Adhesive Retention Suture Device
Closing acute wounds under tension on fragile skin is challenging. Suture can rip through the skin, second intent healing can take months to heal with frequent dressing changes, and flaps and grafts have a high rate of complications.
The HEMIGARD™ Adhesive Retention Suture (ARS) device was created to address these problems.
The HEMIGARD™ ARS bolsters skin strength to enable use of a retention suture under high tension without skin ripping, enabling linear closure of the wound.
The HEMIGARD™ ARS has three zones: (1) a rigid and waterproof zone with that faces the wound and will not rip under high tension, (2) a middle zone that is less stiff, but still waterproof, and (3) a trailing zone with low stiffness to lessen the risk of shear-induced blistering at the trailing edge.
HEMIGARD™ ARS device
How it works
The HEMIGARD™ ARS is intended to be used to close surgical wounds surrounded by clean and dry skin with minimal hair. After preparing the skin, one HEMIGARD™ ARS strip is laid on each side of the wound with holes facing the wound, about 10mm or more from the edge of the wound. Then, a retention suture is placed by piecing its needle down through the hole on one of the HEMIGARD™ ARS strips. The same needle is then pierced up through the hole of the second HEMIGARD™ ARS strip on the other side of the wound. Two holes are in each strip allowing surgeons to suture with a simple interrupted pattern (one hole) or vertical mattress pattern (two holes).
Next, the surgeon applies tension by pulling the suture so that the wound edges come together. To facilitate placement of dermal sutures, it is helpful to leave a gap of 2-3mm between wound edges. After adequate tension has been applied, the retention suture is knotted and remains in place until suture removal.
Dermal sutures are performed next, prior to completion of a superficial closure (e.g. sutures, staples, adhesives).
Patients are given wound care instructions, which encourage keeping the HEMIGARD™ ARS strips clean and dry. Also, if the lateral zones start to peel off the skin, they should be taped down with bandages, rather than cut off.
For most leg wounds, it is advisable to have patients restrict activity, elevate the leg and, unless there are contraindications, use some form of external compression to mitigate swelling. The patient’s overall, vascular and skin health must be considered when choosing any dressings and/or external compression.
The HEMIGARD™ ARS can be retained for up to two weeks to provide postoperative protection from skin tearing. At removal, the retention suture is first cut, removed and discarded. Then, the rigid inner zone of each HEMIGARD™ ARS strip is lifted off the skin. Grasp that portion and gently pull directly opposite to the wound. If there is resistance, place warm soaks on the HEMIGARD™ ARS strips for several minutes prior to re-attempting.
Remove and discard both HEMIGARD™ devices. If appropriate, remove any residual non-absorbable wound supports. Provide patient with instructions on further wound care (e.g. steristrips, when to return to activities)
Cleanse and degrease skin as per IFU.
Place HEMIGARD™ Adhesive Retention Suture Device with holes facing toward wound.
Place full thickness suture through reinforced holes of HEMIGARD™ Adhesive Retention Suture Device.
Place additional wound closures supports (e.g. sutures, staples).
*Please refer to the Instructions for use for additional information.
How is HEMIGARD™ ARS better than suturing through other retention tapes or film dressings?
Those materials may work well for select cases in which fragile wounds are closed under minimal tension. However, they may fail intraoperatively and postoperatively. They also lack the zonal advantages of the HEMIGARD™ ARS in providing a stiff, rip resistant advancing edge with stretchy trail edge to prevent blistering.
What minimum size of retention suture do you recommend?
At minimum, 2-0 nylon. We offer a custom 0 nylon with 24mm needle.