Safe and inexpensive alternative to suture passer

BACKGROUND

As the name suggests, the suture passer is used to achieve solid fixation of structures, often removed during the operative approach, by pulling an anchoring suture through an osseous tunnel. In addition, the suture passer can be used to pass tendons and other soft tissue structures through bone during reconstructive procedures. The expense of this single use instrument has been highlighted and a potentially dangerous alternative suggested.

Our method is inexpensive, successful and uses materials available in all theatres.

TECHNIQUE

A loop of nylon suture is passed through a blunt ended 18G drawing-up needle (Fig 1). Leaving a 5mm loop protruding from the end, this is passed through the tunnel. The suture or tendon for reattachment is passed through the loop and pulled back through the tunnel (Fig 2).

Figure 1.

Loop of nylon suture passed through drawing-up needle

Figure 2.

Needle (with suture loop) passed through metatarsal head

DISCUSSION

We have successfully used this technique in passing the extensor digitorum tendon through the metatarsal head during a modified Cobb–Stainsby procedure.² This technique works the same way as the suture passer and can be set up by the scrub nurse. Cost saving is important in the current economic climate. The previously published technique of passing a suture, on a straight needle, through the tunnel (blunt end first)¹ exposes the surgeon and operating team to the risks of handling a sharp. Our technique can be utilised for any procedure where the suture passer is commonly used and has already found favour with our hip unit in repairing the posterior approach.