WOUND CLOSURE PRODUCTS

Transcription

1 WOUND CLOSURE PRODUCTS Desktop Reference Guide

2 PRODUCTS Absorbable Sutures Braided Synthetic Absorbable Sutures 8 Polysorb Suture 10 Velosorb Fast Suture Monofilament Synthetic Absorbable Sutures 12 Caprosyn Suture 14 Biosyn Suture 16 Maxon Suture Non-Absorbable Sutures 20 Surgipro /Surgipro II Suture 22 Ti-Cron Suture 24 Vascufil Suture 26 Steel Suture 28 Flexon Suture 30 Novafil Suture 32 Monosof /Dermalon Suture 34 Surgidac Suture 36 Surgilon Suture 38 Sofsilk Suture V-Loc Suturing Devices 44 V-Loc 90 Device 46 V-Loc 180 Device 50 V-Loc PBT Device PROCEDURES CV Procedures 54 Coronary Artery Bypass Graft 58 Valve Replacement PV Procedures 62 Abdominal Aortic Aneurism (AAA) Procedure 64 Femoral-Popliteal Bypass OB/GYN 68 Episiorrhaphy 69 C-Section Plastics 70 Breast Reconstruction 71 Abdominoplasty 72 Sleeve Gastrectomy 73 Laparoscopic Hysterectomy Ortho 74 Total Knee 75 Total Hip 76 Common V-Loc Device Usage NEEDLES 82 Charts FREQUENTLY ASKED QUESTIONS 96 FAQ/Objection Handling

3 KEY PRODUCTS

4 ABSORBABLE SUTURES

5 Polysorb Fast Suture Polysorb Fast Suture Polysorb suture has been your trusted brand for more than 20 years with a history of improvements and performance. Features and Benefits Stronger than Vicryl * during the critical wound healing period Average Knot Pull Strength (size 1 to 3-0) 27 Out of Package Polysorb suture is from 27 to 58% stronger than Vicryl * After 1 week of implantation After 2 week of implantation Polysorb suture is 15 to 35% stronger than Vicryl * Polysorb suture is comparable to 32% stronger than Vicryl * Polysorb is triclosan free. Frequent Uses Ligation Ophthalmic Soft tissue approximation Polysorb Suture Top Codes Note: N=30 per material, size (USP) and data point. GL69MG Polysorb suture UD V-20 DT CL13MG Polysorb suture UD GS-21DT CL14MG Polysorb suture 0 18 UNDYED GS-21 DT SL5627 Polysorb suture UNDYED P-12 GLS322 Polysorb suture UNDYED V-20 Product Polysorb Suture 28 Vicryl * /Vicryl * PLUS 29 Structure Braided Braided Suture Type Mid-Term Absorbable Mid-Term Absorbable Composition Coating 93% Polyglicolic acid and 7% Polylactic acid Glycolide, Caprolactone and Calcium Stearoyl Lactylate 90% Polyglicolic acid 10% Polylactic acid Vicryl * : Caprolactone; Vicryl * PLUS: Caprolactone and Triclosan Color Violet, Undyed Violet, Undyed Tensile Strength 80%: 2 weeks; 30% 3 weeks. % of USP 75%: 2 weeks; 50%: 3 weeks; 25%: 4 weeks % of initial strength Absorption Profile days days Sizes 8-0 to to 3 Indications Contraindications Polysorb sutures are indicated for use in soft tissue approximation or ligation and ophthalmic surgery, but not in cardiovascular or neural tissue. Polysorb sutures, being absorbable, should not be used where extended approximation of tissue is required. Coated Vicryl * suture is indicated for use in general soft tissue approximation and/or ligation, including use in ophthalmic procedures, but not for use in cardiovascular and neurological tissues. This suture, being absorbable, should not be used where extended approximation of tissue is required. Coated Vicryl * Plus antibacterial suture should not be used in patients with known allergic reactions to Igracare * MP (triclosan) Box Quantities 1, 2 or 3 dozen 1, 2 or 3 dozen 8 9

6 Velosorb Fast Suture Velosorb Fast Suture Velosorb Fast braided absorbable suture for use in soft tissue approximation of the skin and mucosa, when only 7 to10 days of wound support is required. Features and Benefits Pliable handling and easy knot tying during closure2 Strong when 7 to 10 days of wound support is needed A fast absorption profile with no need for suture removal Original strength essentially gone by day 14 A variety of needles to meet surgeons needs Convenient because patients won t have to get sutures removed Ease of use ensured Strength throughout critical wound healing period Material is not present long term Frequent Uses OB/GYN Dental/oral Soft tissue approximation Velosorb Fast SutureTop Codes CV917 Velosorb suture 2-0 UD 36 KV-34 SV425 Velosorb suture 3-0 UD 30 P-12 SV426 Velosorb suture 4-0 UD 30 P-12 SV2298 Velosorb suture 3-0 UD 30 C-13 SV935 Velosorb suture 3-0 UD 30 P-14 Product Velosorb Fast Suture 30 Vicryl * Rapide 31 Structure Braided Braided Suture Type Short-Term Absorbable Absorbable Composition 90% Glycolide and 10% Lactide (derived from glycolic and lactic acids) Coating Glycolide, Lactide Copolymer and Calcium Stearate 90% Polyglicolic acid and 10% Polylactic acid Caprolactone Color Violet, Undyed Violet, Undyed Tensile Strength 45%: 5 days; All of the original tensile strength is gone by 14 days. Absorption Profile days 42 days Sizes 6-0 to to 1 Indications Contraindications Velosorb suture is indicated for use in soft tissue approximation of the skin and mucosa, where only 7 to 10 days of wound support is required. Not for use in ligation, ophthalmic, cardiovascular or neurological procedures. Velosorb sutures, being absorbable, should not be used where extended approximation of tissue beyond 7 days is required. 50%: 5 days; 0%: 14 days Vicryl * Rapide is intended for use in soft tissue approximation where only short-term wound support is required and where the rapid absorption of the suture would be beneficial. Due to its absorption profile, Vicryl * Rapide is useful for skin closure, particularly in pediatric surgery, episiotomies, circumcision and closure of oral mucosa. Vicryl * Rapide is also successfully used in ophthalmic surgery for conjunctiva sutures. Due to the rapid loss of tensile strength, Vicryl * Rapide should not be used where extended approximation of tissue under stress is required or where wound support or ligation beyond 7 days is required. Vicryl * Rapide is not for use in cardiovascular and neurological tissues. Box Quantities 1 or 3 dozen 10 11

7 Caprosyn Suture Caprosyn Suture Caprosyn suture has been your trusted brand for more than 10 years with a proven history of performance. Features and Benefits Short-term tensile strength is accompanied by rapid absorption. Frequent Uses Soft tissue approximation Ligation Most plastic, gynecology and urology procedures Caprosyn Suture Top Codes SC5617G Caprosyn suture UD P-12 SC5637G Caprosyn suture UD P-12 SC5689G Caprosyn suture UD P-13 SC5690G Caprosyn suture UD P-13 GC122 Caprosyn suture UD V-20 Product Caprosyn Suture 32 Structure Suture Type Composition Coating Color Tensile Strength Absorption Profile Monofilament Short-Term Absorbable POLYGLYTONE 6211 Glycolide, Caprolactone, Trimethylene Carbonate, and Lactide Uncoated Violet, Undyed 5 days: 50%-60% USP; 10 days: 20%-30% USP; 21 days: All strength lost 56 days Sizes 6-0 to 1 Indications Caprosyn synthetic absorbable suture is indicated for use in general soft tissue approximation and/ or ligation, but not for use in cardiovascular or neurological surgery, microsurgery, or ophthalmic surgery. Contraindications Box Quantities This suture, being absorbable, should not be used where extended approximation of tissue is required. 1, 2 or 3 dozen 12 13

8 Biosyn Suture Biosyn Suture Biosyn suture has been your trusted brand for more than 15 years with a proven history of performance. Features and Benefits Provides mid-term tensile strength with the benefit of 1 additional week of wound support Ideal for most plastic surgery procedures when 3 weeks of tensile strength and good cosmesis are desirable Frequent Uses Soft tissue approximation Ligation Plastic GI anastomosis General closure Gynecology Biosyn Suture Top Codes SM5627 Biosyn UD P-12 SM5637 Biosyn UD P-12 SM5638 Biosyn UD P-12 SM5628 Biosyn UD P-12 SM5687 Biosyn UD P-13 Product Biosyn Suture 33 Monocryl * and Monocryl * Plus 34 Structure Monofilament Monofilament Suture Type Mid-Term Absorbable Synthetic Absorbable Composition Synthetic polyester composed of Glycolide, Trimethylene Carbonate and Dioxanone Poliglecaprone Coating Uncoated Uncoated Color Violet, Undyed Tensile Strength 2 weeks: 75% USP; 3 weeks: 40% USP 1 week: 50%-60% USP; 2 weeks: 20%-30% USP Absorption Profile days days Sizes 6-0 to to 1 Indications Contraindications Biosyn synthetic absorbable suture is indicated for use in general soft tissue approximation and/ or ligation including use in ophthalmic surgery, but not for use in cardiovascular or neurological surgery. This suture, being absorbable, should not be used where extended approximation of tissue is required. Monocryl * and Monocryl * Plus suture is indicated for use in general soft tissue approximation and/ or ligation, but not for use in cardiovalcular or neurological tissues, microsurgery or ophthalmic surgery. This suture, being absorbable, should not be used where extended approximation of tissue under stress is required. Monocryl * Plus antibacterial suture should not be used in patients with known allergic reactions to Igracare * MP (triclosan). Box Quantities 1, 2 or 3 dozen 1 or 3 dozen 14 15

