Right Left r

Hypoc Epig Hypoc Digestive: Digestive Digesti

hondri astric hondri      Liver : ve:
ac ac (tip)      Stoma     
Right Left      Gall ch Small
Umbi
Lumba Lumba Bladder      Intesti
lical
r r      Small Pancreas ne
Hypo Left Intestine      Small     
Right      Intestine Descen
gastri Iliac
Iliac Ascendin      ding
c
g Colon Transvers Colon
The Nine Abdominal e Colon
Regions
Endocrine Endocr
Left
Right : Endocrin ine:
      Epiga Hypoc
Hypochon      Right e:      Left
stric     hondri
driac Kidney      Kidney
ac
Pancreas (tip)
Digestive: Digestive Digesti      Right
     Liver : ve: Excretory
& Left
     Gall           Sto : Excret
Kidneys
Bladder Esophagu mach      Right ory:
     Small s      Kidney      Left
Intestine      Liver Excretory Kidney
     Stomach (tip) : (tip)
Lymphati
Ascendin      Liver           Right
c:
g Colon      Pancre & Left
     NONE Lymph
     Pancreas as (tail Kidneys
atic:
Transvers      Small of)      Right
     NO
e Colon Intestine      Reproduct& Left
NE
     Small ive: Ureters
Transvers Intesti      NONE
Endocrine Reprod
e Colon ne Lymphati
: uctive:
     c:
     Right      NO
Transv      Cister
Kidney Endocrin NE
erse na chyli
e:
Colon
     Right
Excretory     
& Left Reproduc
: Descen
Adrenal tive:
     Right ding
Glands      NON
Kidney Colon
     E
Pancreas
Lymphati      Right Endocr
c: & Left ine:
     NONE Kidneys         
Pancre
as
Reproduct Excretory Right   Hypoga Left
     Left
ive: : Iliac stric    Iliac
Kidney
     NONE      Right Digestive: Digestive Digesti
& Left      Small : ve:
Kidneys Excret Intestine      Small     
     Right ory:      Intestine Small
& Left      Left Appendix      Intesti
Ureters Kidney      Cecum Sigmoid ne
& Colon     
Lymphati Lymph Ascendin      Descen
c: atic: g Colon Rectum ding
     Spleen     Spl Colon
een     
Endocrine Endocrin
Sigmoi
Reproduc : e:
d
tive: Reprod      Right          
Colon
     NON uctive: Ovary Right &
E      NO (Females) Left
NE Ovaries Endocr
(Fem.) ine:
Excretory
     Left 
:
Right     Umbili Left Ovary
     NONE Excretory
Lumbar cal     Lumba (Femal
  Intestinal needles are specifically designed to
use in areas with a risk of leakage, such as the
Lymphati : es)
gastrointestinal (GI) tract, the urogenital tract and the
c:      Right
biliary tract (for the conveyance of bile). The needle
     NONE & Left
Excret makes a hole that is immediately filled with the suture
Ureters
ory: material.
    
Reproduct      NO
Urinary
ive: NE Point
Bladder
    
Female - 
Lymph This portion of the needle extends from the tip to the
          Lymphati
atic:
Right c: maximum cross-section of the body.
     NO
Ovary      NON
NE
          E
Right Body
Fallopian Reprod
Reproduc
Tube uctive:
tive: This part of the needle incorporates most of the needle
     Male -     
    
          NO Female length. The body of the needle is important for
Female - 
NE - 
          Ute interaction with the needle holder and the ability to
         
rus *
Left transmit the penetrating force to the point. The needle
         
Ovary
Right & factors that affect this interaction include needle
         
Left
Left diameter and radius, body geometry, and stainless
Ovaries
Fallopi
          steel alloy. These components determine the needle-
an
Right &
Tube bending moment, ultimate moment, surgical-yield
Left
     Mal
Fallopian moment, and needle ductility.
e-
Tubes
          
     Male -
NONE Swage
         
Vas
Deferens The suture attachment end creates a single, continuous
         
Seminal unit of suture and needle. The swage may be designed
Vessicle to permit easy release of the needle and suture material
         
Prostate (pop-off).

