FSS-65-II-A - A2A Integrated Logistics Inc. - 36F79719D0083

General Services Administration Federal Supply Service

Authorized Federal Supply Schedule Price List

On-line access to contract ordering information, terms and conditions, up-to-date pricing, and the option to create an electronic delivery order are available through GSA Advantage!, a menu-driven database system. The INTERNET address for GSA Advantage! is: www.GSAAdvantage.gov.

Schedule 65IIA Medical Equipment & Supplies Contract No. 36F79719D0083

Contract Period: 1/15/2019 through 1/14/2024

A2A Integrated Logistics Inc.

1830 Owen Dr. Ste 10-2 Fayetteville, NC 28301

Phone: (Main) 910-356-5500, Ordering: 800-493-3736 FAX: Main – 973-527-5299 www.a2a-logistics.com

Small Business CAGE CODE: 6HR51

Contract Administration tbryant@a2a-logistics.com

PH: 973-527-5299

DUNS: 96-891-3900 SAM Registered

Ordering & Customer Service salesservice@a2a-logistics.com PH: 800-493-3767, FAX: 973-527-5299 As of 01/15/2019

Customer Information

1. Table of awarded SINs:

Accepted SINs A,1, A·2b, A·l0, Allc, A· 17, A•l8a, A•l9, A·21b. A·33a, A-82, A-83, and A·92

2. Maximum Order: $100,000.00

3. Minimum Order: $100

4. Geographic Coverage: 48 Contiguous States and the District of Columbia, Alaska, Hawaii, The Commonwealth of Puerto Rico, and U. S.

Territories

5. Points of Production: US Only

6. Discount Range: 1.99% to 6.51%.

7. Quantity Discounts: 1.5% additional discount for purchases of 100 Cases or more. Products may be combined to achieve this discount term. Orders must be on a single purchase to a single location. Total discount will be taken off net invoice.

8. Prompt Payment Terms: Net 30 days.

9. (a & b) Government Purchase Cards: Government Purchase Cards are accepted both above and below the micro-purchase level.

10. Foreign Items: All items under Contract 36F79719D0083 are Trade Agreements Act (TAA) compliant - made in the USA.

11. Delivery Times:

30 days After Receipt of Order (ARO) SINS A·l, A-2b, A-10. A-llc. A-17, A-18a, A·l9. A·2lb, and A·33a

Contact Contractor Contact Contractor

Time of Delivery:

Expedited Delivery:

Overnight & 2 Day:

Urgent Requirements: Contact Contractor

12. FOB Point: Destination within 48 contiguous states and the District of Columbia. Delivery to Alaska, Hawaii, Puerto Rico, and the U.S.

Territories will be FOB inland carrier, point of exportation, with the transportation charges to be paid by the Government from point of exportation to destination in Alaska, Hawaii, Puerto Rico, and the U.S. Territories, or as designated by the ordering office.

13. Ordering Address: A2A Integrated Logistics Inc, 1830 Owen Dr., Suite 10-2, Fayetteville, NC 28301, Attn: Tony Bryant

14. Payment Address: 1830 Owen Dr., Suite 10-2, Fayetteville, NC 28301

15. Warranty Provision: Standard Commercial Warranty. Please contact A2A Integrated Logistics for a copy of the warranty.

16. Export Packaging Charges: Not Applicable

17. Terms & Conditions of Government Purchase Card Acceptance: Government Purchase Card accepted for all orders meeting card limits.

18. Terms & Conditions of Rental, Maintenance & Repair: Not Applicable

19. Terms & Conditions of Installation: Not Applicable

20. Terms & Conditions of Repair Parts: Not Applicable

21. List of Service & Distribution Points: Not Applicable

22. List of Participating Dealers: Not Applicable

23. Preventive Maintenance: Not Applicable

24a. Special Attributes: Not Applicable

24b. Section 508 Compliance for EIT: Not Applicable

25. DUNS Number: 968913900

26. Central Contractor Registration (CCR): A2A Integrated Logistics is

Registered in CCR A2A Integrated Logistics CAGE CODE: 6HR51

45 days After Receipt of Order (ARO) SINS A-82, A-83, and A-92

Table of Contents Supplies Contract No. 36F79719D0083

PRODUCT AREA PRODUCT DESCRIPTION Pages

SURGICAL LUBRICANTS

ULTRASOUND GELS

4 - 26

SPECIALTY ENDOSCOPY

• Paracentesis Pumps & Kits

• Specialty Garments

• Bite Blocs

• Drainage

Our FSS listing features the RenovaRP Paracentesis Management System and all related products for safe, efficient and cost effective procedures for Ascites.