9 Maxon Suture Maxon Suture Maxon suture has been your trusted brand for more than 25 years with a history of improvements and performance. Features and Benefits 35 Offers superior tensile strength out of package and throughout the critical stages of healing, when strength is most important Ideal for fascial closure when 6 weeks of tensile strength is desirable Frequent Uses Soft tissue approximation Ligation Fascial closure GI anastomosis General closure Plastic Orthopedics General surgery Maxon Suture Top Codes Maxon suture GRN 3-0 1X30 CE-6/C Maxon suture GRN 3-0 1X30 T-5/V-20 GMM344L Maxon suture GRN 240CM 1X12 LP GS Maxon suture GRN 2-0 1X30 CE-6/C Maxon suture GREEN 2-0 1X30 T-5/V-20 Product Maxon Suture 36 PDS * and PDS * II Plus 37 Structure Monofilament Monofilament Suture Type Long-Term Absorbable Synthetic Absorbable Composition Polyglyconate Copolymer of Glycolic Acid and Trimethylene Carbonate Polydioxanone Coating Uncoated Uncoated Color Green, Clear Violet, Clear Tensile Strength 2 weeks: 70%USP; 4 weeks: 50%USP; 6 weeks: 25%USP Absorption Profile 180 days 180 days Sizes 7-0 to to 2 Indications Contraindications Maxon and Maxon CV suture is indicated for use as absorbable suture in general soft tissue approximation and/or ligation, including use in pediatric cardiovascular tissue, where growth is expected to occur, and in peripheral vascular tissue. Maxon and Maxon CV suture is not indicated for use in adult cardiovascular tissue, ophthalmic surgery, microsurgery and neural tissue. The use of this suture is contraindicated in patients with known sensitivities or allergies to its components. This suture, being absorbable, should not be used where extended approximation of tissue is required or for fixation of permanent cardiovascular prostheses or synthetic grafts. 2 weeks: 70% USP; 4 weeks: 50% USP; 6 weeks: 25% USP PDS * and PDS * II Plus suture is indicated for soft tissue approximation, including use in pediatric cardiovascular tissue where growth is expected to occur and ophthalmic surgery. PDS * II Plus is not indicated in adult cardiovascular tissue, microsurgery and neural tissue. This suture is particularly useful where the combination of an absorbable suture and extended wound support (up to 6 weeks) is desirable. PDS * II suture, being absorbable, is not to be used where prolonged (beyond 6 weeks) approximation of tissue under stress is required and is not to be used in conjunction with prosthetic devices (i.e., heart valves or synthetic grafts). PDS * Plus advanced antibacterial suture should not be used in patients with known allergic reactions to Igracare * MP (triclosan). Box Quantities 1, 2 or 3 dozen 1,2 or 3 dozen 16 17

10 NON- ABSORBABLE SUTURES

11 Surgipro Suture Surgipro II Suture Surgipro Suture Surgipro II Suture Surgipro / Surgipro II suture is a brand you have trusted for many years with several product innovations. Timeline 1991 Surgipro suture launched 1994 Surgalloy premium needle alloy introduced 1996 Lubricant added to help minimize suture breakage Surgipro II suture launched with improved handling characteristics 2. NuCoat coating added to improve needle with multipass penetration Surgipro II suture resin enhanced to improve knot run down characteristics 2. NuPack designed to reduce memory in suture Frequent Uses Soft tissue approximation Ophthalmic Cardiovascular Neural tissue Product Surgipro Suture 2 Surgipro II Suture 2 Prolene * Suture 3 Structure Monofilament Monofilament Suture Type Non-Absorbable Non-Absorbable Composition Polypropylene Polypropylene Coating Uncoated Uncoated Color Blue, Clear Blue, Clear Tensile Strength Permanent Permanent Absorption Profile Permanent Permanent Sizes Sizes 10-0, 6-0, 2-0 through 2 (Surgipro suture) and sizes 8-0 to 3-0 (Surgipro II suture) Indications Surgipro and Surgipro II polypropylene suture is indicated for use in general soft tissue approximation and/or ligation, including use in cardiovascular, ophthalmic and neural tissue through 2 Prolene polypropylene suture is indicated for use in general soft tissue approximating and/or ligation, including use in cardiovascular, ophthalmic and neurological procedures. Contraindications None known None known Box Quantities 1, 2 or 3 dozen 1, 2 or 3 dozen Surgipro II Suture Top Codes VP709X Surgipro II suture BL CV-1D/A VP557X Surgipro II suture BL CV-23 DA VP703X Surgipro II suture BL CV-1D/A SP5698G Surgipro II suture BL P-13 VP702X Surgipro II suture BL CV-1D/A 20 21

12 Ti-Cron Suture Ti-Cron Suture Ti-Cron suture has been your trusted brand for more than 20 years with a proven history of performance Features and Benefits 4 Soft and supple Silicone (impregnated) coating designed for handling and pliability Knot security Pledgets Available as firm and soft pledgets rectangular and oval in different sizes: Rectangular 3 mm by 3 mm 3 mm by 5 mm 3 mm by 7 mm 4.8 mm by 9.5 mm Frequent Uses Oval Soft tissue approximation Ophthalmic Cardiovascular Neurological surgery 3 mm by 6 mm 4.5 mm by 6 mm Product Ti-Cron Suture 5 Ethibond * Excel 6 Structure Braided Braided Suture Type Non-Absorbable Non-Absorbable Composition Polyester Polyester Coating Silicone Polybutylate Color Blue, White Green, Undyed (white) Tensile Strength Permanent Permanent Absorption Profile Permanent Permanent Sizes 7-0 through through 2, 5 Indications Contraindications Box Quantities Ti-Cron polyester suture is indicated for use in general soft tissue approximation and/or ligation, including use in cardiovascular, ophthalmic and neurological surgery. None known. 1/2, 1, 2 or 3 dozen Ti-Cron Suture Top Codes Ethibond * Excel suture is indicated for use in general soft tissue approximation and/ or ligation, including use in cardiovascular, ophthalmic and neurological procedures Ti-Cron suture W-B 10X30 CV DA 7F Ti-Cron suture WB 8X30 Y DA 7F Ti-Cron suture 5 BLUE 30 C-20-HOS Ti-Cron suture W-B 10X30 CV D/A Ti-Cron suture W-B 8X30 Y DA 3F 22 23

13 Vascufil Suture Vascufil Suture Suture selection can be critical for a CABG procedure. Vascufil suture is made of polybutester designed to minimize premature suture breakage. The crosslinking molecular structure of polybutester helps maintain structural integrity of the suture designed for less fraying and breaking of the strand. Polybutester is a fray-resistant material with a unique feel and performance that meets the demands of CV and PV surgery. 7-9,58 Features and Benefits 10,11 Polybutester provides a 20% larger luminal opening. The unique handling characteristics of polybutester include less memory, softness, suppleness and elasticity. The elastic properties of polybutester are designed to provide greater knot security and tighter and smaller knots. The unique handling characteristics of polytribolate coating are designed to provide smooth knot run down, facilitate parachute technique and reduce tissue drag. Frequent Uses Cardiovascular Ophthalmic Soft tissue approximation Product Vascufil Suture 9 Pronova *12 Structure Monofilament Monofilament Suture Type Non-Absorbable Non-Absorbable Composition Polybutester Hexafluoropropylene- VDF Coating Polytribolate Color Blue Blue Tensile Strength Permanent Permanent Absorption Profile Permanent Permanent Sizes 7-0 to through 2-0 Indications Contraindications Vascufil polybutester suture is indicated for use in general soft tissue approximation and/or ligation, including use in cardiovascular and ophthalmic surgery, but not in microsurgery and neural tissue. The use of this suture is contraindicated in patients with known sensitivities or allergies to its components. Box Quantities 1 or 3 dozen Vascufil Suture Top Codes Pronova * suture is indicated for use in general soft tissue approximation and/ or ligation, including use in cardiovascular, ophthalmic and neurological procedures V Vascufil suture 7-0 2X24 BL MV DA V Vascufil suture BL D/A CV V Vascufil suture 7-0 4X24 BL MV DA V Vascufil suture BL D/A CV V Vascufil suture BL D/A CV

