Surgical techniques
Note: Due to various stages of approval, not all product models represented here are available in all regions.
 1. Remove Safety Lock ASSISTANT: Using sterile technique, remove the SubQ It! Stapler from the foil pouch and remove the safety lock by a twisting/pulling motion. |  2. Grasp Tissue with Adson Forceps SURGEON: Using Adson forceps, grasp dermal tissue to expose the underside 3-4 mm back from the wound edges. |  3. Slide Stapler into Position SURGEON: Bring forceps together and elevate to thin tissue and allow it to slide between stapler feet. ASSISTANT: Use handle at base of stapler to advance stapler into position. If the tissue is thick, use other hand to apply reverse traction. |
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 4. Press Forceps into Locators SURGEON: Hold forceps at 45° angle and press tips securely into Forceps Locators. ASSISTANT: Hold stapler up so surgeon can feel pressure against forceps locators and to ensure that tissue is not folded or slack. |  5. Press Plunger Down Until it Stops SURGEON: Hold tissue FIRMLY resisting slippage while assistant deploys fastener. ASSISTANT: Press plunger down in a smooth and deliberate motion until it stops. CAUTION: If plunger is partially pressed and released, fastener may fall or jam stapler. |  6. Reposition for Additional Sutures SURGEON: If additional sutures are needed grasp tissue immediately in front of stapler feet. This will provide spacing of 8-10mm between fasteners. ASSISTANT: Keep stapler in place until surgeon grasps next bite, then slide forward and lift as in step 3. |
 7. Expected Appearance SURGEON: Assess closure by spreading wound at the base near the dimples. Additional sutures may be placed between previous ones if needed. |
SubQ It! in action
SubQ It! works in a completely new way for skin closures. All other staplers, even manually tied stitches, pinch, clamp and tightly bind small amounts of tissue which causes local ischemia. The barbs of the SubQ It! fastener engage relatively far from the cut edge (red lines in drawing below) potentially providing improved healing, lowered risk of infection, and less reparative response of the tissue.
Adson forceps are used to fold each side of incision over foot to expose sub-dermal tissue. Barbed legs of the fastener are hollow and supported by surgical needles during insertion.
Needles drive fastener legs into the tissue and then retract, leaving the fastener embedded in the dermal tissue. Barbs on each leg catch in tissue.
Legs spread angularly, incision is held together by tensile strength of the bridge.