 Channel swage: A needle is created with a

Cutting Needles
 Cutting needles are designed to cut through
thick or dense tissues. This type of surgical needle is
commonly used for sutures.
Taper-Point Needles
 Taper-point needles, often called round
needles, are designed to penetrate and pass through
tissues by stretching the tissue without cutting it.
Beveled, Conventional Cutting-Edge Needles
 Beveled, conventional cutting-edge needles
are bend-resistant needles made from stainless steel
that was heat-treated after being curved. These surgical
needles are typically used to close lacerations.
Blunt-Point Needles
 Blunt-point needles dissect tissue rather than
cut it. These surgical needles have rounded points to
reduce the risk of needlestick injuries.
Intestinal Needles
channel into which the suture is introduced,
and the channel is crimped over the suture to
secure it into place. The diameter of the
channel swage is greater than the diameter
of the needle body.
 Drill swage: Material is removed from the
needle end (sometimes with a laser), and the
needle is crimped over the suture. The
diameter of the drill swage is less than the
diameter of the needle body.
 Nonswaged: Alternatively, the suture may be
passed through an eye, similar to that found
in a sewing needle. In a closed-eye
configuration, the shape may be round,
oblong, or square. In a French (split or
spring) eye, a slit is in the end of the needle
with ridges that catch and hold the suture in
place.
Several disadvantages are associated with the use of a
nonswaged needle. Tissue passage of a double strand
of suture leads to more tissue trauma. In a swaged
needle, the suture is less likely to become unthreaded
prematurely. Also, decreased handling helps maintain
suture integrity. Swaged sutures are not subject to
suture fraying or damage due to sharp corners in the
eye of eyed needles.
Needle coating
The needle may be coated with silicone to permit easier
tissue passage. The coating helps reduce the force
needed to make initial tissue penetration and the
frictional forces as the body of the needle passes
through the tissue.
Needle measurements
 Chord length: This is the linear distance from
the point of the curved needle to the swage
(bite width).
 Needle length: The distance measured along
the needle from the point to the swage is
termed needle length. Needle length, not

chord length (bite width), is the measurement
supplied on suture packages.
 Radius: This is the distance from the body of
the needle to the center of the circle along
which the needle curves (bite depth).
 Diameter: The gauge or thickness of the
needle wire is considered the diameter.
Point types
 abdominal viscera) and minimizes potential
Cutting: The needle has at least 2 opposing
cutting edges (the point is usually triangular).

This type is designed for penetration through
dense, irregular, and relatively thick tissues.
The point cuts a pathway through tissue and
is ideal for skin sutures. Sharpness is due to
the cutting edges.
o Conventional cutting: This type of
needle has 3 cutting edges
(triangular cross-section that
changes to a flattened body). The
third cutting edge is on the inner,
concave curvature (surface-
seeking).
o Reverse cutting: The third cutting
edge is on the outer convex
curvature of the needle (depth-
seeking). These needles are
stronger than conventional cutting
needles and have a reduced risk of
cutting out tissue. The needles are
designed for tissue that is tough to
penetrate (eg, skin, tendon
sheaths, oral mucosa). Reverse-
cutting needles are also beneficial
in cosmetic and ophthalmic
surgery, causing minimal trauma.
o Side-cutting (spatula): These
needles are flat on the top and
bottom surfaces to reduce tissue
injury. The needles allow maximum
ease of penetration and control as
they pass between and through
tissue layers. Side-cutting needles
were designed initially for
ophthalmic procedures.
Taper-point (round needle): This type of
needle penetrates and passes through
tissues by stretching without cutting. A sharp
tip at the point flattens to an oval/rectangular
shape. The sharpness is determined by taper
ratio (8-12:1) and tip angle (20-35°). The
needle is sharper if it has a higher taper ratio
and lower tip angle. The taper-point needle is
used for easily penetrated tissues (eg,
subcutaneous layers, dura, peritoneum,
tearing of fascia.
Beveled, Conventional Cutting Edge
Needles:  A new beveled, conventional
cutting edge needle, has been developed
with superior performance characteristics
over those of other conventional cutting edge
needles.  It is composed of a unique stainless
steel, ASTM 45500, that has been heat-
treated after the curving process to enhance
the resistance to bending.  The angle of
presentation of its cutting edge has been
decreased to enhance needle sharpness. On
the basis of the results of experimental and
 clinical studies done by Kaulbach et al, this needle also may facilitate vessel
needle is recommended for closure of approximation in microvascular surgery.
lacerations.17
 
Blunt-point: This type of needle dissects
friable tissue rather than cuts it. The point is
rounded and blunt, ideal for suturing the liver
and kidneys. Additionally, blunt needles are
being developed for more conventional uses
in an effort to reduce needlestick injuries.

Body types

 Straight: This body type is used to suture

easily accessible tissue that can be
manipulated directly by hand. The straight-
body needle is also useful in microsurgery for
nerve and vessel repair. Examples of
straight-body needles include the Keith
needle, which is a straight cutting needle
used for skin closure of abdominal wounds,
and the Bunnell needle, which is used for
tendon/GI tract repair.
 Half-curved ski: This type of needle is rarely
used in skin closure because it is difficult to
handle. The straight portion of the body does
not follow the curved point, resulting in an
enlarged curved point, which makes the
needle difficult to handle.
 Curved: The needle has a predictable path
through tissue and requires less space for
maneuvering than a straight needle. The
semicircular path is the optimal course for
sutures through tissue and provides an even
distribution of tension. Body curvature is
commonly a quarter-inch, three eighths-inch,
half-inch, or five eighths-inch circle. The three
eighths–inch circle is used most commonly
for skin closure. The half-inch circle was
designed for confined spaces, and more
manipulation by the surgeon is required (ie,
increased wrist motion is required).
 Compound curved: This needle curvature
was originally designed for anterior segment
ophthalmic surgery. The body has a tight 80°
curvature at the tip, which becomes a 45°
curvature throughout the remainder of the
body. A microvascular compound curved