutting needles

• The danger of tissue cutout is greatly reduced

• The hole left by the needle leaves a wide wall of tissue

against which the suture is to be tied
Conventional Cutting

Inaddition to the two cutting

edges, conventional cutting
needles have a third cutting
edge on the inside concave
curvature of the needle.
The shape changes from a
triangular cutting blade to that of
a flattened body
 CCS, LSS,
Tissues where Conventional Cutting Needles
are used

• Skin and Sternal closure

• Ideal for skin as they must pass through the
dense irregular and relatively thick dermis
• This needle type may be prone to cutout of tissue
because the inside cutting edge cuts toward the
edges of the incision or wound.
Prime Geometry

 Prime Geometry mass of

the cutting tip has been
removed to enhance
needle sharpness
The square body provides
additional stability in the
needle holder
 PC Prime, PS Prime, P
 Prime Geometry was designed
for Plastic / Cosmetic Surgery

• Designed specifically for aesthetic plastic surgery, and

has conventional cutting edges

• Where cosmetic results are important, the PC PRIME

needle is superior to any other for more delicate surgery,
especially facial surgery

• The narrow point, fine wire diameter, and fine taper ratio
allow superior penetration of soft tissue
Side Cutting Needles

 Flat on both the top

and bottom,
eliminating the
undesirable tissue
cut-out of other
cutting needles
 Designed for
ophthalmic
procedures
 Side Cutting Needles are specifically
designed for eye surgery

• Needle separates or splits through the thin layers of

scleral or comeal tissue and travel within the plane
between them
• The optimal width, shape, and precision sharpness of this
needle ensure maximum ease of penetration and gives
the surgeon greater control of the needle as it passes
between or through tissue layers.
• The position of the point varies with the design of each
specific type of spatulated needle.
Side Cutting Needles

The SABRELOC* spatula needle has

two cutting edges and a trapezoidal-
shaped body.
The SABRELOC* needle with the
cobra-shaped tip has four equidistant
defined edges.
The CS ULTIMA* ophthalmic needle
is the sharpest needle in its category
and is used for corneal scleral closure.
The smaller angles and increased
cutting-edge length result in superior
sharpness facilitating easy tissue
penetration.
 Needle Shapes
1/ Circle 3/ Circle 1/ Circle 5/ Circle
4 8 2 8

J Shape
Ski
Compound
Straight Curve
 Needle Shapes
1/4 circle: Eye, Microsurgery

3/8 circle: Skin

1/2circle: Pelvis, Peritoneum, Subcutaneous

Fat, GI-Tract, Muscel, Urogenital Tract,
Respiratory Tract

5/8 circle: Nasal & Oral Cavaty; CV System; Anal

Urogenital Tract
Needle Shapes

Coumpound Curved: Anterior Segment Eye

Surgery, CV Surgery, Oral Cavaty, GI Tract

J Shape: MIC Surgery

Ski: MIC Surgery, Skin, GI Tract

Straight: Skin closure of abdonimal wounds,

MIC Surgery, Tendon, Meniscal repair
 Suture to Needle Attachment

 EYED NEEDLES
Traumatic needle suture combination

Double suture strand

Threading time Eyed French /

Split Eye

Re-sterilisation
Stitch canal bleeding
Worse cosmetic result
Virtually all needles used today are swaged

 Swaging joins needle and suture together as a

continuous unit—one that is convenient to use
and minimizes trauma
 Channel needles
- mechanically drilled for standard
gauges up to 2/0
- suture strand is fixed by
compression of the needle end

 Laser Drilled
- for very fine gauges
up to 11/0
- suture becomes secured
by crimping the needle end
Use of a needle holder
 Needle ribs
 Stability in needle holder
 All ETHICON needles with a wire diameter
of 22 mil wire or heavier are ribbed as well
as flattened
 NEEDLE SALES TYPES AND THEIR MEANING
The following is a listing of general SALES TYPE designations
and their meaning

BB Blue Baby
BIF Binkhorst or Blunt Intraocular Fixation
BN Bunnell (Dr. Sterling Bunnell, Hand Surgeon)
BP Blunt Point
BV Blood Vessel
BVH Blood Vessel Half (circle)[1]
C Cardiovascular
CC Calcified Coronary
CCS Conventional Cutting Sternotomy
CE Cutting Edge
CFS Conventional for Skin
CIF Cutting Intraocular Fixation
CP Cutting Point
CPS Conventional Plastic Surgery
CPX Cutting Point Extra Large
CS Cornneal-Scleral[2]
CT Circle Taper
CTB Circle Taper Blunt
CTX Circle Taper Extra Large
CTXB Circle Taper Extra Large Blunt
CV Cardiovascular
DC Dura Closure
DP Double Point
EST Eyed Straight Taper
FN For Tonsil
FS For Skin (originally Facial Surgery)
FSL For Skin Large
FSLX For Skin Large Extra
G Greishaber
GS Greishaber Spatula
J Conjunctiva
KS Keith Straight
L-Shape L-Shape
LH Large Half (circle)
LR Large Retention
LS Large Sternotomy
M Muscle
MF Modified Ferguson
MH Medium Half (circle)
MO Mayo
OPS Ocular Plastic Surgery
OS Orthopaedic Surgery
P Plastic*
PC Precision Cosmetic
PS Plastic Surgery
RB Renal (artery) Bypass
RD Retinal Detachment
RH Round Half (circle)
RV Retinal-Vitreous
S Spatula (point)
SC Straight Cutting
SFS Spatulated for Skin
SH Small Half (circle)
SIF Ski Intraocular Fixation
SKS Sternotomy Keith Straight
SM Spatulated Muscle
ST Straight Taper
ST Straight Taper
STB Straight Blunt
STC Straight Cutting [1] Numbers which follow typically represent
STP Straight Taper Point diameter (microns) & chord length (mm).
STRAIGHT Straight [2] Numbers which follow typically represent
TE Three Eighths curvature (degrees) & diameter (mils) chord
TF Tetralogy of Fallot length (mm).
TG Transverse Ground2 2 Numbers which follow typically represent
TGW Transverse Ground Wide2 diameter (microns) & chord length (mm).
TP Taper Pericostal or Taper Point 2 Numbers which follow typically represent
TS Tendon Straight curvature (degrees) & diameter (mils) chord
UCL 5/8 Circle Colateral Ligament3 length (mm).
UR Urology 3 “U” is the symbol for “5/8 Circle”
URB Urology Blunt
V (used for TAPERCUT Surgical Needles)1
VAS Vas Deferens1
X or P Exodontal (Dental)
XLH Extra Large Half (circle)
XXLH Extra Extra Large Half (circle)