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      Chirurgische Nadeln in Orthopädie und Unfallchirurgie Translated title: Surgical needles in orthopedics and trauma surgery

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          Abstract

          Für Chirurgen in der Klinik und Praxis ist der Umgang mit Nahtmaterial das „tägliche Brot“. Daher könnte man annehmen, dass die Kenntnisse dieses Materials kompetent und umfassend sind. Die tägliche Erfahrung zeigt indes ein anderes Bild. Oft sind die Kenntnisse bezüglich Nadelform, Nadelbeschaffenheit sowie Nadelgröße nur marginal und der Chirurg muss sich auf die Kenntnisse seiner OP-Pflegefachkraft verlassen. Die Wahl der Nadel ist für jeden Operationsschritt und jedes Gewebe ausschlaggebend. Die Verwendung des korrekten Nahtmaterials in Bezug auf das zu nähende Gewebe ist jedoch essenziell, einerseits hinsichtlich der Qualität der Naht, aber auch hinsichtlich der Traumatisierung des Gewebes andererseits. Je nach Gewebe sind an Nadel wie auch an Fäden verschiedene Anforderungen zu stellen respektive zu berücksichtigen. Mit diesem Beitrag sollen die wesentlichsten und grundlegendsten Kenntnisse vermittelt werden wie Einfluss der Nadelform und Dimension, Auswirkung von atraumatischen respektive traumatischen (sog. scharfe) Nadeln auf das Gewebe, die Form der Nadelspitze. Das Zusammenspiel zwischen Nadelhalter und Nadel und der Hand des Operateurs bei verschiedenen Anwendungen wird dargestellt. In diesem Beitrag wird das Hauptaugenmerk auf Nadel und Nadelhalter gelegt. In Planung ist ein Nachfolgebeitrag, der sich speziell dem Nahtmaterial widmet. Der Beitrag erhebt nicht den Anspruch auf 100 %ige Vollständigkeit, es sollen jedoch die wesentlichsten, alltäglich vorkommenden Fragen geklärt werden.

          Zusatzmaterial online

          Die Online-Version dieses Beitrags (10.1007/s00064-021-00734-7) enthält eine Vergleichstabelle der chirurgischen Nadeln verschiedener Hersteller (ESM2) inklusive Erläuterungen (ESM1) sowie 2 Videos zu den Nadelhaltergriffen: Video 1 Nadelhaltergriff: Daumen-Ringfinger-Griff (ESM3) und Video 2 Nadelhaltergriff: Daumenballengriff (ESM4) (Videos: Mit freundl. Genehmigung von © Dr. Theddy Slongo [Autor der Videos], Inselspital Bern, Paediatric Trauma and Orthopaedics, University Children’s Hospital, Dept. of Paediatric Surgery. Alle Rechte vorbehalten).

          Translated abstract

          For surgeons in the clinic and practice, the handling of suture material is the “daily bread”. Therefore, one might assume that knowledge of this material is competent and comprehensive. However, daily experience shows a different picture. Often, the knowledge regarding needle shape, needle composition as well as needle size is only marginal and the surgeon has to rely on the knowledge of his OR nurse.

          The choice of needle is critical for each surgical step and each tissue; however, the use of the correct suture material in relation to the tissue to be sutured is essential, not only with respect to the quality of the suture but also with respect to the traumatization of the tissue. Depending on the tissue, different requirements must be placed on or taken into account for both the needle and the sutures. The purpose of this article is to provide the most essential and basic knowledge, such as the influence of needle shape and dimensions, effect of atraumatic or traumatic (so called sharp) needles on the tissue and shape of the needle tip. The interaction between the needle holder and the needle and the surgeon’s hand in different applications is presented. In this present article, the main focus is on the needle and needle holder. A follow-up article specifically dedicated to sutures is being planned. The article does not claim to be 100% complete but the most essential, everyday questions should be clarified.

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          Suture and Needle Characteristics in Orthopaedic Surgery.

          There remains a dearth of research on and general knowledge with regard to materials used for wound closure and soft-tissue repair and approximation. Critical suture properties include physical configuration, fluid absorption and capillarity, caliber or diameter, tensile strength, torsion, absorbability, elasticity, plasticity, memory, coefficient of friction, and knot security. The optimal ranges of each of these characteristics remain undefined for most sutures and indications. Needle types and basic design characteristics affect suture passage and require further consideration with regard to specific suture-needle selection. Suture must perform its intended purpose with a minimum of undesirable reaction and infectious potential, adequate duration of efficacy, and adequate strength. However, stronger, or high tensile strength, suture is not always better because of the requisite increase in suture caliber as well as the potential for inadvertent tissue strangulation, possibly increasing inflammatory reactivity. Sometimes, we seek stable, watertight fascial closure; occasionally, strong and durable tendon repair; and other times, gentle, cosmetically friendly, skin eversion and opposition. A variety of common suture types differ in these critical characteristics and may be optimally utilized for contrasting, but sometimes overlapping, indications.
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            Biomechanical analysis of needle holding security.