14 Steel Suture Steel Suture Steel sutures are composed of 316L stainless steel conforming to ASTM Standard F138 Grade 2 stainless steel bar and wire for surgical implants. Steel sutures meet all requirements established by the United States Pharmacopeia (USP) and for nonabsorbable surgical sutures. Steel sutures are for use in abdominal wound closure, intestinal anastomosis, hernia repair and sternal closure. Product Steel Suture 25 Structure Monofilament Suture Type Non-Absorbable Composition Stainless Steel Coating Uncoated Color Steel Tensile Strength Permanent Absorption Profile Permanent Sizes 2-0 to 7 Features and Benefits Roto-Grip s (available on some monofilament steel) are designed to reduce kinking. Frequent Uses Soft tissue approximation Ophthalmic Cardiovascular Neurological surgery Indications Contraindications Box Quantities Steel sutures are indicated for use in abdominal wound closure, intestinal anastomosis, hernia repair and sternal closure. The use of this suture is contraindicated in patients with known sensitivities or allergies to steel and/or its principal metallic components, chromium and nickel. Additionally, the presence of steel may interfere with certain radiodiagnostics and its use is contraindicated where radiotransparency of suture material is required. 1 or 3 dozen Steel Suture Top Codes S-Steel suture Mono 6 4X18 CV320 SCC S-Steel suture Mono 7 4X18 CV320 SCC Steel suture 6 18 KV S-Steel suture Mono 6 6X18 CV320 SCC Steel suture 5 18 BGS-29 Competitive product is Stainless Steel * 26 27

15 Flexon Flexon Flexon suture is a temporary cardiac pacing lead with a stainless steel twisted, multistrand wire coated with orange or white PTFE poly (tetrafluoroproethylene) or clear FEP poly (tetrafluoroethylene-cohexafluoropropylene). Features and Benefits PTFE poly or FEP poly coating on the wire provides insulation and ease of removal Breakaway cutting needles (after chest wall penetration) eliminates requirement to cut needle. Product Flexon Suture 26 Structure Multifilament Suture Type Non-Absorbable Composition Stainless Steel Coating FEP Polymer, or PTFE Polymer Color Clear, Orange, White Tensile Strength Permanent Absorption Profile Permanent Sizes 3-0 to 0 Frequent Uses Temporary atrial and ventricular pacing and sensing during and after cardiac surgery Indications Contraindications Box Quantities Flexon suture temporary cardiac pacing lead is indicated for use in temporary atrial and ventricular pacing and sensing during and after cardiac surgery. 1. When permanent pacing or monitoring is required, the use of Flexon suture temporary cardiac pacing lead is contraindicated. 2. The use of this product is contraindicated in patients with known sensitivities or allergies to its components. 3. The particular medical condition and anatomy of the patient may dictate the lead system and implantation procedure to be used. 1, 2 or 3 dozen Flexon Suture Top Codes Flexon suture OR-WH SC-6V-20 D/A Flexon suture OR SC-6 V-20 D/A Flexon suture 0 24 CL SC-2 V-20 D/A Flexon suture WH SC-6 V-20 D/A Flexon suture 0 24 CL SC-6 V-20 D/A 28 29

16 Novafil Suture Novafil Suture Novafil suture has been your trusted brand for more than 30 years with a proven history of performance. Features and Benefits 13 Minimal memory Pliability (easy to handle, easy to tie) Elastic (stretchy suture) Hydrophobic suture Accommodates for edema Creep resistant Frequent Uses Soft tissue approximation Ophthalmic Product Novafil Suture 14 Structure Suture Type Composition Coating Color Tensile Strength Absorption Profile Monofilament Non-Absorbable Polybutester Uncoated Blue and clear Permanent Permanent Sizes 7-0 to 2 Indications Novafil polybutester sutures are indicated for use in general soft tissue approximation and/or ligation, including use in cardiovascular and ophthalmic surgery, but not in microsurgery and neural tissue. Contraindications Box Quantities The use of this suture is contraindicated in patients with known sensitivities or allergies to its components. 1 or 3 dozen Novafil Suture Top Codes SPB5633G Novafil suture BL P-12 SPB5223G Novafil suture BL P-13 SPB1213G Novafil suture BL P Novafil suture BL 1X T19-GS-22 SPB1233G Novafil suture BL P

17 Monosof /Dermalon Suture Monosof /Dermalon Suture Monosof /Dermalon suture has been your trusted brand for more than 50 years with a proven history of performance. Features and Benefits Pliability (easy to handle and tie) Strength Frequent Uses Soft tissue approximation Ophthalmic Cardiovascular Neurological surgery Monosof Suture Top Codes SN5667 Monosof suture 4-0 BLACK 18 P-12 SN5698G Monosof suture 5-0 BLACK 18 P-13 SN5669 Monosof suture 3-0 BLACK 18 P-12 SN5663 Monosof suture 3-0 BLACK 18 P-14 SN5667G Monosof suture 4-0 BLACK 18 P-12 Dermalon Suture Top Codes Dermalon suture BL CE-6 - C Dermalon suture BL C Dermalon suture BL C Dermalon suture BL CE-6 - C Dermalon suture BL P-13 Product Monosof /Dermalon Suture 15 Ethilon * Suture 16 Structure Monofilament Monofilament Suture Type Non-Absorbable Non-Absorbable Composition Nylon Nylon Coating Color Uncoated Black, Clear (Monosof suture) Blue (Dermalon suture) Black, Green, Clear Tensile Strength Gradual loss over time Gradual loss over time Absorption Profile Sizes Indications Contraindications Permanent 2 through 11-0 (Monosof suture) 1 through 6-0 (Dermalon suture) Monosof and dermalon monofilament nylon suture is indicated for use in general soft tissue approximation and/ or ligation, including use in cardiovascular, ophthalmic, and neurological surgery. Due to the gradual loss of tensile strength which may occur over prolonged periods in vivo, nylon sutures should not be used where permanent retention of tensile strength is required through 2-0 Ethilon * suture is indicated for use in general soft tissue approximation and/ or ligation, including use in cardiovascular, ophthalmic, and neurological procedures. Due to the gradual loss of tensile strength which may occur over prolonged periods in vivo, nylon suture should not be used where permanent retention of tensile strength is required. Box Quantities 1, 2 or 3 dozen 1, 2 or 3 dozen 32 33

18 Surgidac Suture Surgidac Suture Surgidac suture has been your trusted brand for more than 20 years with a proven history of performance. Features and Benefits Uniform braided structure is designed to provide resistance to breaking. Cutting-edge spatula needles are designed for anterior segment surgery in ophthalmology. Spatula needles separate or split through the thin lamellar plane of corneal and scleral tissue. Frequent Uses Soft tissue approximation Ophthalmic Cardiovascular Neurological surgery Surgidac Suture Top Codes D1764K Surgidac suture WH SS-24 D/AUNC D1683K Surgidac suture WH SS-28 SS-28 D1779K Surgidac suture WH SS-2 SS-2 D1760K Surgidac suture WH SS-14 D/A D1780K Surgidac suture WH SS-2 SS-2 Product Surgidac Suture 17 Mersilene * Suture 18 Structure Braided Braided and Monofilament Suture Type Non-Absorbable Non-Absorbable Composition Polyester Polyester Coating Uncoated Color White, Green Green, Clear (undyed) Tensile Strength Permanent Implantation studies in animals show no meaningful decline in polyester suture strength over time. Absorption Profile Permanent Sizes 6-0 to and 10-0, 6-0 through 5 Indications Surgidac polyester suture is indicated for use in general soft tissue approximation and/ or ligation, including use in cardiovascular, ophthalmic and neurological surgery. Mersilene * polyester fiber suture is indicated for use in general soft tissue approximation and/or ligation, including use in cardiovascular, ophthalmic and neurological procedures. Contraindications None known None known Box Quantities 1, 2 or 3 dozen 1, 2 or 3 dozen 34 35

19 Surgilon Suture Surgilon Suture Surgilon braided suture is inert, nonabsorbable, sterile suture composed of the long-chain aliphatic polymers Nylon 6 and Nylon 6.6. The braided sutures are coated uniformly with silicone to enhance handling characteristics. Surgilon sutures are also non-absorbable nylon surgical sutures available dyed black or undyed (white). Features and Benefits Uniform braided structure is designed to provide resistance to breaking Easy to handle Knot security Frequent Uses Ophthalmic Neurological surgery Soft tissue approximation Surgilon Suture Top Codes Surgilon suture 4-0 BK 5X18 CV-22 DT Surgilon suture 0 BLK 5X18 T-12GS-21 DT Surgilon suture 0 BLK 5X18 T-19GS-22 DT Surgilon suture 4-0 BLK 5X18 CV-23 DT Surgilon suture 2-0 BLK 5X30 T-5-V-20 Product Surgilon Suture 21 Nurolon * Suture 22 Structure Braided Braided Suture Type Non-Absorbable Non-Absorbable Composition Nylon Nylon Coating Silicone Color Black, White Black Tensile Strength Gradual loss over time Gradual loss over time Absorption Profile Permanent Sizes 6-0 to through 1 Indications Contraindications Surgilon braided nylon suture is indicated for use in general soft tissue approximation and/ or ligation, including use in cardiovascular, ophthalmic, and neurological surgery. Due to the gradual loss of tensile strength which may occur over prolonged periods in vivo, nylon sutures should not be used where permanent retention of tensile strength is required. Nurolon * suture is indicated for use in general soft tissue approximating and/ or ligation, including use in cardiovascular, ophthalmic procedures, and neurological procedures. Due to the gradual loss of tensile strength which may occur over prolonged periods in vivo, nylon suture should not be used where permanent retention of tensile strength is required. Box Quantities 1, 2 or 3 dozen 1, 2 or 3 dozen 36 37

