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Product complaint # (b)(4).This is a combination product, and the event has been reviewed for both the suture and the triclosan.This report is being submitted pursuant to the provisions of 21 cfr, part 803, part 4 subpart b.This report may be based on information which has not been investigated or verified prior to the required reporting date.This report does not reflect a conclusion by ethicon, or its employees that the report constitutes an admission that the product, ethicon, or its employees caused or contributed to the potential event described in this report.If information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.D4: udi: as the lot number for the device involved in the event was not provided, the full udi is currently not available.To date the device has not been returned.If the device or further details are received at a later date a supplemental medwatch will be sent.Additional information was requested, and the following was obtained: surgeon has been closing with stratafix symmetric the same for approximately 6 years (on thousands of tja) with no issues and over the last couple months he has run into a string of dehiscences.His stratafix symmetric technique is not typical as he starts two strands in the middle of the knee and runs them in opposite directions to the proximal and distal apexes of the incisions and then backstitches all the way back to the center again (so the entire capsule is closed with a double stitch of symmetric and in some areas it is triple stitched), he has done it this way for years but not until recently is having breakage.He said when he went back in for the revision surgeries it looked like all the passes of the stratafix symmetric were broken along the incision, but the suture was still in both sides of the tissue (did not unravel at all).Attempts are being made to obtain the following information.To date no response has been provided.If further details are received at a later date a supplemental medwatch will be sent.Please provide the patient's demographic information including age, gender, weight, bmi at the time of index procedure date of index surgical procedure? what was the initial approach for the index surgical procedure? (open, laparoscopic or other)? on what tissue was the suture used? what was the tissue condition (normal, thin, calcified, fragile, diseased)? for the original intended closure, how were all layers closed? when beginning the running suture, did the surgeon take the first pass above or adjacent to the incision in a direction away from the incision? after taking the first pass away from the incision, did the surgeon then take a pass of tissue perpendicular to the initial pass? if so, how many perpendicular passes? did the surgeon then proceed with wound closure in the opposite direction of the first pass? was the fixation tab seated against the tissue at the initiation of suture use during the index procedure? were two reverse stitches performed across the incision prior to closure? did the wound dehis? if yes, what tissue dehisced? onset date/time of dehiscence? (# post op days) how was the dehiscence managed? please provide additional details about the "small defect" for each patient.Please describe any medical/surgical intervention required for this suture event including dates and results.Please describe the appearance of the suture during the second procedure, if applicable.Did the suture break? if so, where was the break noted (termination, middle, end)? did the suture pull out of the tissue? did the knots untie? did the operating surgeon observe any suture deficiency or anomaly before, during, after the suture placement or during any re-operation? were there any precipitating patient stress factors that led to the sutures untying, breakage or pulling out of the tissue? are photos available? other relevant patient history/concomitant medications? what is the physician¿s opinion as to the etiology of or contributing factors to this event? what is the patient's current status? lot number? will product be returned? if so, please provide the return date and tracking information.
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