Amy Dunklee

ISM-Period 1

Freed, Jeffrey S, and John Ko. “Innovative Advance in Non-Invasive Wound Closure: A New

Paradigm.” OUP Academic, Oxford University Press, 3 Apr. 2018,

academic.oup.com/milmed/article/183/suppl_1/472/4960040. 20 Mar. 2019

• The Military Medicine’s new device, “Derma Clip Skin Closure Device”, is known as a
“new, non-invasive, painless” innovation that is helping revolutionize army medicine.
• The Derma Clip Device does not require the use of needles or anesthesia.
• The device is mainly being used as applicable to emergency medicine setting, and in any
• Battlefield setting.
• For their experiment, they tested the “efficacy” of the product in a “120 patient trial”
composed of “60 experimental cases” and “60 control cases”.
• Injuries in a wartime setting are commonly associated with cutaneous injuries and require
a relatively quick, easy to use, and efficient application.
• Sutures, staples and adhesives are the commonly known “traditional” wound closure
systems.
• The source concluded that for sutures and staples, “there is insufficient evidence to justify
the use of staples over sutures”.
• The research they based this on were 4 different studies, all comprised in the US National
Library of Medicine’s database from the late 1980’s to 2006.
• Other studies he referenced utilized glue, however patients in those trials were
anesthetized or had local anesthesia.
• They found the glue to be efficient in lacerations measuring less than 10cm, but any
larger would be quite costly.
• The way the application is composed is through two pieces of “adhesive joined by a
polypropylene bridge.”
• The study further regarded the clip to be simple in design but very complex.
• It brought up the concept of wound eversion, which is when a wound develops a tag that
makes a rift where the scar tissue heals.
• Dermaclips utilize two tabs that pull to act as a good suture or staple holding the wound.
• The clips have a “clip on” and “clip off” factor that help to have better access and ease
when applying the device.
• For the experiment, the control group used a “random numbers table” depicting which
skin closure (sutures, staples, or glue) would be used.

I think the device, Dermaclip, will hopefully save many lives in army combat or in any rushed
clinical setting, yet I think it may be a while before many hospitals will begin to adopt such a
new concept.
 Amy Dunklee
ISM-Period 1

Levine-October, Hallie. “Stitch in Time: 18 Fascinating Facts About the History of

Sutures.” Content Lab - U.S., Johnson & Johnson, 29 Oct. 2018, www.jnj.com/our-

heritage/history-of-sutures-ethicon. 26 Mar. 2019.

• Sutures have been around for thousands of years.

• The earliest recollection of suturing dates to 30,000 B.C. Humans in the Neolithic era
utilized “Eyed Needles” for surgery and tying wounds
• Galen of Pergamon, a Greek surgeon from 1600 B.C., records the use of silk or catgut
(twisted intestines of sheep/horses) as a good material for suturing gladiators’’ wounds.
• Silk and catgut were used for suturing well into 20th century, before modern suturing was
developed.
• In 150 A.D. Egypt, Egyptian records state to “draw together for him his gash with
stitching.”
• In 1876, Sir Joseph Lister, a British surgeon speaks out about inspiring sterilizing
medicine, and his presentation inspire Robert Wood Johnson to start Johnson & Johnson
• Patient survival rates in hospitals grew tremendously with the introduction of mass-
produced sterile sutures.
• Made from catgut and silk, Johnson & Johnson begin manufacturing sterile sutures that
aid in revolutionizing modern antiseptic sutures.
• “Mersutures” debut in the 1920’s. Mersutures are eyeless needle sutures that already
come with a pre-attached strand, very similar to modern sutures used today.
• Ethicon Inc., begins a suture laboratory in 1949, and is bought by Johnson & Johnson
• The first “breakthrough” in sterilizing sutures began with Ethicon introducing sutures that
utilized radiation.
• The Ethicon package was sterilized by sealing their sutures and making sure bacteria
stays out.
• Polypropylene today is still used as the “Gold Standard” for cardiovascular surgeons
because it “stretches easily” and “doesn’t tear”.
• Vicryl is made by Ethicon, and it’s more stronger and “pliable”.
• In 1979, the addition of Vicryl allows the surgeons knots to stay down, and allow for less
trauma to occur.
• In 1982, “PDS” or polydioxanone sutures utilized antibacterial ointment and allowed for
the sutures to last between 4-6 weeks.
• In 1993, Monocryl sutures debuted and allowed for the fascia within the skin to be pulled
together more compactly.

I think the article was really interesting to read about, I really liked the information about the
sutures and the history about the sutures, and I really enjoyed reading about how we came about
to getting newer sutures we sue today.
 Amy Dunklee
ISM-Period 1

Satteson, Ellen Stolle. “Materials for Wound Closure: Wound Healing and Closure, Suture

Characteristics, Suture Materials.” Materials for Wound Closure: Wound Healing and

Closure, Suture Characteristics, Suture Materials, Medscape, 1 Feb. 2019,

emedicine.medscape.com/article/1127693-overview. 26 Mar. 2019

• The Purpose of utilizing certain materials when suturing is to ensure that the wound will
close correctly and not gain any infection.
• Specifically, to ensure that the wound is strong enough to withstand daily forces.
• Many sutures come in standard sizes of 18-27 inches.
• Shorter sutures measuring in lengths of 7-9 inches are generally less pricy and are
generally used for less intrusive procedures.
• Absorbable sutures are used for placements where the sutures may need to be buried deep
within the skin, or used as an alternative in some cases.
• Catgut, was one of the first forms of absorbable suture material. It is made from the
intestines of sheep, cattle, or goats.
• Absorbable sutures are generally absorbed completely in 70 days.
• The needles of sutures contain 3 different parts.
• The shank, body, and point. Contrary to the name, the body is the part of the suture where
the suture material is attached to the needle.
• The body may sometimes come as ribbed to ensure better grip when stitching a patient.
• Staples are flat pieces of metal that will lay perpendicular to skin.
• Staples may be used on extremities that may suffer under high tension, such as the scalp.
• The cost is generally greater for staples than traditional conventional sutures.
• The depth of any staple is judged by the pressure exerted onto the skin.
• Staples should be inserted at 45 degrees and 60-degree angles, to minimize trauma
exerted onto tissue.
• If placed at 90-degree angle, such as you would for suturing needles through skin, the
staple may “strangulate” the skin and cause further trauma.
• Staples are generally removed using a pair of extractors.
• “Tapes” are strips of “microporous non-inclusive material, and contain a thin layer of
adhesive on the back.
• Advantages of utilizing tapes are the ease and low pain comfort seen with using tapes.
• Risk of infection is greatly minimized, similar to tissue adhesives, which have been
around for more than 20 years, but have recently been legalized in the united states.

I think this source had a lot of good information, not only about sutures but other conventional
closure techniques such as staples, tapes and tissue adhesives, and in the future, will be a good
resource to come back to later.