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| Dr. Joel Aronowitz |
Dr. Joel Aronowitz: “So when I'm about to do a case, my nurse will always ask me, what suture do you want? So, let's drill down a little bit on the choice of sutures. There's basically two kinds of suture material, suture material that's permanent and suture material that gets absorbed. So sometimes you want suture material that's permanent. For example, the sutures on the outside of the skin, usually those are permanent sutures because they can be removed in a few days. Then underneath, if you're sewing a hernia, for example, where you need to have strength for a long time, you want permanent suture material. Where would you want absorbable suture material? In the skin, if you want a suture to fall out by itself, then you want an absorbable suture material. Under the skin, in the deeper tissues, you want suture material that's absorbable when you want it to go away after a few weeks. You want it to hold that tissue together for, let's say, a month or six weeks. After that time, there’s enough strength of the native tissues that you don't need that are in the body permanently. You just needed it long enough to hold the tissue so that it would heal. So, let's look at a couple of examples. For example, let’s say I want to sew something on the inside of the mouth and I don't want to have to remove sutures from that awkward area.
I can use a suture like this, which is plain gut. It's no longer made out of a cat's intestine, which is why it's got the name gut. But it's fast absorbing. So, in just three or four days, it will fall out by itself. That's an example of an absorbable suture. The same size suture, 60 nylons, this suture is permanent. And if I place this in the skin, I have to take it out. Proline, this is another example of a permanent suture material. And you can see the number. We'll talk about that in a few minutes. Number one. The other thing I'm going to tell you about is the needle on the suture.
Here's a type of suture that's absorbable, monocryl. This suture we can use to close the deeper tissues and we can go back after a few weeks and this will be absorbed. So, we don't have to worry about it being a permanent material under the. Okay, let's talk about the size of this suture and the needle. So first of all, we can see this is proline. It's color coded so we can just glance at the box and see. And then here is the size of the suture. Number one getting larger is going to be bigger, bigger, bigger suture. So, two is bigger than one. Three is bigger than two. And then it goes the other way. So, it'll go from one to oh, and then two ohs, three oh, four oh, five oh, et cetera, getting smaller and smaller. And it's important to note that the different kind of suture material has a different tensile strength. And the number one or oh, whatever the size is doesn't really refer to the size. It refers to the tensile strength. Tensile strength is how much can I pull on it before it breaks. So, it's the tensile strength. So, whether I'm looking at a chromic gut or I'm looking at a nylon or a proline, if it's the same size, it'll have the same tensile strength. So, the surgeon knows if they want a certain strength, no matter what the suture material is, it will be the same strength as long as it's got the same number. Now, the needle is a different thing. There are two kinds of needles, basically. One is a taper needle, and here's the cross-section of that needle. That's a taper needle.
But right here, this is a cutting needle. And you can see that little triangle. That's the cross-section of that needle. So, as it goes into the skin, it actually cuts like a knife. And sometimes you want a needle that cuts, and sometimes you want a needle that's tapered. So more later.”
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