Sutures/staples: threatened, but still holding on

(Since the thrust of our analysis in medtech is toward advanced, emerging technologies that represent areas of growth and opportunity, our coverage of well established markets is typically limited to characterizing such markets as those that are often likely to be penetrated, and ultimately replaced, by new technologies.  In this context, we have through our ongoing coverage and multiple published reports covered advanced areas of wound closure and management — sealants, glues, hemostats, etc. — which are both competitive with and complementary to the traditional markets for sutures and staples.  See below from our Report #S180, "Worldwide Surgical Sealants, Glues, Wound Closure and Anti-Adhesion, 2009-2019.")

 

The vast majority of sutures, staples and endostaples are used following procedures involving acute surgical wounds. Typically, chronic wounds do not involve use of suture and staple products unless some degree of surgical intervention is employed to remove necrotic tissue or to create a new acute wound bed to aid healing.

Sutures comprise two component parts, the needle and the suture, and these can be found in a wide range of sizes and types, made of a range of materials, and the method of attachment of the suture to the needle can involve a variety of methods. Sutures are divided into braided and monofilament categories. Braided sutures are typically more pliable than monofilament and exhibit better knot security. Monofilament sutures are more wirey and may require a more secure knot. Their major advantage is that they cause less tissue drag, a characteristic that is especially important in cardiovascular, ophthalmic and neurological surgery. Over the last few years, some companies have developed devices (such as Abbott Vascular’s Perclose, ProGlide and Prostar suture-mediated devices) that can complete the suturing process and tie the finishing knot quickly.

Stapler devices can be seen as an evolution of suture technology. The goal of stapler products is to avoid infection, remove some of the difficulty of skillful suturing, and make total procedures quicker and easier. Staples are made of stainless steel and biomaterials and are used to join internal tissues, reconstruct or seal off organs, remove diseased tissue, occlude blood vessels, and close skin incisions. They are primarily used during surgery as internal and/or external closure devices.

Staples are available in an assortment of sizes and features; procedure-specific stapler devices have been developed to take staple clips for use in one specific procedure or for multiple uses.

Internal staplers are used to approximate internal tissues and organs. The devices may be reusable or disposable. Some disposable staplers may be reloaded several times during the course of a single patient surgical procedure and then discarded.

The most recent internal staplers are used to perform minimally invasive surgical procedures that allow the surgeon to endoscopically secure internal wounds instead of having to operate through an open procedure. Staples can be made to dissolve, and this obviates the need for removal; these staples are ideally suited to laparoscopic surgery and delivered via procedure-specific laparoscopic instruments. However, most staples are still made of stainless steel and when used for internal stapling procedures, whether open or laparoscopic, are not removed after healing. Skin staples are removed after the incision is healed.

Perhaps the major benefit of staples is that they can be applied more rapidly than sutures and can be placed precisely without requiring the skill necessary for sutures. This also means increased safety for the patient, and patients can often be discharged more rapidly as a result of stapling procedures.

While cosmetically acceptable results are usually obtained, staplers normally are not used in highly visible areas such as the face. Here surgeons will still close by hand to minimize any scarring. In many procedures, sutures have begun to be replaced by cyanoacrylate glues, but the ideal alternative to suturing has not yet been developed; for example, cyanoacrylate glues used for external skin closure are only one-fifth as strong as sutures.

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