Needles and their holders

Needles can be round-bodied, or they can have cutting edges. They can be thin or thick, large or small; straight, or curved into 3/8, half, or 5/8 of a circle. Curved needles are for working in confined spaces. The smaller ones have to be held in a needle holder. Use a 3/8 circle needle in a shallow space, and a 5/8 needle in a deep one. The narrower and deeper the hole the smaller and more curved the needle has to be. If necessary, you can try to bend a half curved needle into a 5/8 circle. If you don't have a suture needle, you can bend the wire stylet of an intramuscular needle into a loop, push both ends back into the neeedle, crimp them with a pair of pliers, and then bend the needle into any kind of curve you want, as in K, Fig. 4-6.

A needle can have an eye, or the suture material can be fixed to it to form an atraumatic needle. These are expensive, but they make smaller, neater holes, because the suture material is not doubled through the extra thickness of the eye. Use atraumatic needles to suture gut, the urinary tract, blood vessels, nerves, the cornea and the face, especially the eyelids. For anything else they are unnecessary and wasteful. Unfortunately, because atraumatic needles are so extensively used in the industrial world, needles with eyes may be difficult to get.

Always use a cutting needle for the skin, either a straight one or a large curved one held in your hand, or a smaller curved one held in a needle holder. Use a cutting needle for tough fascia. Mayo's needle is a hybrid[md]it has a trocar point and a curved round shank. Use it for big wide vascular pedicles and tough tissues, such as ligaments. Use round-bodied needles for most other tissues. If you have difficulty getting needles, we list a supplier in Appendix B (SHO). Resharpen cutting needles on a stone (Appendix A).

You will want a needle-holder to hold small needles and suture in a confined space. Use a holder with a short handle near the surface, and a long one deeper inside. Use big needles in big holders, and small needles in small holders. A large needle can break a fine needle-holder such as Derf's, so treat it with care. Needle-holders can have plain jaws, or tungsten carbide inserts which prevent the hard steel of the needles wearing them away. These cost twice as much, but last more than twice as long. Quality counts in needle-holders, so get good ones.

Fig. 4-6 NEEDLES. A, an atraumatic suture with a needle swaged on to it for suturing the gut. B, Keith's straight triangular hand-held needle for suturing the skin. C, a 5/8 circle round-bodied needle for suturing deep in a wound. D, a half circle triangular cutting needle for suturing soft tissues such as the broad ligament. E, a 3/8 circle needle. F, Colt's large curved needle for putting tension sutures in the abdomen. G, and H, needles can be round or triangular. I, the best needle holders have tungsten carbide tips. J, hold a needle where its cutting edge joins the shaft. K, if you don't have a suture needle you can improvise one from an intramuscular needle by bending its wire stylet into a loop, pushing this into the shaft and crimping it tight. Partly after Robert Remis. NEEDLES, suture, Keith, triangular straight 64 mm, 25 needles only. This is the standard straight, hand held needle for stitching skin. It is easy to sharpen and one needle may last you a year.

NEEDLES, suture, 3/8 circle, curved, triangular point, sizes 4, 12, and 18, 25 needles of each size. These are the standard curved needles. Hold the largest ones in your hand and the smaller ones in a holder.

NEEDLES, suture, 1/2 circle curved, triangular, sizes 2, 8, 14 and 20, 50 needles of each size only. Use these strong, triangular cutting needles for the scalp.

NEEDLES, suture, round bodied, 3/8 circle curved, sizes 4, 10 and 18, 25 needles of each size only. Use these for suturing soft tissue such as the peritoneum and broad ligament.

NEEDLES, Moynihan, 5/8 circle curved, round bodied, fine, sizes 1, 4, and 6, 50 needles only of size 1, 25 needles only of sizes 4 and 6. Hold the larger ones in your fingers for suturing stomach and intestine. Use the small ones in a needle holder for suturing deep in a wound.

NEEDLES, Mayo, intestinal, round-bodied, half circle curved with sharp perforating ends, 23 mm, size 20, 100 needles only. Use this small curved needle in a holder.

NEEDLES, suture, round bodied, half circle curved, sizes 1, 4, 10, 15, and 20, 25 needles of each size only. Hold these in a holder and use them in the depths of a wound.

NEEDLES, suture, Moynihan, Lance point, 5/8 circle, 115 mm, twenty five needles only. Use these large curved needles for sewing up the abdomen as described in Section 9.8.

NEEDLES, suture, curved, tension, Colt, 102 mm, five needles. This is a very large curved needle used for putting tension sutures into the abdomen (9.8).

NEEDLES, straight triangular, cutting, 35 mm, 20 needles only. Hold these in your hand and use them for suturing tendons.

NEEDLES, suture, Jameson Evans, triangular, curved, 10 mm, 25 needles only. These small curved needles have flattened shafts, triangular points and lateral eyes. Use them for delicate sutures, such as repairing the eyelids.

NEEDLES, suture, Dennis Brown, round pointed, 5/8 circle, 16 mm, 25 needles only. Hold these small curved needles in a needle holder, when you are working at the bottom of a narrow deep hole, such as the bottom of a burr hole.

NEEDLES, suture, 1/2 circle, catgut, Mayo, sizes 1 and 3, 25 needles of each size only. These are strong needles for tough tissues. They have short cutting edges, so you can use them to repair an artery.

NEEDLE, Deschamps, angled to the right, five only. This is the only needle (not illustrated) in this list which you can use to thread wire, to close the abdomen (9.8), or to wire the patella (79.12).

NEEDLE HOLDER, Boseman, 210 mm, ratchet and box joint, tungsten carbide jaws, two only. This is the standard needle holder for medium and large needles.

NEEDLE HOLDER, Mayo's, with ratchet and box joint, tungsten carbide jaws 185 mm, one only.

NEEDLE HOLDER, Mayo Dunhill, 160 mm, ratchet and box joint, tungsten carbide jaws, three only.

NEEDLE HOLDER, Mayo's with narrow serrated jaws, box joint, tungsten carbide jaws and ratchet, 185 mm, three only.

NEEDLE HOLDER, Derf, box joint and rachet, tungsten carbide jaws, 115 mm, two only. This is an expensive fine needle holder for tiny needles.

Fig. 4-7 SUTURE METHODS FOR THE SKIN. A, a continuous over- and-over suture. B, simple inturrupted sutures. C, a vertical mattress suture. D, a horizontal mattress suture. E, a buried horizontal mattress suture. F, an interrupted subcuticular suture. G, a continuous over-and-over suture which is being locked. After Grabb MD and Smith JW, ''Plastic Surgery', Figs. 1-8 and 1-9. Little Brown, with kind permission.