Listing features CLIA-Waived HpFast™ and HpOne™ H.

pylori Tests for safe cell removal utilizing breakaway biopsy pic and spatula eliminating the use of syringes

27- 28

SUTURES

Self-Retaining Knotless Sutures Barbed / Micro-sutures

Listing features three (3) brands of knotless sutures manufactured by Surgical Specialties 1) Sharpoint 2) Quill-Barbed Sutures and 3) Sharpoint Micro-sutures.

Applications include proven multiple tissue layer closure and scar elimination for:

• Dermatologic Surgery

• Orthopedic Surgery

• Laparoscopic and Robotic gynecologic procedures

• Pacemaker procedures

• Plastic Surgery

• Urologic Procedures and other soft tissue procedures

29 - 74

MEDICAL CARTS

• Emergency

• Anesthesia

• Isolation

• Treatment / Procedure

• Bedside / Slim Carts

• Hyperthermia and phlebotomy charts

• RX – Pharmacy Dispensing

Listing features medical carts manufactured by Waterloo providing a diverse selection of medical carts in aluminum and steel medical carts with options for security that include key locking systems, breakaway locking systems, gate locking systems, push button, electronic with WiFi option and dual access controlled substance drawers. Every solution is fully customizable to the customer’s needs.

75 - 93

POWERED MEDICAL

COMPUTER WORKSTATIONS

• Emergency

• Anesthesia

• Electronic Record Integration

Listing features mobile technology workstations manufactured by Altus. The design of these workstations are the result of studying clinicians’ needs to enhance efficiency and workflow. Proven to enable optimized mobility, adjustability, access to patient data, documentation at the point of care, and clinician well-being.

FSS TOTAL Price List Full List of Prices as Listed on GSA Advantage 125-132

94 - 124

Manufactured by HR Pharmaceuticals listing includes SurgilubeTM the only cabomer-free surgical lubricant manufactured without gamma. The only surgical lubricant approved for use with the Hologic Thin Prep

Pap test. Listing also features Ultrasound gels including the green processed EcoVue.

anthony_laj_bryant A2A Logo

RenovaRP®

Paracentesis Pump

� Automated procedure for large volume paracentesis

�Disposable heavy-duty bags may be changed without interrupting procedure

� Clean, safe and fast

Sp ec ia lt y En d o sc o p ic

P ro d u ct s

Save time through efficiency. Traditional paracentesis relies on glass bottles and/or gravity bags to drain ascitic fluid from the abdomen, taking hours.

By using an automated pump, your patient is treated quickly and effectively, saving valuable clinical time.

T

Item No. Title Quantity

GIS-27 Paracentesis Pump One Unit

GIS-28 Paracentesis Kit Box of 5

GIS-29 Bags Box of 20

Ordering Information

� Special cannula design prevents leakage of ascitic fluid

� Pre-assembled tubing set

� Convenient

� Additional bags and tubing sets available

� Sets up quickly

Kit Contents:

2 - Drainage Bags 1 - Pump Tube Set 1 - Paracentesis Device Assembly 1 - 30cc Luer Lock Syringe 1 - Filter Straw® 5 um Particulate Matter Filter 1 - 10cc Luer Lock Syringe 1 - 15 Gauge Needle 1 - Package Povidone-Iodine Swabsticks

(3 per package) 1 - Fenestrated Drape 2 - 5 ml Ampuls 1% Lidocaine 1 - 25 Gauge x 1-1/2” (3.81cm) Needle 1 - 18 Gauge x 1-1/2” (3.81cm) Needle 3 - 5 ml Printed Sample Vials 3 - Sample Vial Caps 1 - #11 Blade Scalpel 1 - Plastic Bandage 5 - 4”x 4” Gauze Pads 3 - Alcohol Prep Pads

Paracentesis Kit (for use with RenovaRP Pump)

© 2015 GI Supply. All rights reserved.

G-1216-02

An ISO 13485 Certified Company

Quill™ Knotless Tissue Closure Device for Dermatologic Reconstruction

The Quill™ device eliminates suture knots saving valuable time and improving practice efficiency.

Quill™ Knotless Tissue Closure Device

Barbs arranged in spiral along suture

Variable loop provides a simple fixation method

Square body for stability in the needle holder Multilayer silicone coating to reduce drag

Long taper for easy penetration

A needle designed for control during dermatologic reconstruction.

Proprietary alloy maintains sharpness and resists bending

Barbs provide eight (8) points of fixation per cm

Key Benefits Time and cost savings:

• Faster wound closure time.

• Security of an interrupted stitch with the speed of a running stitch.

• Eliminates need for surface suture.

Better patient outcomes:

•Wound tension is evenly distributed across the barbs.

• Eliminates train-track scars.

