Quill™ Knotless Tissue-Closure Device
Quill™ Knotless Tissue-Closure Device represents a revolutionary technology in wound closure made possible by bidirectional fixation within the wound. Its patented design allows the surgeon to do things they could previously not do with traditional sutures.
Barbs within the Quill™ device distribute tension across the entire length of the wound or tissue being approximated, and eliminate the need for interrupted suture or tying knots. The unique bidirectional barb design of the Quill™ device allows two surgeons to work on one wound at the same time which may increase operating time efficiency.
Main Features
- Controls and distributes tension across the entire length of the wound
- Enables use of running vs interrupted sutures
- Eliminates the need to tie knots
- Has the potential to decrease time under anesthesia, thereby reducing surgery risks associated with prolonged anesthesia
- Increases efficiency by saving time
- Allows two individuals to close a wound at the same time
- May help reduce tissue trauma, facilitate healing and minimize scarring
- Eliminates the need for a 3rd hand or assistant
- Facilitates closure of difficult wounds, including purse-string applications or deep wounds where space may be limited
- Reduces the number of sutures needed to securely close multiple deep layers
- Is well suited for a variety of soft tissue-closure procedures in orthopedic, plastic, gynecologic and urologic surgery
Deep Subcuticular Closure
Advantages
- Avoids knot tying and palpable knots.
Closure of wounds where the depth is limited to the full thickness of the skin.
Figure 1 Start by taking one end of the Quill™ device and pulling it through until the transition zone has reached the tissue. Estimation of the center of the device can be aided by taking a single bite of tissue, then aligning the two needles until both ends of the Quill™ device are of roughly equal length.
Figure 2 Taking one arm of the Quill™ device, complete at least two loose arcs through the tissue, then take a few tissue bites with the other arm of the device.
Figure 3 Once at least two arcs per side have been deployed, each of the strands can then be grasped and the tissue approximated to the desired tension. Continue the bites sinusoidally until you reach the end of the wound.
Figure 4
Take the last bite 2 cm beyond the end of the wound, exiting through the skin. Repeat the technique on the opposite side. Push down on the tissue and cut the device and needle flush with the skin.
Dual Layer Closure
Advantages
- Single device is used to close the subcutaneous tissue, deep dermis, and subcuticular layer.
- Avoids knot tying and palpable knots, and possibly uncomfortable or extruding knots.
Closure of wounds that include the full thickness of the skin and the subcutaneous fat.
Figure 1 Using a helical suturing technique, pass the first needle through the tissue until the midpoint is reached. The midpoint can be approximated by roughly aligning the needles together as illustrated. Do not pass the first needle beyond the midpoint.
Figure 2 Take at least 1 more pass with the first needle, followed by at least 2 loose passes with the second needle. Once each needle has been loosely passed at least twice, secure the midpoint by cinching Quill™ device.
Figure 3 Close the deeper layer using a helical suturing technique. After the last pass in deep tissue, use a backstitch to secure Quill™ device. Cut the excess.
Figure 4Use the second needle to close the superficial layer. Beginning at the edge of the incision, close the wound subcuticularly, using a deep subcuticular suturing technique. At the end of the incision, exit through the skin lateral to the wound incision or use a backstitch to secure Quill™ device. Push down on the tissue and cut the excess
Deep Layer Closure
Advantages
- Faster closure with fewer Quill™ devices required and no knot tying.
Closure of incisions that include the SFS and deep fat. Multiple layer closures can be performed using a helical suturing technique.
Figure 1 Start at the midpoint. Using a helical suturing technique, pass the first needle through the tissue until the midpoint is reached. The midpoint can be approximated by roughly aligning the needles together as illustrated. Do not pass the first needle beyond the midpoint.
Figure 2 Take at least 1 more pass with the first needle, followed by at least 2 loose passes with the second needle.
Figure 3 Once each needle has been loosely passed at least twice, approximate the wound by pulling on both ends of Quill™ device. Based on surgeon experience and the particular configuration used, some surgeons may find it unnecessary to loosely pass both needles twice before approximating the wound.
Figure 4 Continue closing the deep layer with each needle, securing the ends by employing a backstitch within the wound margin. When approximation is complete, simply cut off the excess without the need to tie knots.
High Tension Closure
Advantages
- Allows distribution of tension at right angles to device line, for increased support to discourage scar widening
Aid in wound approximation with an additional 90 degree angle of tension control.
Figure 1 Mark the vector lines of the Quill™ device; at 5 cm intervals. Insert the needle from either side of the wound through the full thickness of the wound, exiting the skin at least 3 cm from the border of the wound.
Figure 2 Hold tension on the device and ratchet the wound edges close together.
Figure 3 Repeat the procedure until the wound is an optimal size. Close the wound in layers discarding the ends of the Quill™ device and the attached needles.
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