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A wide variety of suture materials are available, all with variable handling characteristics, tissue reactivity, absorption characteristics, and costs. While much attention is paid to suture material, the needle may be as or more important than the suture material itself in promoting an ideal surgical outcome. Needles vary by manufacturer and even by suture material, and utilizing the most appropriate needle for the task is critical. Even the most accomplished surgeon will perform in a less-than-ideal fashion if their instruments or needle choices are flawed.

Most needles used for skin and soft tissue reconstruction are 3/8 circle in diameter, and most needles used for skin and soft tissue reconstructions are reverse cutting in nature (Figure 3-1). There are, however, important exceptions to this rule. For example, a semicircular P-2 needle may be used for narrow closures, such as those sometimes encountered on the nose, and a cutting needle, with the sharp edge on the inside of the curve, may be useful for nasal reconstruction where the thin atrophic dermis may be cut by the superficially coursing outside of the needle.

The two largest manufacturers of suture material used in cutaneous surgery are Ethicon and Covidien. While suture size is governed by USP guidelines (the larger the number of zeros, the smaller the suture), needle size and configuration is largely proprietary. Thus, the surgeon must be comfortable understanding the various needle sizes and configurations of the various manufacturers. Suture material packaging does include a cross-sectional image of the needle, permitting some comparison between companies. Of note, Covidien does not (except on its website) refer to any of its needles as reverse cutting; instead, they label cutting needles as conventional cutting and reverse cutting needles as cutting (Table 3-1). These distinctions are important when choosing suture, though many suture type and needle combinations are only available with a finite number of permutations. Since cutting and reverse cutting needles have a triangular tip, the orientation of the cutting end is indicated by whether the triangle on the box is pointing up (cutting) or down (reverse cutting).


The material used to make the needles themselves also varies considerably between manufacturers, as proprietary alloys are used to maximize strength and durability. While Ethicon and Covidien products are used most ...

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