Quill™ is ideal for these clinical scenarios:

Where speed and efficiency are needed Wounds under high tension Older patients with friable tissue

Wound tension is distributed across eight (8) barbs per cm reducing the force as compared to a single suture knot.

The Quill™ knotless tissue closure device is designed with barbs that engage the tissue and evenly distribute tension across the wound.

Testing performed by independent lab.

Acculine Engineering; Waterbury, CT

Suture Knots Quill™ Barbs

Fo rc e (G ra m s F or ce

Tension at Fixation Point Suture Knots vs Quill Barbs

1 2 3 4 5 6 7 8 9 10

Fo rc e Gr am s

Needle Pass #

Penetration Force PS-2 on 3-0 Monoderm

Standard Dermatologic

60% improvement

60% improvement in penetration

Less tension is better

Basic Quill™ Closure Technique

Anchor the Quill™ device with the variable loop.

Step 1 Anchor the Quill Device With the Quill™ device needle, take initial bite of tissue. Then, pass the needle through the variable loop.

Cinch down to engage the barbs at the fixation point.

Watch this two layer closure surgical animation at QuillDevice.com/Derm

Step 2 Run the Stitch Continue approximating the tissue in a running fashion until the opposite end of the wound is reached.

Step 3 Lock the Stitch Secure the end by employing a few backstitches and cut the remaining Quill™ flush with the tissue to complete.

If approximating the subcuticular layer, exit laterally and cut flush with the skin.

Dermatologic Surgeon Testimonials

Keith LeBlanc, M.D.

New Orleans, LA

Quill saves time, especially on large closures and in elderly patients with friable skin. It has been a game changer for repair of these defects.

John Strasswimmer, M.D.

Delray Beach, FL

I can now close wounds that would normally require a skin graft by using Quill PDO on the deep subcutaneous layer to reduce tension followed by Quill Monoderm subcuticularly.

Helen Raynham, M.D.

Boston, MA

Quill is my “go-to" suture for any linear closure whether it be on the face, trunk, or extremities. My closures are quicker and cheaper with Quill sutures. Cosmetic outcomes are excellent. 30

Quill™ Knotless Tissue Closure Device for Dermatologic Reconstruction

USP Size (Box of 12)

Fine Reverse Cutting Needle Color Length 4-0 3-0 2-0

P-3 13mm 3/8 Circle Undyed

20cm VLM-3001 VLM-3002

30cm VLM-3003

PS-2

19mm 3/8 Circle Undyed

20cm VLM-3007 VLM-3009

30cm VLM-3008 VLM-3010

USP Size (Box of 12)

Fine Reverse Cutting Needle Color Length 4-0 3-0 2-0

P-3 13mm 3/8 Circle Violet

20cm VLP-3021

30cm VLP-3022

PS-2

19mm 3/8 Circle Violet

20cm VLP-3026 VLP-3027

30cm VLP-3028

PS-1

24mm 3/8 Circle Violet 30cm VLP-3029

Monoderm™ (PGA-PCL)

PDO (polydioxanone)

Surgical Specialties Corporation, 247 Station Drive, Suite NE1, Westwood, MA 02090, U.S.A.

Phone: 610.404.3520 • 877.991.1110 (USA and Canada only) • Fax: 610.404.4010 All trademarks are owned by the company and its affiliates. ©2018 Surgical Specialties Corporation.

All Rights Reserved. SSC-088 R0 11/17

For More Information, Visit QuillDevice.com

Call Customer Service at 877-991-1110.

Quill™ is available through major healthcare distributors.

Material Guide Description BSR Profile Mass Absorption

Monoderm™

(PGA-PCL)

Absorbable Monofilament Undyed (clear)

In vivo strength retention:

42% to 76% at 7 days 36% to 52% at 14 days

Essentially complete between 90 and 120 days

PDO

(polydioxanone)

Absorbable Monofilament Dyed (violet)

In vivo strength retention:

80% at 2 weeks 60% at 4 weeks 40% at 6 weeks

Minimal until approximately 120 days Essentially complete by 180 days

As with traditional sutures, the Quill™ device suture size is determined by its OUTER diameter. It is therefore recommended that when using the Quill™ device, you upsize by one USP compared with traditional suture. For example if previously using a 3-0 traditional suture, we recommend using a 2-0 Quill™ device.

Experience the extraordinary in laparoscopic and robotic gynecologic procedures

In sacrocolpopexy and hysterectomy procedures, surgeons report:

• The bidirectional barbed structure “enables the surgeon to be more independent and agile” during the tedious and time-consuming task of peritoneal closure in laparoscopic sacrocolpopexy procedures.