20 Sofsilk Suture Sofsilk Suture Sofsilk silk suture is non absorbable,sterile, non-mutagenic surgical suture composed of natural proteinaceous silk fibers called fibroin. This protein is derived from the domesticated silkworm species Bombyx mori of the family bombycidae. The silk fibers are treated to remove the naturally occurring sericin gum and braided to produce Sofsilk silk sutures. The braided sutures are available coated uniformly with either silicone or a special wax mixture. Frequent Uses Soft tissue approximation Ophthalmic Cardiovascular Neurological surgery Product Sofsilk Suture 23 Perma-Hand Silk *24 Structure Braided Braided Suture Type Non-Absorbable Non-Absorbable Composition Silk Silk Color Black, White Black, Undyed Tensile Strength Gradual loss over time Gradual loss over time Absorption Profile Permanent Permanent Sizes 8-0 to through 2, 5 Indications Contraindications Sofsilk suture is indicated for use in general soft tissue approximation and/ or ligation, including use in cardiovascular, ophthalmic, microsurgery, and neurological surgery. The use of this suture is contraindicated in patients with known sensitivities or allergies to silk. Due to the gradual loss of tensile strength which may occur over prolonged periods in vivo, Sofsilk sutures should not be used where permanent retention of tensile strength is required. Perma-Hand * Silk suture is indicated for use in general soft tissue approximating and/or ligation, including use in cardiovascular, ophthalmic, and neurological procedures. Due to the gradual loss of tensile strength which may occur over prolonged periods in vivo, nylon suture should not be used where permanent retention of tensile strength is required. Box Quantities 1, 2 or 3 dozen 1, 2 or 3 dozen Sofsilk Suture Top Codes GS63M Sofsilk suture BLACK V-20 DT GS62M Sofsilk suture 2-0 5X18 BLACK V-20 DT GS833 Sofsilk suture BLACK V-20108Q SS685 Sofsilk suture BLACK C-15 02E GS66M Sofsilk suture BLACK V-20 DT 38 39

21 V-LOC WOUND CLOSURE DEVICES

22 V-Loc Wound Closure Device The V-Loc wound closure device is a revolutionary product that lets surgeons close wounds without tying knots. The V-Loc device is backed by over 7 years of clinical experience and is supported by Oxford Level 1 evidence. 38 It is sold in over 40 countries, with over 10 million strands put into the hands of surgeons. Features and Benefits Closes dermal incisions up to 50% faster without compromising strength or security. 39,40 Has 20 unidirectional barbs per centimeter that precisely grasp the tissue at numerous points, providing even distribution of tension both along and across the wound. 41 Each strand has circumferential barbs to anchor tissue at numerous points. Potentially reduces knot-related complications by limiting the knot mass in the wound. Composition V-Loc Glycolide, dioxanone and trimethylene carbonate V-Loc Copolymer of glycolic acid and trimethylene carbonate Tensile Strength 7 days, 90% 14 days, 75% 7 days, 80% 14 days, 75% 21 days, 65% Absorption Profile 7 days, 90% 14 days, 75% Color Clear Violet 180 days Clear Green Frequent Uses Plastic: abdominoplasty, breast reconstruction, breast augmentation Gynecology Urology Mohs: skin cancer removal General/bariatric V-Loc Polybutester Permanent Permanent Blue PBT

23 V-Loc Wound Closure Device V-Loc Wound Closure Device V-Loc 90 wound closure device is a unidirectional short-term, absorbable, knotless barbed suture. V-Loc 90 Device Top Codes Product V-Loc 90 Device 42 Stratafix * Spiral PGA-PCL 45 Structure Unidirectional barbed monofilament Unidirectional or bi-directional barbed monofilament Suture Type Short-Term Absorbable Short-Term Absorbable Composition Synthetic polyester composed of glycolide, dioxanone and trimethylene carbonate Color Violet, Clear Clear Tensile Strength 7 days, 90% 14 days, 75% Absorption Profile VLOCM0345 V-Loc 90 device 2-0 VL 9 GS-21 VLOCM0024 V-Loc 90 device 3-0 CL 18 P-12 VLOCM0023 V-Loc 90 device 4-0 CL 18 P-12 VLOCM0804 V-Loc 90 device 3-0 VL 6 CV-23 VLOCM2145 V-Loc 90 device 2-0 VL 9 GS-22 Copolymer of glycolide and e-caprolactone 7 days, 62%; 14 days, 27% days days Sizes 4-0, 3-0, , 3-0, 2-0 Product V-Loc 90 Device42 Stratafix * Spiral PGA-PCL 45 Indications Contraindications V-Loc 90 absorbable wound closure devices are indicated for soft tissue approximation where use of an absorbable suture is appropriate. The use of the V-Loc 90 absorbable wound closure device is contraindicated in patients with known sensitivities or allergies to its components. The V-Loc 90 absorbable wound closure device is not for use where prolonged (beyond 2 weeks) approximation of tissues under stress is required or for fixation of permanent cardiovascular prostheses or synthetic grafts. V-Loc 90 absorbable wound closure device should not be used for interrupted suture patterns. V-Loc 90 absorbable wound closure device is not intended to be used by tying surgical knots. V-Loc 90 absorbable wound closure device should not be used for ligating vessels or luminal structures. Stratafix * Spiral PGA-PCL is indicated for use in soft tissue approximation where the use of absorbable sutures are appropriate. Stratafix * Spiral PGA- PCL device is not to be used where extended approximation of tissue under stress is required and is not to be used in conjunction with or for fixation of prosthetic devices (e.g. heart valves or synthetic grafts) that are non-absorbable in nature. Box Quantities 1 dozen 1 dozen 44 45

24 V-Loc 180 Wound Closure Device V-Loc 180 Wound Closure Device V-Loc 180 wound closure device is a unidirectional long-term, absorbable, knotless barbed suture. V-Loc 180 Device Top Codes Product V-Loc 180 Device 43 Stratafix * Spiral PDO 46 Structure Unidirectional barbed monofilament Unidirectional or bidirectional barbed monofilament Suture Type Long-Term Absorbable Long-Term Absorbable Composition VLOCL0316 V-Loc 180 device 0 GR 12 GS-21 VLOCL0804 V-Loc 180 device 3-0 GR 6 CV-23 VLOCL0315 V-Loc 180 device 2-0 GR 12 GS-21 VLOCL0024 V-Loc 180 device 3-0 CL 18 P-12 VLOCL0124 V-Loc 180 device 3-0 CL 18 P-14 Polyglyconate Copolymer of glycolic acid and trimethylene carbonate Color Green, Clear Violet Tensile Strength 7 days, 80% 14 days, 75% 21 days, 65% Dyed (violet) polyester, poly (p-dioxanone) 3-0 and larger days, 80%; 42 days, 40-70% days, 67%; 28 days, 50% 42 days, 37% Product V-Loc 180 Device 43 Stratafix * Spiral PDO 46 Indications V-Loc 180 absorbable wound closure devices are indicated for soft tissue approximation where use of an absorbable suture is appropriate. Contraindications The use of the V-Loc 180 absorbable wound closure device is contraindicated in patients with known sensitivities or allergies to its components. The V-Loc 180 absorbable wound closure device is not for use where prolonged (beyond 3 weeks) approximation of tissues under stress is required or for fixation of permanent cardiovascular prostheses or synthetic grafts. V-Loc 180 absorbable wound closure device should not be used for interrupted suture patterns. V-Loc 180 absorbable wound closure device is not intended to be used by tying surgical knots. V-Loc 180 absorbable wound closure device should not be used for ligating vessels or luminal structures. Box Quantities 1 dozen 1 dozen Stratafix * Spiral PDO device is indicated for use in soft tissue approximation where use of absorbable sutures is appropriate. Stratafix * Spiral PDO device is not to be used where prolonged (beyond 6 weeks) approximation of tissue under stress is required and is not to be used in conjunction with or for fixation of prosthetic devices (e.g. heart valves or synthetic grafts) that are non-absorbable in nature. Absorption Profile 180 days days Sizes 4-0, 3-0, 2-0, 0 5-0, 4-0, 3-0, 2-0, 0,

25 V-Loc 180 Wound Closure Device V-Loc 180 Wound Closure Device Product V-Loc 180 Device 43 Stratafix * Symmetric PDS * Plus 47 Product V-Loc 180 Device 43 Stratafix * Symmetric PDS * Plus 47 Structure Unidirectional barbed monofilament Unidirectional barbed Suture Type Long-Term Absorbable Long-Term Absorbable with anti-bacterial barrier Composition Polyglyconate Copolymer of glycolic acid and trimethylene carbonate Color Green, Clear Violet Tensile Strength 7 days, 80%; 14 days, 75%; 21 days, 65% Dyed (violet) polyester, poly (p-dioxanone) 14 days, 75%; 28 days, 65%; 42 days, 55% Absorption Profile 180 days days Sizes 4-0, 3-0, 2-0, 0 3-0, 2-0, 0, 1 Indications V-Loc 180 absorbable wound closure devices are indicated for soft tissue approximation where use of an absorbable suture is appropriate. Contraindications The use of the V-Loc 180 absorbable wound closure device is contraindicated in patients with known sensitivities or allergies to its components. The V-Loc 180 absorbable wound closure device is not for use where prolonged (beyond 3 weeks) approximation of tissues under stress is required or for fixation of permanent cardiovascular prostheses or synthetic grafts. V-Loc 180 absorbable wound closure device should not be used for interrupted suture patterns. V-Loc 180 absorbable wound closure device is not intended to be used by tying surgical knots. V-Loc 180 absorbable wound closure device should not be used for ligating vessels or luminal structures. Stratafix * Symmetric PDO Plus devices are indicated for general soft tissue approximation where use of absorbable sutures is appropriate. Stratafix * Symmetric PDS * Plus device, being absorbable, is not to be used where prolonged (beyond 6 weeks) approximation of tissue under stress is required and is not to be used in conjunction with prosthetic devices (i.e., heart valves or synthetic grafts). Stratafix * Symmetric PDS * Plus device should not be used in patients with known allergic reactions to Irgacare * MP (triclosan). Box Quantities 1 dozen 1 dozen 48 49

