COATED VICRYL PLUS ANTIMICROBIAL (POLYGLACTIN 910) SYNTHETIC ABSORBABLE SUTURE

K132580 · ETHICON, Inc. · GAM · Feb 28, 2014 · General, Plastic Surgery

Device Facts

• Record ID: K132580
• Device Name: COATED VICRYL PLUS ANTIMICROBIAL (POLYGLACTIN 910) SYNTHETIC ABSORBABLE SUTURE
• Applicant: ETHICON, Inc.
• Product Code: GAM · General, Plastic Surgery
• Decision Date: Feb 28, 2014
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 878.4493
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

Coated VICRYL Plus Antibacterial Suture is indicated for use in general soft tissue approximation and/or ligation, except for ophthalmic, cardiovascular and neurological tissues.

Device Story

Coated VICRYL Plus Antibacterial Suture is a sterile, synthetic, absorbable, multifilament (braided) surgical suture; composed of 90% glycolide and 10% L-lactide copolymer; coated with Polyglactin 370 and calcium stearate; contains antibacterial agent Irgacare MP (triclosan). Used by surgeons in clinical settings for soft tissue approximation and ligation. Suture provides mechanical support during healing; triclosan coating inhibits bacterial colonization of the suture by Staphylococcus aureus, Staphylococcus epidermidis, Methicillin-resistant S. aureus, Methicillin-resistant S. epidermidis, and Escherichia coli. Device is absorbed by the body over time; essentially complete absorption between 56 and 70 days.

Clinical Evidence

No new clinical data generated for this submission. Evidence consists of literature meta-analyses of randomized clinical trials regarding the use of triclosan-coated sutures to lower surgical site infection rates, and previously established in vivo challenge studies demonstrating inhibition of bacterial colonization.

Technological Characteristics

Synthetic absorbable multifilament (braided) suture; copolymer of 90% glycolide/10% L-lactide; coated with Polyglactin 370 and calcium stearate; contains triclosan (max 472ug/m). Available in USP sizes 5-0 through 2. Sterilized by Ethylene Oxide. Meets USP Monograph requirements (except diameter).

Indications for Use

Indicated for general soft tissue approximation and/or ligation in patients requiring surgical sutures. Contraindicated for ophthalmic, cardiovascular, and neurological tissues, and in patients with known allergic reactions to Irgacare MP (triclosan).

Regulatory Classification

Identification

An absorbable poly(glycolide/l-lactide) surgical suture (PGL suture) is an absorbable sterile, flexible strand as prepared and synthesized from homopolymers of glycolide and copolymers made from 90 percent glycolide and 10 percent l-lactide, and is indicated for use in soft tissue approximation. A PGL suture meets United States Pharmacopeia (U.S.P.) requirements as described in the U.S.P. “Monograph for Absorbable Surgical Sutures;” it may be monofilament or multifilament (braided) in form; it may be uncoated or coated; and it may be undyed or dyed with an FDA-approved color additive. Also, the suture may be provided with or without a standard needle attached.

Special Controls

*Classification.* Class II (special controls). The special control for this device is FDA's “Class II Special Controls Guidance Document: Surgical Sutures; Guidance for Industry and FDA.” See § 878.1(e) for the availability of this guidance document.

Predicate Devices

• Coated VICRYL Plus Antibacterial (Polyglactin 910) Synthetic Absorbable Suture (K032420)

Reference Devices

• Wang, Z.X., Jiang, C.P., Cao, Y., Ding, Y.T., Systematic review and meta-analysis of triclosan-coated sutures for prevention of surgical site infections., Br. J. Surgery, 2013.
• Edminston, C.E., Doud, F.C., Leaper, D. Is there an evidence based argument for embracing an antimicrobial (triclosan) - coated suture technology to reduce the risk for surgical site infections? : A meta-analysis. Surgery; 2013; 154; 89-100.