- Ghomi A, Askari, R. 20101

• In a one-year retrospective analysis of 113 consecutive total laparoscopic hysterectomies, “No cases of cuff dehiscence, hematoma or cellulitis occurred.” The authors concluded that the use of the Quill™ device appears to be safe and efficient when closing the vaginal cuff in a

TLH…”

-Einarsson JL, et al. 20092

1 Ghomi A, Askari, R. Use of a bidirectional barbed suture in robot-assisted sacrocolpopexy. J Robotic Surg. Published online 2010: http://springerlink.com/content/r22q11555V123755/fulltext.html.

2 Einarsson, JL, et. Al. The use of bidirectional barbed suture in laparoscopic myomectomy and total laparoscopic hysterectomy: an evaluation of safety and clinical outcomes.

J Minim Invasive Gynecol. 2009;16:S28-S29.

Learn more about how the Quill™ device is transforming the nature of soft tissue closure at www.angioedupro.com.

© 2007-2010 Angiotech Pharmaceuticals, Inc.

© 2007-2010 Surgical Specialties Corporation All Rights Reserved.

Quill™ is a trademark of Quill Medical, Inc.

Quill™ 0065 03/11

4 NEW

Codes!Quill™ Knotless Tissue-Closure Device

Now Available in Four New Laparoscopic / Robotic GYN codes

The Quill™ PDO device in peritoneal closure for the Sacrocolpopexy procedure. Angiotech, Reading, PA.

Experience the extraordinary

Transforming the nature of tissue closure

• With its unique bidirectional barbed design, the QuillTM Knotless Tissue-closure Device is the only one that completely eliminates the need to tie knots and the potential for knot-related complications

• Makes soft tissue approximation faster and easier by replacing knots with running closure

• Engineered to evenly distribute tension along the closure

• Barbs provide immediate tissue hold on placement, potentially eliminating the need for an assisting “third hand”

• Outperformed same-size conventional suture material in both tensile strength and tissue-holding capacity in in-vitro testing1

• Proven across a wide range of gynecologic procedures— including myomectomies, hysterectomies, sacrocolpopexies, and utero-ovarian suspension techniques

Extend your reach in gynecologic surgery with greater speed and security

In gynecologic surgery

Experience the extraordinary in laparoscopic and robotic gynecologic procedures

In myomectomy defect repair, surgeons report

• The QuillTM device reduced tissue “recoil,” making it easier to reapproximate the myometrium, while achieving excellent hemostasis —Greenberg JA, Einarsson JI. 20082

In an analysis of approximately 300 laparoscopic procedures including 100 myomectomies, Einarsson found3,4

• The Quill™ device “greatly facilitates myometrial closure because there is no need to tie knots and there is no backsliding of the suture, which enables continuous wound closure… throughout the repair.”

—Einarsson JI. 20104

• Knotless tissue closure may be especially valuable in single-incision myomectomy, as the task of knot-tying is even more challenging than in the multi-port approach4

In sacrocolpopexy and hysterectomy procedures, surgeons report

• The bidirectional barbed structure “enables the surgeon to be more independent and agile” during the tedious and time-consuming task of peritoneal closure in laparoscopic sacrocolpopexy procedures —Ghomi A, Askari R. 20105

• In a one-year retrospective analysis of 113 consecutive total laparoscopic hysterectomies, “No cases of cuff dehiscence, hematoma or cellulitis occurred.” The authors concluded that the use of the Quill™ device “appears to be safe and effi cient when closing the vaginal cuff in a TLH…” —Einarsson JI, et al. 20096

Myomectomy closure using size 0 PDO QuillTM device.

Procedure performed by John Ivar Einarsson, MD, MPH, and Jim Greenberg, MD.

© 2007-2010 Angiotech Pharmaceuticals, Inc.

© 2007-2010 Surgical Specialties Corporation All Rights Reserved.

QuillTM is a trademark of Quill Medical, Inc.

0034 10/10 OB/Gyn Sell Sheet

References: 1. Leung JC, Ruff GL, Batchelor SD. Performance enhancement of a knotless suture via barb geometry modifi cations. 7th World Biomaterials Congress 2004 Proceedings.

p. 1587. 2. Greenberg JA, Einarsson JI. The use of bidirectional barbed suture in laparoscopic myomectomy and total laparoscopic hysterectomy. J Minim Invasive Gynecol. 2008;

15(5):621-623. 3. Einarsson JI. Laparoscopic myomectomy: 8 pearls. OBG Management. 2010;22(3):49-62. 4. Einarsson JI. Single-incision laparoscopic myomectomy. J Minim Invasive Gynecol. 2010;17(3):371-373. 5. Ghomi A, Askari R. Use of a bidirectional barbed suture in robot-assisted sacrocolpopexy. J Robotic Surg. Published online 2010: http://springerlink.com/ content/r22q11555V123755/fulltext.html. 6. Einarsson JI, Vellinga T, Twijnstra ARH, et al. The use of bidirectional barbed suture in laparoscopic myomectomy and total laparoscopic hysterectomy: an evaluation of safety and clinical outcomes. J Minim Invasive Gynecol. 2009;16:S28-S29.

