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| Dr. Joel Aronowitz |
Dr. Joel Aronowitz: “So let's talk about suturing errors. So one suturing error is to, if I pick up my suture with my needle driver, and let's say, let's say I pick it up here, and you see those teeth on the needle driver. Now, not all needle drivers have teeth, and different teeth, different needle drivers have different teeth. But when you pick up a stitch with that, it's going to crush that suture and weaken it. And I don't know if you can make out all the little bite marks here where I've been touching it. So each one of those is a potential point of my suture. So basically, that stitch no longer has the strength that the manufacturer intended it. And I don't know that it's weak. So it's a potential disaster because if I'm depending on that stitch to hold and I damaged it like that, then I'm going to have a suture break, and the wound may de-hiss or something worse. And what's de-hissing? De-hissing means it will come apart, which is not a good thing. It's a good word for Scrabble in the future. De-hiss. Anyway, so other suturing errors. Picking up the needle with the needle driver.
Again, if I start picking it up with my needle holder, it'll damage the tip of the needle, and it will not be as sharp. Already I'm losing sharpness every time it penetrates the skin. But if I use metal on it, it's going to be in no time; it's going to be ruined. Here's another suturing error. From picking up the tissue, I'm going to go from deep to superficial. But oops, what did I do? I did a buttonhole. So if we see, you can't even make a mistake on purpose. I certainly can. So now I'm paying attention to this side. But meanwhile, I managed to go through the skin and buttonhole the skin. So that's called a buttonhole. So we don't want a buttonhole.
So when we, we can do that with a knife, we can do that with a cutter, we can do that with a suture, so I'm feeling with the tip of my needle for the skin. And now you can see it puckering a little bit, but I haven't actually gone through the skin. So that's a safe suture. And your assistant can help avoid this a lot of time. Because if your assistant holds the tissue up at a right angle like this at a right angle to the plane, then it's easy to tell where it's much easier to tell where the skin is. But if he goes back like this, then as I'm dissecting, it's much easier for me to go through the skin. So buttonholing is a significant problem. It's a technical error that one should be aware of and should seek to avoid. Notice how I've lined up these edges. But what if I, what if I come across and I pick the wrong spot to come across. So let's say I come across up here. And then?
My next stitch is too far back. So what I've done is I've created this pucker right here because I've advanced further on this side than on this side. And sometimes we'll do that on purpose like I did down here. But sometimes we'll do that accidentally. So if we do that accidentally, that's not a good thing. And what we need to do is simply take the suture out. And it may not be obvious, but a lot of times you can just take the suture out like that and do it. So even the most experienced surgeon will sometimes make a suturing error, and it's totally forgivable. What is not forgivable is not recognizing your own error, being honest with yourself, and correcting that as you go.”
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