RUTTER SUPRA STOMAL STENTS

K091135 · Boston Medical Products, Inc. · FWN · Sep 14, 2009 · Ear, Nose, Throat

Device Facts

• Record ID: K091135
• Device Name: RUTTER SUPRA STOMAL STENTS
• Applicant: Boston Medical Products, Inc.
• Product Code: FWN · Ear, Nose, Throat
• Decision Date: Sep 14, 2009
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 874.3620
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The Rutler Supra Stomal Stent is indicated for the prevention and treatment of laryngeal and tracheal stenosis.

Device Story

Rutter Supra Stomal Stent is a medical device used for the prevention and treatment of laryngeal and tracheal stenosis. It functions as a mechanical stent to maintain airway patency. The device is intended for use by clinicians in a medical setting. By providing structural support to the airway, it helps prevent or manage narrowing (stenosis), thereby facilitating breathing and potentially improving patient outcomes in cases of airway obstruction.

Clinical Evidence

No clinical data provided; bench testing only.

Technological Characteristics

Synthetic polymer material; ear, nose, and throat stent; class II device; product code FWN; 21 CFR 874.3620.

Indications for Use

Indicated for patients requiring prevention or treatment of laryngeal and tracheal stenosis.

Regulatory Classification

Identification

Ear, nose, and throat synthetic polymer material is a device material that is intended to be implanted for use as a space-occupying substance in the reconstructive surgery of the head and neck. The device is used, for example, in augmentation rhinoplasty and in tissue defect closures in the esophagus. The device is shaped and formed by the suregon to conform to the patient's needs. This generic type of device is made of material such as polyamide mesh or foil and porous polyethylene.

Submission Summary (Full Text)

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

Boston Medical Products, Inc. c/o Mr. Michael A. Warren 117 Flanders Road Westborough, MA 01581

## JAN 1 0 2017

Re: K091135

Trade/Device Name: Rutter Supra Stomal Stents Regulation Number: 21 CFR 874.3620 Regulation Name: Ear, Nose, and Throat Synthetic Polymer Material. Regulatory Class: Class II Product Code: FWN Dated: August 5, 2009 Received: August 5, 2009

Dear Mr. Warren:

This letter corrects our substantially equivalent letter of September 14, 2009.

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.

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Page 2 - Mr. Michael A. Warren

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 801); medical device reporting (reporting of medical 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 Industry and Consumer Education at its toll-free number [phone] or [phone] or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR 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 Industry and Consumer Education at its toll-free number [phone] or [phone] or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

Kesia Alexander

for Malvina B. Eydelman, M.D. Director Division of Ophthalmic and Ear, Nose and Throat Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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091135

## SECTION 4: STATEMENT OF INDICATIONS FOR USE

## INDICATIONS FOR USE

The Rutler Supra Stomal Stent is indicated for the prevention and treatment of laryngeal and tracheal stenosis.

Prescription Use: ____________________________________________________________________________________________________________________________________________________________

AND/OR

Over-the-Counter Use: (Part 21 CFR 807 Subpart C)

## DO NOT WRITE BELOW THIS LINE

Concurrence of CDRH, Office of Device Evaluation

Thialotut

(Division Sign-Off) Division of Ophthalmic, Neurological and Ear, Nose and Throat Devices

510(k) Number K091135