Learn more about how the QuillTM device is transforming the nature of soft tissue closure at www.angioedupro.com.

Experience the extraordinary

In gynecologic surgery

Clinical Roundtable in Orthopedics

Advanced Wound Closure Techniques: Use of QuillTM SRS bidirectional barbed wound closure device in arthroplasty. Clinical experience in over 8,000 cases.

An expert panel of orthopedic surgeons, with a subspecialty in arthroplasty, was recently convened to share their extensive experience with Quill Self-Retaining System (SRS) (Angiotech, Reading, PA).

Collectively, these surgeons have performed over 8,000 arthroplasty procedures using Quill SRS and, in the process, have gained considerable insight into the optimal application of this novel technology.

A panel of experts weigh in

› Keith R. BeRend, Md

Clinical Assistant Professor, Orthopedics, Ohio State University;

Joint Implant Surgeons, Inc., New Albany, OH

› FRed d. CushneR, Md

Chair, Division of Orthopedics, Southside Hospital, Bayshore;

Director, Insall Scott Kelly Institute, New York, NY

› MiChael e. BeRend, Md

Center for Hip & Knee Surgery, St. Francis Hospital, Mooresville, IN

› CRaig J. della Valle, Md

Associate Professor, Dept. of Orthopedic Surgery, Rush University Medical Center, Chicago, IL

› MiChael a. MOnt, Md

Rubin Institute for Advanced Orthopedics, Director of Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD

FACULTYMODERATOR

Keith BeRend this group of arthroplasty surgeons was brought together from across the country to:

› Discuss various techniques that they have refined using Quill SRS in their individual practices.

› Reflect on their observations regarding the strength, security, and efficiency of wound closures performed with Quill SRS.

› Provide tips to new users based on their experience with this product to date.

how long have you been using Quill sRs?

CRAig DELLA VALLE I started using Quill SRS approximately 2 years ago, and have since performed about 1,500 procedures.

MiChAEL BEREnD Our group has had a similar experience: 2 years and about 1,500 procedures.

MiChAEL MOnT 1 1/2 years and approximately 1,000 to 1,200 cases.

FRED CUshnER 2 1/2 years and 300 cases.

KEiTh BEREnD Our experience goes back about 2 1/2 years and encompasses more than 4,000 cases.

So, in total, the panel has experience using Quill SRS for 1 1/2 to 2 1/2 years in well over 8,000 procedures.

What initially intrigued you about the concept of a bidirectional barbed suture?

CRAig DELLA VALLE What initially caught my interest was the potential for increased operating room efficiency that could be achieved with a device that was both running and self-anchoring.

“So, in total, the panel has experience using Quill SRS for 1 1/2 to 2 1/2 years in well over 8,000 procedures.”

“We found that when we made the switch from traditional sutures to Quill SRS, we reduced our closure time by about 50 percent.”

What have you seen in terms of efficiency of closures performed with Quill sRs compared with traditional sutures?

FRED CUshnER We found that when we made the switch from traditional sutures to Quill SRS, we reduced our closure time by about 50 percent. We actually collected data looking at our operating room times for knee arthrotomy closures during total knee replacement procedures. The only difference between groups was the material used for the closure: interrupted Vicryl™ for one group and Quill SRS for the other. In the latter group, Quill SRS was used for the arthrotomy, the subcutaneous, and the subcuticular layers.

Staples were used for the skin. We found that we reduced closure time by about 10 minutes just by changing the method of closure. Once again, this represented a 50 percent reduction in our closure time.

Clinical Roundtable in Orthopedics

MiChAEL MOnT We have very similar data for our hip closures, which are performed using an anterolateral approach. We were averaging approximately 20 to

25 minutes for putting down our abductors to the fascia lata, subcutaneous tissue, and skin. With Quill SRS, the time became about 10 to 12 minutes. We realized a savings of 10 to 13 minutes per case. The time savings really starts to add up when you consider the number of cases we perform.

This is just one of the potential advantages of Quill SRS that we have found.

Quill SRS has proven to be an efficient wound closure device that eliminates both the tying of knots to secure the closure and the need for a third hand to follow the suture placement.

Quill™ Self-Retaining System –Quill™ SRS do you have any other data or anecdotal comments on the benefits of using Quill sRs over traditional suturing techniques?