Submission Summary (Full Text)

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### 510(K) SUMMARY

In accordance with 21 CFR 807.87(h) and 21 CFR 807.92, the 510(k) Summary is provided below.

| Device Common Name: | Absorbable Poly (glycolide/L-lactide) Surgical Suture | |
|----------------------------|----------------------------------------------------------------------------------------------|--|
| Device Proprietary Name: | Coated VICRYL* Plus Antibacterial (Polyglactin 910)<br>Synthetic Absorbable Suture | |
| Submitter: | Ethicon, Inc.<br>Route 22 West<br>P.O. Box 151<br>Somerville, NJ 08876 | |
| Contact: | Peter Cecchini<br>Fellow, Regulatory Affairs<br>908-218-2457<br>[e-mail] | |
| Date Prepared: | February 27, 2014 | |
| Classification Regulation: | Suture, Surgical, Absorbable Poly (glycolide/L-lactide)<br>Surgical Suture; 21 CFR §878.4493 | |
| Panel: | General and Plastic Surgery Devices | |
| Product Code: | GAM | |
| Predicate Device: | Coated VICRYL* Plus Antibacterial (Polyglactin 910)<br>Synthetic Absorbable Suture (K032420) | |

#### Indications for Use:

Coated VICRYL Plus Antibacterial Suture is indicated for use in general soft tissue approximation and/or ligation, except for ophthalmic, cardiovascular and neurological tissues.

#### Device Description:

The Coated VICRYL* Plus Antibacterial (Polyglactin 910) Synthetic Absorbable Suture is a sterile, synthetic absorbable surgical suture (dyed and undyed) and is composed of a copolymer made from 90% glycolide and 10% L-lactide. It is coated with a mixture composed of equal parts of Polyglactin 370 (65%PLA/35%PGA, a copolymer of glycolide and L-lactide) and calcium stearate. A small amount of an antibacterial agent, Irgacare MP** (triclosan), has been added to the suture coating. Irgacare** MP is the tradename given by CIBA Specialty Chemicals Corp. for their high purity material that meets U.S.P. specifications for triclosan. Coated VICR YL*

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Plus Antibacterial (Polyglactin 910) Synthetic Absorbable Suture is a multifilament suture and is available dyed and undyed. It meets U.S.P. requirements, except for diameter, as described in the U.S.P. Monograph for synthetic absorbable surgical suture. The dyed version of the device is available with an approved color additive (D&C Violet No.2). The product is available in U.S.P. sizes 5-0 through 2 in a variety of lengths, with or without needles, and on LIGAPAK* dispensing reels.

The subject device is identical to the predicate device (K032420) in all aspects, including design, materials, sterilization and packaging. The only difference between the proposed and the predicate devices lies in the some labeling statements.

#### Performance Data:

The technological characteristics of the proposed device are identical to the predicate device, therefore, performance data are not necessary to establish substantial equivalence.

#### Substantial Equivalence:

The purpose of this 510(k) submission is to obtain a modified indication for use and modified labeling for the Coated VICRYL Plus Antibacterial (Polyglactin 910) Synthetic Absorbable Suture. A comparison of the proposed and predicate device is provided below.