26 V-Loc PBT Wound Closure Device V-Loc PBT Wound Closure Device V-Loc PBT wound closure device is a unidirectional permanent knotless barbed suture. V-Loc PBT Device Top Codes Product V-Loc PBT Device 43 Stratafix * Spiral Polypropylene 48 Structure Unidirectional barbed monofilament Unidirectional or bidirectional barbed monofilament Suture Type Permanent Permanent Composition VLOCN0644 V-Loc device NON ABS 3-0 BL 9 V-20 VLOCN0327 V-Loc device NON ABS 1 BL 18 GS-21 VLOCN0615 V-Loc device NON ABS 2-0 BL 12 V-20 VLOCN0326 V-Loc device NON ABS 0 BL 18 GS-21 VLOCN0604 V-Loc device NON ABS 3-0 BL 6 V-20 Copolymer of butylene terephthalate and polytetramethylene ether glycol Polypropylene Color Blue Blue, Clear Product V-Loc PBT Device 44 Stratafix * Spiral 48 Indications Contraindications V-Loc PBT nonabsorbable wound closure devices are indicated for soft tissue approximation. The use of the V-Loc PBT nonabsorbable wound closure device is contraindicated in patients with known sensitivities or allergies to its components. V-Loc PBT nonabsorbable wound closure device should not be used for interrupted suture patterns. V-Loc PBT nonabsorbable wound closure device is not intended to be used by tying surgical knots. V-Loc PBT nonabsorbable wound closure device should not be used for ligating vessels or luminal structures. Box Quantities 1 dozen 1 dozen Stratafix * Spiral polypropylene device is indicated for use in soft tissue approximation, excluding closure of the epidermis. Stratafix * Spiral polypropylene device is not indicated for surface closures through the epidermis, as the small opposing facing barbs make Stratafix * Spiral polypropylene device removal unfeasible. Tensile Strength Permanent Permanent Absorption Profile Permanent Permanent Sizes 3-0, 2-0, 0, 1 0,

27 KEY PROCEDURES

28 Coronary Artery Bypass Graft Procedure Coronary Artery Bypass Graft Procedure Step One: Harvesting Graft Saphenous vein is harvested The Saphenous Vein, Internal Mammary Artery are the two most common bypass grafts used for the CABG procedure. The Saphenous Vein is harvested from the leg and LIMA is diverted from the chest wall to the coronary artery beyond the blockage. INDICATIONS: Polysorb sutures are indicated for use in soft tissue approximation or ligation and ophthalmic surgery, but not in cardiovascular or neural tissue. Suture Brand: SofSilk Suture Size: 4-0 Step Three: Cardio-Pulmonary Bypass Sternotomy: Bone Hemostasis Accessory: Bone Wax (BW-25G) Pericardium is retracted, heart is cannulated and patient is placed on a heart-lung bypass machine. Cardioplegia is introduced so that the heart can be safely stopped. Saphenectomy Transfix Ligature Skin Closure Deep Dermal Layer Skin Closure Subcuticular/ Epidermis Suture Brand Polysorb Ti-Cron Sofsilk Suture Size Type 3-0, 4-0 Pre-cuts or reel Tip Curvature Polysorb 2-0 V-20 Caprosyn Biosyn V-Loc 90 Novafil 3-0, 4-0 Step Two: Median Sternotomy P-12 P-14 Premium Reverse Cutting Surgeons make 8-10 inch incision and retractor is used to hold the chest open. Saphenectomy Pericardium Retraction Bypass Cannulation Cardioplegia Cannulation Coronary Artery Exposure Closure of Right Atrium and Aortotomy Suture Brand Suture Size Type Tip Curvature Sofsilk 2-0 V-20 Ti-Cron 2-0 CV-305 Surgipro II Vascufil Surgipro II Vascufil Surgipro II Vascufil CV-331 Y-5 Y-31 Penetrating Taper Penetrating Taper 4-0 CV-15 (d/a) 5-0 CV , 4-0 KV-11 (d/a) Penetrating Taper V-20 (d/a) Saphenectomy Suture Brand Suture Size Type Tip Curvature Transfix Ligature Polysorb Ti-Cron Sofsilk 3-0, 4-0 Pre-cuts or reel Skin Closure Deep Dermal Layer Polysorb 2-0 V

29 Coronary Artery Bypass Graft Procedure Coronary Artery Bypass Graft Procedure Step Four: Graft Anastomosis Grafts are sewn into the coronary arteries to bypass the blockage. Proximal and distal anastomoses are made with the graft material. Graft Anastomosis Proximal Anastomosis Distal Anastomosis (Saphenous Vein) Suture Brand Surgipro II Vascufil Surgipro II Vascufil Distal Surgipro II Anastomosis Vascufil (Internal Mammary Artery) Suture Size 5-0, , , 8-0 Type CV-11 CV-22 CV-23 CV-20 CVL-11 CV-15 (d/a) CV-1 CV-351 MV-175-8/MVF MV MV (d/a) MV (d/a) MV (d/a) MV CV-1 (d/a) Tip Curvature CardioCurve Chest Closure Temporary Pacing Leads Pericardial Closure (Optional) Sternum Closure Skin Closure Fascia Skin Closure Subcuticular/ Epidermis Suture Brand Suture Size Flexon 0, 2-0, 3-0 Type Surgipro II 2-0, 3-0 V-20 Tip V-20/SC-6 / SC-2/V-20 Cutting Cutting/Taper VF-20 Steel 5, 6, 7 SCC SCC-1 KV-40 Polysorb 2-0 V-20 GS-21 Caprosyn Biosyn V-Loc 90 Novafil 3-0, 4-0 P-12 P-14 Point Conventional Cutting Conventional Cutting Penetrating Taper Premium Reverse Cutting Curvature / straight Straight/ 1/2 circle Drain Fixation Sofsilk 2-0 GS-11 Reverse Cutting In the CABG procedure, proximal and distal anastomoses of the graft material typically takes minutes per anastomosis. Topical Skin Adhesive (sterile barrier) V-Loc (Subcuticular Closure) Step Five: Chest Closure Clamps on the aorta are removed, tubes are disconnected and blood flow to heart is restored. Chest tubes are inserted to drain fluid and temporary pacing wires are placed. The skin layers are closed. Fascia Polysorb 2-0 Chest Closure Sternum - Steel 5, 6, 7 Temporary pacing wires Flexon 0, 2-0, 3-0 Temporary Pacing Wires 56 57

30 Valve Replacement Procedure Valve Replacement Procedure Step One: Median Sternotomy Pericardium Surgeons make 8-10 inch incision and retractor is used to hold the chest open. Top Bone Hemostasis Code: Bone Wax (BW-25G) Step Three: Aortic Valve Replacement An opening is made and traction sutures are placed. The aortic valve leaflets are then excised. A mechanical or biological valve is placed, using sutures (alternate colors Blue and White Ti-Cron 2-0). The alternating combination of blue and white sutures helps in keeping the order correct. The mechanical or biological valve is glided down and secured with sutures. Once the new valve is placed, the opening in the aorta is closed. Aortic Valve Replacement Suture Brand Suture Size Type Tip Curvature Step Two: Valve Replacement Pericardium is retracted, heart is cannulated and patient is placed on a heart-lung bypass machine. Cardioplegia is introduced so that the heart can be safely stopped. Valve Replacement Pericardium Retraction Bypass Cannulation Median Sternotomy Suture Brand Suture Size Type Tip Curvature Sofsilk 2-0 V-20 Ti-Cron 2-0 CV-305 CV-331 Y-5 Y-31 Penetrating Taper Penetrating Taper Traction Sutures on Aortotomy Aortic Valve Closure of Aortotomy Closure of Right Atrium and Aortotomy (Cannulation) Surgipro II 5-0, 4-0 V-20 Ti-Cron with or without soft/ firm pledgets 2-0 CV-331 Y-31 CV-23 CV-24 KV-5 Surgipro II 5-0, 4-0 CV-15 CV-23 KV-15 Penetrating Taper Penetrating Taper Penetrating Taper Surgipro II 3-0, 4-0 V-20 Cardioplegia Cannulation Surgipro II 4-0 CV-15 (d/a) Cardioplegia Surgipro II 3-0, 4-0 Pulmonary valve Aortic valve Pulmonary valve Mechanical or biological valve SofSilk 2-0 TiCron 2-0 SofSilk Surgipro II 3-0, 4-0 Mitral valve Aortic Valve Replacement Tricuspid valve Mitral valve Tricuspid valve Aortic Valve Replaced with Mechanical Valve Retracted Pericardium Cardio-Pulminary Bypass 58 59