What is the learning curve for use of this device? and, how does that extrapolate to new users, residents, fellows, or medical students?

“Another benefit is that, when 2 surgeons are sewing away from each other with Quill SRS, the chance of having an accident is minimized.”

Page 4 Clinical Roundtable in Orthopedics

MiChAEL BEREnD I think the learning curve is very short.

First you need to get a feel for the system – how to put the initial 2 stitches in, how to set the tension at the central portion of the wound – and you need to get used to closing from the middle out. I think that, with 5 to 10 cases, you will get a good feel for the tension, the function of the device, the strength of the suture, and the strength of the needle and suture interface. I believe that the tension achieved with

Quill SRS across the entire wound is superior to that of an interrupted suture, and failure should be less common, as articulated in the work from Dr. Khanuja.

MiChAEL MOnT I believe that Quill SRS is so much easier and safer to use than tying knots. every time you grab a

Quill SRS needle, in my opinion, it makes a quite even biomechanical closure that almost anybody can do from the beginning. You cannot get consistently good closure when you are tying suture knots with different residents and fellows. One person ties this way; another person ties another way. With Quill SRS, it is consistent.

Clinical Roundtable in Orthopedics Clinical Roundtable in Orthopedics

FRED CUshnER We had the impression that we were getting a more watertight closure with Quill SRS. So, we went to the lab and did a study comparing interrupted Vicryl sutures to Quill SRS for the arthrotomy closure. We hooked up an arthroscopy pump, and then set it at 100 mm of pressure.

Unlike the interrupted suture that leaked significantly, we achieved a more watertight closure using Quill SRS. We also loaded it to failure by cutting 1 or 2 stitches. Quill SRS did not unravel or dehisce. However, the loss of 1 or 2 of the interrupted stitches led to increased loss of fluid from the joint capsule.

MiChAEL BEREnD We have used Quill SRS closure system for probably 1,500 cases, with 60% of those being knees, including partial knee replacements, total knee replacements, and total knee revisions. Overall, Quill SRS has made the closures significantly easier and more efficient. Switching from an interrupted suture to a running self-anchoring suture is obviously a time-saver for us. In addition, it is also my perception that both the strength of the closure and the reproducibility of a watertight closure are significantly better with PDO Quill SRS. Initially, we had concerns over the strength of the closure and reinforced it with additional figure eight sutures. However, with the experience we have gained to date, we are now confident to use #2 PDO Quill SRS to close the capsule alone. And, there is efficiency gained by passing Quill SRS back and forth such that 2 assistants can sew throughout the closure period. We believe this is a significant advantage over traditional closure techniques.

KEiTh BEREnD At the recent 2010 AAOS meeting in new Orleans, Simon Mears presented some interesting data on this subject from Dr. Khanuja’s group. Using a cadaveric model of medial parapatellar arthrotomy repair, their team performed a running closure with #2 PDO Quill SRS and an interrupted closure with #1 Vicryl sutures in 8 paired knees.

The knees were then subjected to cyclic loading. Both repairs maintained the closure during the initial 2,000 cycles.

After that, sutures were cut sequentially starting at the center and subjected to further cycling. The closure using

Quill SRS survived significantly more cuts than did the interrupted closure, with the interrupted repair failing after a mean of 3 sutures cut, while the running repair using

Quill SRS failed after a mean of 5 cuts. So, these data confirm our impression that an arthrotomy closed with

Quill SRS is indeed stronger and is more resistant to suture failure than one closed with an interrupted approach.

What other benefits have you observed with this device?

CRAig DELLA VALLE We also found a statistically significant improvement in operative time. In addition, the needle count was less. This should not be underestimated. Having additional sharp objects on the field is a negative. Using fewer needles is really helpful. In addition, data that Mike Mont has shared with me has shown that, depending on what is used for the traditional closure, Quill SRS can really lead to cost savings.

MiChAEL MOnT We have definitely found a cost savings, although this may be specific to the prices at our hospital.

I had been using 5 to 6 traditional sutures compared with

3 Quill SRS. But, some of the surgeons have been using pop-offs, going through 12 or 14 regular Vicryl sutures.

So for them, there was an obvious cost savings. Another benefit is that, when 2 surgeons are sewing away from each other with Quill SRS, the chance of having an accident is minimized. We have had virtually no glove perforations or penetrations while using Quill SRS. every time that you are re-setting a needle with a standard suture, there is a chance of glove perforation. Obviously this has to do with experience, but we are working with residents and fellows.

CRAig DELLA VALLE When I first started using Quill SRS, I was a little intimidated to use this device in complex wounds, particularly around the knee – for example, in a second stage re-implantation where closing the arthrotomy can be tight.