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              An expanded surgical suture and needle evaluation and selection program by a healthcare resource management group purchasing organization.

              The purpose of this report is to describe an expanded suture and needle clinical evaluation program jointly designed by hospital representatives of Consorta, Inc. (Rolling Meadows, Illinois), a leading healthcare resource management and group purchasing organization, and United States Surgical/Davis & Geck Sutures (Division of United States Surgical, Norwalk, Connecticut). In this expanded evaluation program, 42 Consorta shareholder hospitals enrolled 1913 surgeons to participate in Phase II of this non-experimental observational study of the clinical performance of surgical needles and sutures. Performance characteristics of the sutures and needles produced by USS/DG that were evaluated in 25,545 surgical procedures included packaging/ease of opening, needle strength and sharpness, tissue drag, knot security, tensile strength, clinically acceptable determinations, and clinically unacceptable determinations. In these 30-day studies, the surgeons found that the needles and sutures were clinically acceptable in 98.1% of the evaluations. The general, cardiothoracic, and orthopedic surgeons who performed 61.2% of the product evaluations reported that the suture and needle products were clinically acceptable in 98.2% of the evaluations. Nearly half (49.2%) of the evaluations involved the POLYSORB* braided synthetic sutures that received a clinically acceptable rating in 98.2% of the evaluation. The silk suture (SOFSILK*), followed by the monofilament nylon suture (MONOSOF*), were the next most frequently used sutures. The SOFSILK* was found to be clinically acceptable in 99.2% of the evaluations, while MONOSOF* was noted to be clinically acceptable in 98.7% of the evaluations. Surgical needles made by USS/DG Sutures also had a high rating of clinical acceptability (97.9%).
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                Author and article information

                Contributors
                klaus.dresing@med.uni-goettingen.de
                langer.martin@ukmuenster.de
                theddy.slongo@insel.ch
                Journal
                Oper Orthop Traumatol
                Oper Orthop Traumatol
                Operative Orthopadie Und Traumatologie
                Springer Medizin (Heidelberg )
                0934-6694
                1439-0981
                16 September 2021
                16 September 2021
                2021
                : 33
                : 5
                : 405-421
                Affiliations
                [1 ]GRID grid.411984.1, ISNI 0000 0001 0482 5331, Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, , Universitätsmedizin Göttingen, ; Robert-Koch-Str. 40, 37075 Göttingen, Deutschland
                [2 ]GRID grid.16149.3b, ISNI 0000 0004 0551 4246, Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, , Universitätsklinikum Münster, ; Waldeyerstr. 1, 48149 Münster, Deutschland
                [3 ]GRID grid.412353.2, Paediatric Trauma and Orthopaedics, , University Children’s Hospital, ; 3010 Berne, Schweiz
                Author notes
                [Wissenschaftliche Leitung]

                Klaus Dresing, Göttingen

                Frank Unglaub, Bad Rappenau

                Article
                734
                10.1007/s00064-021-00734-7
                8460540
                34529101
                af7e908d-5c6e-48c1-9ecf-458797d314d8
                © The Author(s) 2021

                Open Access Dieser Artikel wird unter der Creative Commons Namensnennung 4.0 International Lizenz veröffentlicht, welche die Nutzung, Vervielfältigung, Bearbeitung, Verbreitung und Wiedergabe in jeglichem Medium und Format erlaubt, sofern Sie den/die ursprünglichen Autor(en) und die Quelle ordnungsgemäß nennen, einen Link zur Creative Commons Lizenz beifügen und angeben, ob Änderungen vorgenommen wurden.

                Die in diesem Artikel enthaltenen Bilder und sonstiges Drittmaterial unterliegen ebenfalls der genannten Creative Commons Lizenz, sofern sich aus der Abbildungslegende nichts anderes ergibt. Sofern das betreffende Material nicht unter der genannten Creative Commons Lizenz steht und die betreffende Handlung nicht nach gesetzlichen Vorschriften erlaubt ist, ist für die oben aufgeführten Weiterverwendungen des Materials die Einwilligung des jeweiligen Rechteinhabers einzuholen.

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                History
                : 28 June 2021
                : 12 July 2021
                : 20 July 2021
                Funding
                Funded by: University of Bern
                Categories
                CME
                Custom metadata
                © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2021

                nadelform,konische nadeln,stumpfe nadeln,schneidende nadeln,nadelhalter,needle shape,conical needle,blunt needle,cutting needle,needle holder

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