MONOMAX®
16Pages

ABDOMINAL WALL CLOSURE MONOMAX®

CLINICAL EVIDENCE FOR ABDOMINAL WALL CLOSURE THE INLINE META-ANALYSIS (1) ❙ Evaluation of the optimal suture technique and material for abdominal fascia closure after elective midline laparotomy. ❙ 5 systematic reviews and 14 trials including 7711 patients were analysed. “ … there is a lower change of developing incisional hernia if the abdominal fascia is closed with a continuous technique using slowly absorbable suture material in comparison with interrupted technique with rapid-absorbable suture material.” ❙ Comparison of the interrupted technique using a rapidly absorbable braided...

NEW TRENDS IN ABDOMINAL WALL CLOSURE THE “SMALL BITES” TECHNIQUE In addition to the suture material, the technique plays an important role in the reduction of postoperative complications. STITCH STUDY (5) ❙ Comparison of the large bites suture technique with the small bites technique for fascial closure of midline laparotomy incisions. The primary outcome was the occurrence of incisional hernia. ❙ Prospective, multicentre, double-blind, randomised controlled trial including 560 patients. ❙ At 1 year follow-up: Small bites Incisional hernia rate Large bites Rates of adverse events did not...

THE CHALLENGE OF ABDOMINAL WALL CLOSURE THE CHALLENGE: ❙ Incisional hernias: Incisional hernia is a frequent complication after midline incisions of the abdominal wall. Its incidence varies from 9 % to 20 % in different studies (1). ❙ High intra-abdominal pressure: The suture line is frequently exposed to heavy loads, which might cause conventional sutures to cut the tissue and thus trigger hernias (8). ❙ Trocar site hernias: Incidence of about 1 % (higher incidence rates when using trocars of ≥10 mm compared with smaller trocars) (7). ❙ Long healing process: The abdominal wall fascia...

Monomax® FOR ABDOMINAL WALL CLOSURE Monomax® is the first and unique extra-long term absorbable monofilament synthetic suture material (11). Postoperative period (months) MAXIMUM ELONGATION Figure 2: Abdominal wall strength recovery compared with Monomax® degradation profiles (USP 1 and 0) (10, 12). Monomax elongates twice as much as polydioxanone sutures (13). ® “ Monomax® has peak values of elongation more than double the elongation values of PDS® II. According to the basic assumption that a more elongable suture material should have a positive impact on the tissue strangulation, Monomax®...

Monomax® FOR ABDOMINAL WALL CLOSURE Monomax® FOR SINGLE INCISION LAPAROSCOPY AND CLASSICAL MINIMAL INVASIVE SURGERY: Literature reports the need to use a slowly-absorbable or even non-absorbable suture to prevent trocar site hernias (7). Monomax® possibly reduces the incidence of incisional hernias in comparison to polypropylene sutures (in 2 years follow-up) (14). The use of Monomax® is adequate for fascia closure in open or in laparoscopic procedures (15, 16). Monomax® WITH HOOK NEEDLES FOR LAPAROSCOPIC PROCEDURE

Monomax® PRODUCT FEATURES Chemical composition Poly-4-hydroxybutyrate Color Violet Size USP 1 (metric 4), USP 0 (metric 3.5), USP 2/0 (metric 3) Tensile strength retention Mass absorption 50 % tensile strength retention at 90 - 210 days Essentially completed between 13 months and more than 36 months (17) General soft tissue approximation, especially when the use of an absorbable monofilament suture with an extended wound support up to 15 weeks is indicated. i.e. abdominal wall closure

Monomax® NEEDLE-THREAD COMBINATION ® Needle-thread combination 1/2 circle round bodied needle

1/2 circle round bodied needle

Monomax® NEEDLE-THREAD COMBINATION ® Needle-thread combination 1/2 circle round bodied needle Easyslide Easyslide 5/8 circle round bodied needle Easyslide Easyslide Easyslide HR 37 Ski needle round bodied needle 70 70 90 Hook round bodied needle with short cutting point 150 Easyslide Easyslide violet violet 1/2 circle round bodied needle with trocar point Easyslide Easyslide violet violet

1/2 circle round bodied needle with trocar point

Monomax® NEEDLE-THREAD COMBINATION ® Needle-thread combination 1/2 5/8 circle round bodied needle with trocar point Easyslide Easyslide 70 1/2 circle round bodied needle with blunt point

Monomax® REFERENCES (1) Diener MK, Voss S, Jensen K, Buchler MW, Seiler CM. Elective midline lapa rotomy closure: The INLINE systematic review and meta analysis. Ann Surg. 2010 May;251(5):843-56. (2) Seiler CM, Bruckner I, Diener MK, Papyan A, Golcher H, Seidlmayer C, et al. Interrupted or continuous slowly absorbable sutures for closure of primary elective midline abdominal incisions: a multicenter randomized trial (INSECT:I SRCIN24023541). Ann Surg. 2009 Apr;249(4):576-82. Baumann P, Savulescu F, Ferko A, Neoral C, Wente MN. Evaluation of a Monofile, Ultra-Long Absorbable Suture with High...

Distributed by: B. Braun Surgical, S.A. | Carretera de Terrassa, 121 | 08191 Rubí | Spain Phone +34 93 586 6200 | Fax +34 93 588 1096 | www.bbraun.com AESCULAP ® – a B. Braun brand Aesculap AG | Am Aesculap-Platz | 78532 Tuttlingen | Germany Phone +49 7461 95-0 | Fax +49 7461 95-2600 | www.aesculap.com Manufacturer acc. to MDD 93/42/EEC B. Braun Surgical, S.A. | Carretera de Terrassa, 121 | 08191 Rubí | Spain The main product trademark “AESCULAP” and the product trademarks “Monomax” and “MonoPlus” are registered trademarks of Aesculap AG. The product trademark “Monosyn” is a registered...