We have since found, in conjunction with both hand surgeons and plastic surgeons, that because of the nature of the device, Quill SRS actually works particularly well for these tight wounds that are difficult to close. As you close the wounds, the device shares the stresses – that is, the stress is distributed along the length of the closure. We have found that Quill SRS really does give you a much better closure for very tight wounds than individual sutures do. I would also like to mention that some thinner patients, who do not have a lot of subcutaneous tissue, particularly on the knee, would otherwise feel knots underneath the skin from non-absorbable materials. Quill SRS eliminates that problem.

MiChAEL MOnT I agree. Another great advantage occurs in cases with poor tissue quality. In my experience, Quill SRS will approximate those suboptimal areas where you would not have an easy time putting in a knot. Also, Quill SRS will allow you to get into small crevices in the corners of wounds where it is similarly difficult to place knots. Obviously, this device has tremendous advantages in minimally invasive surgeries where there may be limited access.

KEiTh BEREnD Prior to the use of Quill SRS, we had also seen patients who developed seroma subcuticularly at the site of their Vicryl suture knots. Quill SRS also seems to have eliminated this problem, because there are no knots.

“Quill SRS has made the closures significantly easier and more efficient.... there is efficiency gained by passing Quill SRS back and forth such that 2 assistants can sew throughout the closure period. We believe this is a significant advantage over traditional closure techniques.”

What is the appropriate tension to use with this device? For a knee arthrotomy?

For a hip fascial layer?

MiChAEL MOnT In my practice, I try to close a knee arthrotomy in about 30 degrees of flexion. One of the biggest problems that I have seen with new users is that they pull Quill SRS as if they are tying a knot. They can actually pull the needle off the suture. Then we have to decide what to do: open another Quill SRS or finish the wound with regular Vicryl. I do not have absolute guidelines; just do not overpull this device. As Michael Berend said earlier, the learning curve here is approximately

5 or fewer cases to really get the feel for this technique.

are there any drawbacks to using this device?

FRED CUshnER We have been using Quill SRS now for approximately 2 1/2 years. Initially, we had some superficial reactions with PDO Quill SRS. This was before 3-0 PDO Quill SRS and MOnODeRM Quill SRS product became available. At that time, we were using PDO Quill SRS 0 and 2-0 for the subcuticular layer. I believe we were getting a reaction in cases where the subcutaneous and subcuticular layers were too close. I think that there was just too much long-lasting absorbable material in the subcuticular area. Since we have switched to 3-0 MOnODeRM Quill SRS in the subcuticular space, the problem of superficial reactions in the subcuticular layer has been eliminated.

What are you using to close the skin?

MiChAEL MOnT I use MOnODeRM Quill SRS, which gets absorbed pretty quickly. I had been using staples before this.

The patients love it since there are no staples anymore, and I have been very satisfied with the wound healing and appearance.

FRED CUshnER Getting rid of staples may actually be a good thing. A meta-analysis was just published in March in the British

Medical Journal comparing the clinical outcomes of staples versus traditional sutures in wound closure after orthopedic surgery.

They found a significantly higher risk of superficial skin infections when staples were utilized compared to sutures.

CRAig DELLA VALLE In the hip, I am more comfortable not using staples; we use Dermabond®. In the knee, we use

Dermabond and we still use staples as well.

KEiTh BEREnD Throughout our entire experience with Quill SRS, we have used Dermabond on the skin for all primaries, and staples for most revisions.

Page 6 Clinical Roundtable in Orthopedics

“The other thing that we have experienced is that the workload of the closure – both in terms of time and the amount of energy that it takes to close the wound – is significantly reduced due to the running nature of Quill SRS deployment.”

“A meta-analysis was just published in March in the British Medical Journal comparing the clinical outcomes of staples versus sutures in wound closure after orthopedic surgery.

They found a significantly higher risk of superficial skin infections when staples were utilized compared to sutures.”

do you have any specific tips to offer a new user? What are the pitfalls?

Clinical Roundtable in Orthopedics Clinical Roundtable in Orthopedics

Angiotech Pharmaceuticals, inc.

Dr. Keith Berend and Dr. Fred Cushner are paid consultants to Angiotech Pharmaceuticals, Inc.

© 2007 - 2010 Angiotech Pharmaceuticals, Inc.

© 2007 - 2010 Surgical Specialties Corporation.

All Rights Reserved.

Quill™ SRS is a trademark of Quill Medical, Inc.

0001 05/10 Clinical Roundtable in Orthopedics (Brochure)

For additional information on Quill SRS, visit Angiotech’s educational resource for health care professionals at www.angioedupro.com.

Clinical Roundtable in Orthopedics

“In addition, the needle count was less. This should not be underestimated. Having additional sharp objects on the field is a negative.”