31 Valve Replacement Procedure Valve Replacement Procedure Mitral Valve Replacement Step Four: Mitral Valve Replacement An opening is made and traction sutures are placed. The aortic valve leaflets are then excised. A mechanical or biological valve is placed, using sutures (alternate colors Blue and White Ti-Cron 2-0). The alternate combination of blue and white sutures helps in keeping the order correct. The mechanical or biological valve is glided down and secured with sutures. Once the new valve is placed, the opening in the aorta is closed. Suture Brand Suture Size Type Tip Curvature Chest Closure Temporary Pacing Leads Step Five: Chest Closure Clamps on the aorta are removed, tubes are disconnected and blood flow to heart is restored. Chest tubes are inserted to drain fluid and temporary pacing wires are placed. The skin layers are closed. Suture Brand Suture Size Flexon suture 0, 2-0, 3-0 Type V-20/SC-6 SC-2/V-20 Tip / cutting Cutting/taper point Curvature / straight Straight/1/2 circle Mitral Valve Closure of Left Atrium Closure of Right Atrium and Aortotomy (Cannulation) Ti-Cron suture with or without soft/firm pledgets 0, 2-0, 3-0 CV-305 Y-5 KV-7 KV-26 V-20 Penetrating taper Penetrating taper Penetrating taper Surgipro II suture 4-0 V-20 d/a Surgipro II suture 3-0, 4-0 V-20 d/a Pericardial Closure (Optional) Sternum Closure Skin Closure Fascia Skin Closure Subcuticular/ Epidermis Surgipro II suture 2-0, 3-0 V-20 VF-20 Steel suture 5, 6, 7 SCC SCC-1 KV-40 Polysorb suture 2-0 V-20 GS-21 Caprosyn suture Biosyn suture V-Loc 90 device Novafil suture 3-0, 4-0 P-12 P-14 Conventional cutting Conventional cutting Penetrating taper Premium reverse cutting Mechanical or biological valve Pulmonary valve Aortic valve Tricuspid valve Mitral valve replacement Drain Fixation Sofsilk suture 2-0 GS-11 Reverse cutting Topical Skin Adhesive (sterile barrier) V-Loc device (Subcuticular Closure) Fascia Polysorb suture 2-0 Sternum - Steel 5, 6, 7 Pulmonary valve Aortic valve Tricuspid valve Mechanical or biological valve Chest closure Mitral valve replaced with mechanical valve Temporary pacing wires Flexon suture 0, 2-0, 3-0 Temporary pacing wires 60 61

32 Abdominal Aortic Aneurysm Procedure Abdominal Aortic Aneurysm Procedure Step One A midline vertical incision is made in the abdomen. The intestines are pulled out to expose the aneurysm site. Arteries above and below are clamped to stop blood flow. Distal Anastomosis (Saphenous Vein) Surgipro II suture Ti-Cron suture 4-0 CV-23/ CVF-23 CV-15/ CVF-15 KV-5 KV-15 CV-24 CV-25 CV-13 KV-7 V-20 CV-331 Y-31 YE-7 CV-316 CV-305 Penetrating taper Penetrating taper Penetrating taper Penetrating taper Penetrating taper Step Two Next, the surgeon makes a series of incisions on the artery wall to access the damaged area and may choose to remove clots and suture damaged blood vessels. A graft tube is inserted into the aorta to provide support. Step Three Graft anastomoses are performed at both ends and the aorta is closed on top of the graft. Then, the clamps are removed, and blood flow is restored and monitored. The surgeon checks for blood leaks around the aorta, and uses sutures and topical skin adhesive to close the skin, respectively. Closure Suture Brand Suture Size Type Tip Curvature Posterior Fascia Polysorb suture Surgipro II suture Maxon (looped) suture 1 GS-25 GS-24 Graft Anastomosis Proximal Anastomosis Suture Brand Surgipro II suture Ti-Cron suture Suture Size 2-0, 3-0 Type CV-25 CV-13 KV-7 V-20/ VF-20 V-26 V-30 CV-331 Y-31 KV-5 YE-7 CV-316 Y-16 CV-305 V-20 Y-5 KV-7 KV-26 CV-300 Tip Penetrating taper Penetrating taper Penetrating taper Penetrating taper Penetrating taper Penetrating taper Penetrating taper Penetrating taper Curvature Anterior Fascia Skin Closure Deep Dermal Layers Skin Closure Subcuticular/ Epidermis Polysorb suture Surgipro II suture Maxon (looped) suture 0 GS-25 GS-24 Polysorb suture 2-0 V-20 Caprosyn suture Biosyn suture V-Loc 90 device Novafil suture 3-0, 4-0 P-12 P-14 Premium reverse cutting Opened aorta Removal of blood clot Graft tube inserted 62 63

33 Femoral-Popliteal Bypass Procedure Femoral-Popliteal Bypass Procedure Step One First, the femoral and popliteal arteries are exposed by making an incisionthrough the skin, subcuticular and fascia layers. The saphenous vein is then harvested. Ligation Suture Brand Suture Size Type Tip Curvature Step Two Tubing or silk sutures are passed around the femoral and popliteal arteries for proper exposure. When a good lumen has been demonstrated, the graft is sewn into place to bypass the diseased section of the artery. Proximal and distal anastomoses are then performed. Transfix Ligature Polysorb suture Ti-Cron suture Softsilk suture CV-23 CV-25 (d/a) Ligation Softsilk 4-0 V-20 d/a Graft Anastomosis Proximal Anastomosis Suture Brand Suture Size Surgipro II suture Type CV-23 CV-15 KV-15 KV-5 CV-24 CV-25 CV-13 KV-7 V-20 (d/a) Tip Penetrating taper Penetrating taper Penetrating taper Curvature Popliteal artery exposed Femoral artery exposed Distal Anastomosis (Saphenous Vein) Surgipro II suture CV-11 CV-22 CV-23 CV-20 CV-15 KV-1 KV-5 KV-15 CV-1 KV-1 CV-337 (d/a) Penetrating taper Penetrating taper Penetrating taper Penetrating taper Tubing around femoral artery Tubing around popliteal artery Saphenous vein harvested Proximal and distal anastomosis 64 65

34 Femoral-Popliteal Bypass Procedure Step Three After good blood flow and pulse have been reestablished, the surgeon uses sutures and topical skin adhesive to close the skin, respectively. Closure Suture Brand Suture Size Type Tip Curvature Posterior Fascia Polysorb suture Surgipro II suture Maxon (looped) suture 0 GS-25 GS-24 Anterior Fascia Polysorb suture Surgipro II suture Maxon (looped) suture 2-0 GS-25 GS-24 Skin Closure Deep Dermal Layers Polysorb suture 2-0 V-20 Skin Closure Subcuticular/ Epidermis Caprosyn suture Biosyn suture V-Loc 90 device Novafil suture 3-0, 4-0 P-12 P-14 Premium reverse cutting EpidermisTopical Skin Adhesive (sterile barrier) Subcuticular Layer V-Loc 90 OBSTETRICS/ GYNECOLOGY Deep Dermal Polysorb Anterior Fascia Polysorb Muscle Posterior Fascia Polysorb 66 67

35 Episiorrhaphy C-Section Tissue Layer Surgical repair (suturing) of a lacerated vulva or of an episiotomy Technique Traditional Method Suturing in different layers Vaginal wall Perineal muscles Skin Technique Suture Material USP Size Type Delivery of the fetus through an abdominal incision and hysterotomy A surgical incision through the abdominal wall and the uterus, performed to deliver a fetus Two classifications classical or low cervical Classical refers to delivery of an infant through a vertical incision in the corpus of the uterus (greater blood loss/increased risk of uterine rupture with subsequent pregnancy) Low cervical-transverse incision in the lower, noncontractile portion of the uterus Muscles Interrupted Polysorb or Biosyn suture / taper-cutting Mucosa Continuous Velosorb Fast suture / taper-cutting Skin Continuous subcuticular Velosorb Fast or Caprosyn suture Reverse cutting (P) Tissue Layer Technique Suture Material USP Size Type Uterus Continuous/ interrupted Maxon suture Polysorb suture Fascia Continuous Maxon suture Novafil suture Subcuticular and Dermal Continuous Biosyn suture Caprosyn suture Velosorb suture Reverse cutting (P) 68 69