| | Proposed Device | Predicate Device |
|---------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 510(k) Number | K132580 | K032420 |
| Product Code | GAM | GAM |
| Regulation | 21 CFR § 878.4493 | 21 CFR § 878.4493 |
| Absorbable | Yes | Yes |
| Characteristics | Same | Coated VICRYL* Plus Antibacterial (Polyglactin<br>910) Synthetic Absorbable Suture |
| Intended use | Same | Indicated for use in general soft tissue<br>approximation and/or ligation, except for<br>ophthalmic, cardiovascular, and neurological<br>tissues. Should not be used where extended<br>approximation of tissue under stress is<br>required. Should not be used in patients with<br>known allergic reactions to Irgacare MP**. |
| How supplied | Same | Sterile, Multifilament strand (braided)<br>Available in a variety of lengths, with or without<br>needles, and on LIGAPAK* dispensing reels.<br>The devices are available in one, two or<br>three dozen boxes. |
| Color | Same | Undyed or Dyed Suture Strands |
| | Proposed Device | Predicate Device |
| Material | Same | Composed of a copolymer made from 90% |
| Composition | | glycolide and 10% L-lactide. Coated with a mixture |
| | | composed of equal parts of a copolymer of glycolide |
| | | and lactide (Polyglactin 370) and Calcium Stearate. |
| Breaking Strength | Same | Approximate percent breaking strength remaining |
| Retention profile | | (%BSR) 14 Days -75% 21 Days sizes -50% 28 Days<br>sizes -25% |
| Absorption profile | Same | Absorption is essentially complete between 56 and<br>70 days. |
| USP requirements | Same | Meets USP Monograph -except for diameter |
| Sterilization | Same | Sterilized by Ethylene Oxide |
| Packaging | Same | Foil packaging |
| Antibacterial agent | Same | The suture contains Irgacare MP |
| | | ** (triclosan), a broad-spectrum |
| | | antibacterial agent, at no more |
| :: | | than 472ug/m. |
| Labeling | In ACTIONS section: | In ACTIONS section: |
| | Using zone of inhibition studies, Coated VICR YL | Using zone of inhibition studies, Coated VICRYL |
| | Plus Antibacterial Suture has been shown to inhibit | Plus Antibacterial Suture has been shown to inhibit |
| | colonization of the has been shown to inhibit<br>colonization of the suture by Staphylococcus aurens | colonization of the has been shown to inhibit<br>colonization of the suture by Staphylococcus |
| | Staphylococcus epidermidis, Methicillin Resistant S. | aureus , Staphylococcus epidermidis, Methicillin |
| | aureus . Methicillin Resistant S. epidermidis and | Resistant S. aureus . Methicillin Resistant S. |
| | Escherichia coli which are microorganisms known to | epidermidis and Escherichia coli which are |
| | contribute to surgical site infections. Animal studies | microorganisms known to contribute to surgical site |
| | have demonstrated that VICRYL Plus Antibacterial | infections. Animal studies have demonstrated that |
| | suture inhibits bacterial colonization of suture after | VICR YL Plus Antibacterial suture inhibits bacterial |
| | direct in vivo challenge with bacteria. Prospectively | colonization of suture after direct in vivo challenge |
| | planned meta-analyses of randomized clinical trials | with bacteria. |
| | were performed on the use of suture containing | |
| | triclosan to lower surgical site infection rates. | |
| | Examples of such meta-analyses are referenced | |
| | below 1. 2. | |
| | Wang, Z.X., Jiang, C.P., Cao, Y., Ding, | |
| | Y.T., Systematic review and meta-analysis of<br>triclosan-coated sutures for prevention of<br>surgical site infections., Br. J. Surgery, 2013. | |
| | 2Edminston, C.E., Doud, F.C., Leaper, D. Is there<br>an evidence based argument for embracing an<br>antimierobial (triclosan) - coated suture technology<br>to reduce the risk for surgical site infections? : A<br>meta-analysis. Surgery; 2013; 154; 89-100. | |

#### Substantial Equivalence Comparison Table

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DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/3/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo is a circular seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. Inside the circle is a stylized image of an eagle with its wings spread, clutching a caduceus in its talons.

Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002

February 28, 2014

Ethicon Incorporated Mr. Peter Cecchini Fellow, Regulatory Affairs Route 22 West, P.O. Box 151 Somerville, New Jersey 08876

Re: K132580

Trade/Device Name: Coated VICRYL* Plus Antibacterial (Polyglactin 910) Synthetic Absorbable Suture Regulation Number: 21 CFR 878.4493 Regulation Name: Absorbable poly(glycolide/1-lactide) surgical suture Regulatory Class: Class II Product Code: GAM Dated: February 10, 2014 Received: February 11, 2014

Dear Mr. Cecchini:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you; however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical

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Page 2 - Mr. Peter Cecchini

device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Division of Small Manufacturers, International and Consumer Assistance at its tollfree number [phone] or [phone] or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYowIndustry/default.htm. Also, please note the regulation entitled. "Misbranding by reference to premarket notification" (2) CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

## David Krause -S

for

Binita S. Ashar, M.D., M.B.A., F.A.C.S. Acting Director Division of Surgical Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

#### . Indications for Use

510(k) Number (if known) K132580

Device Name

i

Coated VICR YL * Plus Antibacterial (Polyglactin 910) Synthetic Absorbable Suture

#### Indications for Use (Describe)

Coated VICRYL Plus Antibacterial Suture is indicated for use in general soft tissue approximation and/or ligation, except for ophthalmic, cardiovascular and neurological tissues.

Type of Use (Select one or both, as applicable)

2 Prescription Use (Part 21 CFR 801 Subpart D)

Over-The-Counter Use (21 CFR 801 Subpart C)

#### PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON A SEPARATE PAGE IF NEEDED.

#### FOR FDA USE ONLY

Concurrence of Center for Devices and Radiological Health (CDRH) (Signature)

# avid Krause

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