KEiTh BEREnD Closing thoughts

With its unique barbed design, the Quill Knotless Tissue-closure device completely eliminates the need to tie knots and the potential for knot-related complications

Barbs provide immediate tissue hold on placement, potentially eliminating the need for an assisting “third hand”

The Quill device is currently used by surgeons for soft tissue approximation in the following surgical specialties: orthopedic, plastic, gynecologic, urologic, general and CV surgery

The Quill device makes soft tissue approximation faster and easier- which may significantly reduce closure times

Pacemaker Pocket Closure: The Case for Quill™ Device

Advantages to the Cardiac Electrophysiology Lab

1 42

TRADITIONAL SUTURE QUILL™ DEVICE

Devices Required 2 1

Technique Close one layer at a time Close multiple layers simultaneously

3 Hand May be necessary Not necessary

Knot Required Yes No

Potential Knot • Extrusion • None Complications • Pain •

Subcuticular

Hold Single-point fixation Distributed tension

Time Slower Faster

Allows Coaptation Yes Yes

Traditional Suture Compared to Quill™ Knotless Tissue-Closure Device

Tension more evenly distributed instead

Faster wound closure

Improved appearance and more

Avoidance of knot complications

- No knot pain

- No knot visibility

Pacemaker Pocket Closure: The Case for Quill™ Device of single-point fixation

QuillTM Device Closure Solutions in Pacemake Implantation natural scarring rd

Closure of incisions that include the SFS and deep fat. Multiple layer closures can be performed using a helical suturing technique

Closure is faster, uses less material, and requires no knot tying

Deep Layer Closure

QuillTM Device Techniques for Pacemaker Pocket Closure

Superficial Layer Closure

Single device is used to close the subcutaneous tissue, deep dermis, and subcuticular layer

No knot tying, palpable knots, or potentially uncomfortable extruding knots

1,2

Pacemaker Pocket Closure: The Case for Quill™ Device

References: 1. Paul MD

© 2007-2013 Angiotech Pharmaceuticals, Inc.

© 2007-2013 Surgical Specialties Corporation. All Rights Reserved.

Quill™ and Monoderm™ are trademarks of Surgical Specialties Corporation.

Quill 0133 01/2013

, Budd M. Evaluating the Quill™ self retaining system. http://www.PlasticSurgeryPractice.com. Accessed December 26, 2012. 2. Data on file. Vancouver, BC, Canada: Angiotech Pharmaceuticals, Inc; 2008

For more information, visit www.quilldevice.com.

Experience the extraordinary

• Double-armed bidirectional barbed suture designed to evenly distribute tension along the closure

• Barbs arrayed in opposing directions on either side of a transitional unbarbed segment

• Available in different lengths with various needle types and sizes

• Simple sizing conversion: upsize by 1 to ensure consistent strength

• Indicated for soft tissue approximation

The Quill™ device product overview

Subcuticular Layer Closure Ordering Codes YA-2016Q 3-0 Monoderm

Deeper Layer Closure Ordering Codes RA-1000Q 0 PDO

Commonly used QuillTM device codes in EP Pocket surgery

Clinical Roundtable in Plastic Surgery

An expert panel of plastic surgeons was recently convened to share their extensive experience with the Quill™ Knotless

Tissue-Closure Device (Quill™, formerly Quill™ SRS; Angiotech, Reading, PA). This panel includes some of the earliest adopters of the QuillTM technology. These surgeons have performed hundreds of procedures using the QuillTM device. In the process, they have gained considerable insight into the optimal application of this novel technology in their clinical practice.

A panel of experts weighs in

› Dennis Hammond, MD

Contouring Grand Rapids, MI

› Dennis Hurwitz, MD

› Franklyn Elliott, MD

› Alex Moya, MD

› Allen Rosen, MD

Founding Partner and Medical Director

FACULTYMoDERAToR

DEnnis HAMMonD This panel of plastic surgeons was brought together to:

› Share their experience and techniques using the QuillTM device in a variety of procedures and tissues

› Examine some of the benefits and challenges that they have encountered since first using the QuillTM device

› Provide tips to new users based on their collective experience to date

Experience the extraordinary

Advanced Tissue Approximation Techniques: Clinical Experience with the Quill™ Knotless Tissue-Closure Device in Plastic Surgery

Quill™ Knotless Tissue- Closure Device

Experience the extraordinary

What initially intrigued you about this device?

In which procedures do you use the QuillTM device?

“I cannot imagine putting in another knot.

In abdominal plications alone, I was tying 300 knots.

Now, I simply place one QuillTM device back and forth and I’m done.”

Clinical Roundtable in Plastic surgery