36 Breast Reconstruction Abdominoplasty Step One Place deep adaption sutures to approximate the subcutaneous breast tissue; multiple interrupted 2-0 Maxon suture stitches. Then use the V-Loc device for the subcutaneous and subcuticular closures. The starting point of the V-Loc device subcutaneous layer is the outer angle of the submammary incision. Step Two Complete the subcutaneous wound closure the length of the horizontal incision. From the opposite incision angle, begin the subcuticular closure with the V-Loc device. Once the horizontal incision is completed, begin closing the vertical incision running the V-Loc device toward the areola. Step One Rectus plication: Take 1 bite with the V-Loc device on either side of the wound and advance needle through the anchor loop. Begin to run the suture the length of the incision as for a traditional suture. Once at the end of the incision, take 1 to 2 backbites toward the beginning of the incision and then advance the needle under the suture line perpendicular to the incision. Step Two Deep dermal closure: Interrupted stitches could be used to approximate the incision; these stitches can remain or be removed after using the V-Loc device as desired by the surgeon. Begin the closure by taking a backward, split-thickness bite through the deep dermal layer. Exit the needle directly opposite the looped end. Pull so that the looped end is drawn into the dermal layer. Take a single, forward split-thickness bite away from the vertex on the contralateral edge of the skin incision. The arc of the bite should be such that the needle exits the skin directly opposite the looped end. Pass the needle through the looped end, applying gentle traction to carefully appose the skin edges. Step Three After the subcutaneous and subcuticular layers of the vertical incision are closed, begin the refixation of the areola at the 6 o clock position. Complete the circumferential closure with V-Loc 90 device. Step Four Complete the areola closure by exiting the needle lateral to the initial starting point. Be sure to cut flush with the tissue. Use SwiftSet topical skin adhesive as a final layer of closure to provide an antimicrobial barrier. Step Three Beginning with a sinusoidal bite on the same side as the looped end, close the skin incision in standard fashion with a continuous subcuticular pattern. Take care not to pull too tightly, as this will cause the incision to pucker and inhibit the release of tension. Step Four Once at the end of the incision, take 1 to 2 backbites toward the beginning of the incision. Then take a bite perpendicular to the incision and exit the skin, making sure to cut the suture flush with the tissue. Use SwiftSet topical skin adhesive as a final layer of closure to provide an antimicrobial barrier

37 Sleeve Gastrectomy Laparoscopic Hysterectomy Step One In a sleeve gastrectomy, after creating the gastric sleeve, oversew the staple line. The V-Loc device can be started at the proximal or distal end of the sleeve. Take 2 bites on either side of the sleeve, pass the needle through the loop, and cinch down. Step One Start the V-Loc device at the apex of the cuff, on either side of the opening, and try to incorporate the lateral ligaments. Take 2 healthy bites of the vaginal epithelium, at least 1 to 2 cm in depth, and thread the V-Loc device through the loop. Step Two Continue to run the V-Loc device the length of the sleeve, being sure to imbricate the staple line. Step Two Continue to run the V-Loc device using a baseball stitch for the length of the cuff. Recommend that surgeons use the needle driver to apply countertraction to the vagina when cinching down the V-Loc device. This can be done by opening the jaws of the needle driver in a V shape and pushing against the tissue while pulling back the V-Loc device. Step Three Once the staple line is oversewn, take 1 to 2 backbites with the V-Loc device toward the beginning of the incision. To securely complete the knotless closure, pass the needle under the suture line and exit perpendicular to the staple line. Cut flush with the tissue to ensure that no tail is remaining. Step Three To complete the cuff closure, take 2 bites right before closing the distal end of the cuff. Do not have surgeons pull the suture tight, as this will allow them to evert the cuff to take bites of mucosa. Then take 2 to 3 bites toward the middle of the cuff and advance the needle under the suture line to come out perpendicular to the suture line. Ensure that the V-Loc device is cut flush with tissue. To avoid complications, do not leave a tail

38 Total Knee Replacement Total Hip Replacement Step One After the knee implant is placed and the joint capsule is ready to be closed, approximate the tissue over the implant. Step Two To close the joint capsule, 12 to 15 interrupted Ti-Cron sutures are placed to ensure a secure closure. Step One After the hip implant is placed and the joint capsule is ready to be closed, approximate the tissue over the implant. Step Two To close the joint capsule, 12 to 15 interrupted Ti-Cron sutures are placed to ensure a secure closure. Step Three Use the V-Loc device to close the deep dermal layer. Take 1 bite with the V-Loc device on either side of the wound and advance the needle through the anchor loop. Begin to run the suture the length of the incision as for a traditional suture. Once at end of the incision, take 1 to 2 backbites toward the beginning of the incision. Then advance the needle under the suture line, coming out perpendicular to the incision, and cut flush. Step Four For the subcuticular closure, complete the same actions of Step Three. Use SwiftSet topical skin adhesive as a final layer of closure to provide an antimicrobial barrier. Step Three Use the V-Loc device to close the deep dermal layer. Take 1 bite with the V-Loc device on either side of the wound and advance the needle through the anchor loop. Begin to run the suture the length of the incision as for a traditional suture. Once at end of the incision, take 1 to 2 backbites toward the beginning of the incision. Then advance the needle under the suture line, coming out perpendicular to the incision, and cut flush. Step Four For the subcuticular closure, complete the same actions of Step Three. Use SwiftSet topical skin adhesive as a final layer of closure to provide an antimicrobial barrier

39 Common V-Loc Device Usage Common V-Loc Device Usage Orthopedic Procedure V-Loc device Joint (knee or hip) 180, 90, PBT Size 0, 2-0, 3-0 # of Strands 3-6 Average Length 18", 24" Preferred Layers Closed Plastic Procedure V-Loc device GS-21 GS-22 GS-25 GS-11 Deep Dermal, Subcuticular Abdominoplasty 180, 90, PBT Size 0, 2-0, 3-0 # of Strands 2-5 Average Length 18", 24" Preferred P-12 Layers Closed Plastic Procedure V-Loc device 180, 90 Muscle Plication, Deep Dermal, Subcuticular Joint (knee or hip) Size 2-0, 3-0, 4-0 # of Strands 2-5 Average Length 18", 24" Preferred P-14 Layers Closed Muscle Plication, Deep Dermal, Subcuticular Plastic Procedure V-Loc device 90 Breast Augmentation Size 2-0, 3-0, 4-0 # of Strands 2 Average Length 6" Preferred V-20 Layers Closed Gynecology Procedure V-Loc device 180, 90 Size 0, 2-0 # of Strands 1-2 Average Length 9", 12" Preferred Layers Closed Gynecology Procedure Muscle Plication, Deep Dermal, Subcuticular Hysterectomy GS-21 Vaginal Cuff Myomectomy V-Loc device 180, 90 Size 2-0, 3-0 # of Strands 2-3 Average Length 6", 9" Preferred Layers Closed GS-21 Uterus 76 77

40 Common V-Loc Device Usage Common V-Loc Device Usage Urology Procedure V-Loc device 180, 90 Size 3-0 # of Strands 2-3 Average Length 6", 9" Preferred Layers Closed GEN/Bariatric Procedure V-Loc device Robotic/Lap Prostatectomies CV-23 Bladder-Urethra Anastomosis Rocco Stitch Sleeve Gastrectomy Gastric Bypass 180, PBT Size 2-0, 3-0 # of Strands 2-3 Average Length 6", 9" Preferred GS-22, V-20 Layers Closed Staple Line Oversewing Enterotomy Closure Peterson s Defect Electrophysiologists Procedure V-Loc device 90 Size 3-0, 4-0 # of Strands 2-3 Average Length 9", 12" Preferred V-20, P-12 Layers Closed Dermatology: Mohs Procedure Pacemaker/Defibrillator Deep Dermal Subcuticular V-Loc device 180, 90 Skin Cancer Removal Size 2-0, 3-0, 4-0 # of Strands 2-3 Average Length 9", 12", 18" Preferred P-12, P-14 Layers Closed Deep Dermal Subcuticular 78 79

41 NEEDLES

42 s s We provide a full line of suture needles. Our portfolio offers both choice to accommodate clinical preference and high performance to meet clinical needs. All of our needles are treated with our proprietary NuCoat coating that reduces needle dulling. We use only high grade stainless steel that is heat treated to optimize strength. We use laser and mechanical drilling technology and a proprietary annealing process to limit inadvertent suture detachment. Every suture strand is 100% pull tested. Cutting s (Primarily for Skin Closure) Premium Line For sharpness and a thinner cross section Premium reverse cutting P-needles Premium conventional cutting PC-needles DermaX needles a unique cross-cutting tip Slim Blade SBE needles slim needles for cosmetic surgery Commodity Line For value pricing and when strength and a stiff, robust feel are preferred Cuticular C-needles Cardiovascular s For all Cardiovascular, Peripheral Vascular and some general closure applications We offer a wide array of CV needle options to provide a best fit for surgeon technique and patient needs All SurgiPro suture and Vascufil suture needles are made with our proprietary Surgalloy stainless steel and heat treated for optimized strength Common CABG Distal Anastomosis Options CV-1: Comparable to the BV-1 CVF-1: Flat pressed for the enhanced stability in the needle driver MV-175-8: A shorter 8 mm needle with a smaller wire diameter than the CV-1 for less tissue damage and easier penetration Length Slim Taper Point (CV) Heavy 26 mm V-20/ VF-20 GS-22 HGS-22 KV mm V-26 GS-21 HGS-21 KV mm GS-24 HGS-24 KV mm GS-25 KV-40 When to Use: Length Thinner needle to minimize defect size Reverse Cutting Heavy Reverse Cutting For majority of applications Blunt Taper Point Thicker needle for added strength 5/8 Circle Taper-Cutting/ Diamond Point Taper-cutting tip for better penetration Heavy 5/8 Circle 26 mm GS-10 HOS-10 BTV-20 GU-46 HGU mm GS-11 HOS-11 BGS-21/ HBGS-21/ BTP-1 GU mm GS-12 HOS-12 BGS-24 GU mm GS-13 BGS-25 When Cutting tip Thicker Blunt tip For Thicker to Use: for best cutting for vascular application needle for penetration needle tissue with little applications MVF-175-8: Flat pressed for the enhanced stability in on difficult for best (i.e., liver, space to with little the needle driver tissue penetration pancreas) maneuver space to and better or to reduce (i.e. port site maneuver MV-175-9: Thinner wire diameter for less tissue strength on risk of needle closure or damage and easier penetration toughest stick in a urology) tissue high-risk CVL: A unique geometry designed for speed patient (i.e., KV-1: A sharper tip for difficult tissue HIV, HEP) KVF-1: Flat pressed for the enhanced stability in the needle driver CV-310: 300 series steel for a different feel Common CABG Proximal Anastomosis Options CV-11: Comparable to the C-1 CVF-11: Flat pressed for the enhanced stability in the needle driver CV-301: 300 Series steel for a different feel KV-11: A sharper tip for a difficult tissue KVF-11: Flat pressed for the enhanced stability in the needle driver General Surgery s For a given needle length, we offer a broad range of needle thicknesses and tip geometries to accommodate different clinical applications and surgeon preferences.

