What is the role of the needle-holder in suturing?

Updated: Mar 05, 2020
  • Author: Desiree Ratner, MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

The stability of the needle within the needle holder affects needle control and performance. The jaws of the needle holder must be appropriate to the needle size to hold it securely and prevent rocking, turning, and twisting (see the image below). An ovoid cross-section of the needle body often maximizes both the surface contact with the needle-holder jaws and the bending moment of the needle.

Interaction between needle holder and suture needl Interaction between needle holder and suture needle. (A) Needle holder of appropriate size for needle. (B) Needle holder that is too large for needle—pressure applied by needle holder leads to inadvertent straightening of suture needle. (C) Needle holder that is too small for needle—needle rotates around long axis of needle holder.

The needle-holder handle must be appropriate for the required depth of suture placement. The difference between the length of the handle and the jaw creates a mechanical advantage for exerting force through the needle point.

The needle-holder clamping moment is the force applied to a suture needle by a needle holder. The jaws of the needle holder contact a curved needle at one point on the outer curvature and at two points along the inner curvature. The force against the needle creates a moment arm, which acts to flatten the curvature of the needle.

Technically speaking, the needle-holder clamping moment must be less than the surgical yield of the needle, or the needle will bend and ultimately may break. A bent needle takes a relatively traumatic path through soft tissue and may cause increased soft-tissue injury. Repetitive injury by the needle holder also may cause the needle to break. If the broken portion of the needle is not identified and retrieved immediately, surgery may be delayed in an effort to find it. The need for intraoperative radiology and other potential difficulties may ensue.

Studies by Abidin et al demonstrated that the sharp edges of smooth needle-holder jaws cut the smooth surface of monofilament sutures, weakening their strength. [41] When the smooth tungsten carbide inserts of needle holders clamped 6-0 monofilament nylon suture with the first opposing teeth of the needle holder ratchet mechanism interlock, there was a significant reduction in suture breaking strength.

This damage to the suture can be prevented by mechanically grinding the outer edges of the smooth tungsten carbide inserts so as to achieve a rounded edge. When this was done, clamping the suture with the smooth jaws of the needle holder was atraumatic, with no demonstrable damage to the suture’s breaking strength. [41]


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