43 Cardiovascular Cardiovascular CODE CODE COMP COMP LENGTH LENGTH taper point - ⅜ circle CV-1/CVF-1 BV-1 9mm CV-310 BV 10mm CV/CVF BV 11mm CV-11/CVF-11 C-1 13mm CV-301 C-1 * 13mm CV-307 BB * 16mm CV-15/CVF-15 BB 17mm CV-327 BB * 18mm CV-16 20mm CV-13 BB-1 22mm CV-18 TE-2 26mm CV-17 TE-2 32mm CV-19 50mm taper point - ½ circle CV-20 RB-3 10mm CV-337 RB-3 10mm CVF-21 TF 12mm CV-22/CVF-22 RB-2 13mm CV-330 RB-2 13mm CV-26 RB-1 * 15mm CV-331 RB-1 * 16mm CV-23/CVF-23 RB-1 17mm CV-316 SH-2 20mm CV-24 SH-2 20mm CV-25 SH-1 22mm CV-305 SH * 25mm V-20/VF-20 SH 26mm V-30 30mm CV-300 MH * 35mm V-26 MH * 37mm CODE CODE COMP COMP LENGTH LENGTH taper point - CardioCurve taper point - CardioCurve TM CVL 11mm CVL-11 13mm penetrating taper - ⅜ circle YE-1 CC-1 13mm YE-7 V-4 18mm penetrating taper - ½ circle Y-31 V-5 16mm Y-16 V-6 * 20mm Y-5 V-7 26mm tapercutting - ⅜ circle KV-1/KVF-1 CC 9mm KV-11/KVF-11 CC-1 13mm KV-15 V-4 17mm KV-26 V-26 26mm tapercutting - ½ circle KV-5/KVF-5 V-5 17mm KV-7 V-7 26mm conventional cutting - ½ circle SCC CCS 48mm SCC-1 CCS-1 60mm conventional cutting - ⅜ circle GCC-90 90mm * Suggested * Suggested 84 85

44 Plastic/Cosmetic Cuticular CODE CODE COMP COMP LENGTH LENGTH CODE COMP LENGTH conventional cutting conventional cutting ⅜ circle /8 circle PC-13 P-1 11 mm PC-10 PC-1 13 mm PC-11 PC-3 16 mm PC-12 PC-5 19 mm premium reverse cutting - ⅜ circle P-16 P-6 7mm P-10 P-1 11mm P-13 P-3 13 mm P mm P-11 PS-3 16 mm P-12 PS-2 19 mm P-14 PS-1 24mm P-17 PSL 30mm P-18 PSLX 39mm premium reverse cutting - ½ circle P-21 P-2 9mm P-22 PS-5 13mm P-24 PS-4 * 16mm CODE CODE COMP COMP LENGTH LENGTH CODE COMP LENGTH reverse cutting - reverse cutting - 3 ⅜ circle /8 circle C-1 C-2 * 12mm C-12 FS-3 16mm C-13 FS-2 19mm C-14 FS-1 24mm C-15 FS 26mm C-16 FSL 30mm C-18 35mm C-17 FSLX * 39mm C-50 LS-1 * 50mm GS-18 LS-1 * 77mm reverse cutting - ½ circle C-21 M-1 * 13mm C-26 J-1 * 15mm C-22 J-1 18mm C-27 20mm C-23 X-1 * 24mm C-25 CP-2 * 30mm DermaX premium X cutting - ⅜ circle DX-11 P-1 11mm DX-13 PC-1 13mm DX-16 PC-3 16mm DX-19 PC-5 19mm DermaX premium X cutting - ½ circle DXH-16 PC-12 16mm cutting - straight SC-11 SC-1 * 11mm SC-4 24mm SC 44mm SC-1 TS * 51mm SC-2 KS 60mm SC mm * Suggested * Suggested 86 87

45 General Surgery General Surgery CODE CODE COMP COMP COMP LENGTH LENGTH LENGTH taper point - 1/2 - ½ circle GS-23 CT-3 22mm HGS-23 MO-7 22mm GS-22 CT-2 27mm HGS-22 MO-6 27mm GS-20 CT-1 * 34mm HGS-20 MO-5 * 34mm GS-21 CT-1 37mm HGS-21 MO-4 37mm GS-24 CT 40mm HGS-24 MO-2 40mm GS-25 CTX 48mm GS-26 TP-1 65mm GS-27 XLH 76mm CODE COMP LENGTH BGS-24 40mm BGS-25 CTX-B 48mm BTP-X CTX-B 48mm BGS-29 BP-1 65mm BGST-29 BP-1 65mm BGS-28 BP * 85mm blunt point - Protect Point ½ circle BP-27 64mm taper point - straight ST-4 ST-4 19mm TS-3 38mm ST-2 44mm ST-1 ST 51mm ST 60mm SK taper point - ski 23mm diamond point - ⅜ circle KV-20 20mm diamond point - ½ circle KV-25 22mm KV-30 27mm KV-8 30mm KV-9 35mm blunt taper point - Protect Point - ½ circle BTV-20 SHB 26mm BGS-21 CTB-1 37mm HBGS-21 MOB-4 37mm BTP-1 CTB-1 37mm tapercutting - ½ circle KV-34 V-34 37mm KV-37 V-37 40mm KV-40 V-40 48mm KV-56 V-56 60mm * Suggested 88 89

46 Microsurgery Orthopedic CODE COMP LENGTH taper point - ⅜ circle MV BV mm MV-50-3 BV mm MV-70-3 BV mm MV BV * 4mm MV-70-4 BV mm MV BV * 5mm MV BV mm CV-345 BV mm MVF BV mm MV BV mm CV-351 BV mm MV BV mm MVF BV mm MV BV mm tapercutting - ⅜ circle MVK-70-3 BV mm MVK BV mm UROLOGY taper point - ⅝ circle GU-46 UR-6 27mm HGU-46 UR-6 27mm GU-45 UR-5 37mm GU-44 UR-4 40mm CODE COMP LENGTH reverse cutting - ⅜ circle GS-18 77mm reverse cutting -½ circle GS-10 CP-2 26mm HOS-10 OS-4 * 26mm GS-11 CP-1 37mm HOS-11 OS-6 37mm GS-12 CP 40mm HOS-12 OS-8 40mm GS-13 CPX 48mm HOS-14 55mm KS tapercutting - straight 24mm * Suggested 90 91

47 Ophthalmic Ophthalmic CODE LENGTH CURVATURE COMP CODE LENGTH CURVATURE COMP reverse cutting - ⅜ circle premium spatula - ½ circle HE mm 130 G-6 * 110 HE-6 7.4mm 110 G HE-7 7.4mm 145 G HE-5 8.6mm 135 HE mm 135 G HE mm 155 G reverse cutting - ½ circle HE-2 8.6mm 205 G CUTTING HE HE-2 SE mm 160 TG-160-4/CS SE mm 160 TG-160-6/CS SE mm 160 TG-160-8/CS SE mm 160 TG-160-8/CS SE mm 175 TG-175-6/CS SE mm 175 TG-175-8/CS SS mm 170 S SS-2 8.6mm 200 S premium spatula - compound curve SS-22 inverted premium spatula - ¼ circle SE-CC-6 4.8mm 130 TG6-S SS mm 110 S inverted premium spatula - ⅜ circle SS mm 145 S premium spatula - ⅙ circle SS-1 5.6mm 60 SM-1 60 UM SP premium spatula - ¼ circle SE mm 100 TG SD-1 8.1mm 90 RD-1 90 SS mm 95 S SS mm 115 S SD-1 premium spatula - 5/16 circle SE mm 110 S (previously SLO ) premium spatula - ⅜ circle SE mm 140 TG-140-6/CS SE mm 140 TG-140-8/CS SE mm 140 TG

48 FREQUENTLY ASKED QUESTIONS (Handling Objections)