Table of Contents
- The Foundation of a Perfect Closure: Why Suture Choice Matters
- Absorbable vs. Non-Absorbable Sutures: A Breakdown
- Natural vs. Synthetic: Understanding Suture Fiber Sources
- Monofilament vs. Polyfilament: A Tale of Two Textures
- Decoding Suture Sizes: From 11-0 to 2
- Mastering the Needle: Anatomy, Handling, and Types
- From the Comments: Real Questions, Fast Answers
Watch the video: “A Comprehensive Guide to Suture Material & Needles for Medical Professionals” by Dr. Jordan Kai Simmons, MD
A precise closure starts long before your first bite of skin. It starts with knowing your sutures and choosing a needle designed for the tissue in front of you. In this guided breakdown of Dr. Jordan Kai Simmons’ lecture, we translate the core decisions—material, size, and needle architecture—into confident, repeatable practice.
What you’ll learn
- How to weigh absorption profile, tensile strength, memory, and handling when choosing suture material.
- When to use absorbable versus non-absorbable sutures and why it matters for tension control and follow-up.
- The differences between natural and synthetic fibers, and between monofilament and polyfilament.
- How USP suture sizes work—at a glance.
- Needle anatomy, proper handling, and when to pick taper, conventional cutting, or reverse cutting tips.
The Foundation of a Perfect Closure: Why Suture Choice Matters Suture selection shapes both the biology and the aesthetics of wound repair. Dr. Simmons underscores that outcomes depend on both the suture material and the architecture of the needle. This isn’t just brand preference—it’s tissue mechanics, friction, and inflammation coming together in a single decision.
Characteristics of the Ideal Suture The video highlights what makes an ideal material: minimal tissue injury or reaction, sufficient tensile and knot strength, a favorable absorption profile (if absorbable), and predictable handling. Elasticity helps a closure tolerate early postoperative swelling; plasticity affects how the strand holds deformation; memory influences how easily the strand lies flat and accepts a knot.
Key Properties to Consider: Absorption, Strength, and Handling Absorption profile is step one: know whether you need “here today, gone tomorrow” support or a long-term scaffold. Next, consider strength: tensile and knot tensile strength determine how a repair handles load. Finally, handling lives at the intersection of filament design and your technique—coefficient of friction, pliability, and memory all show up in your first throw.
Pro tip If you feel a suture spring back and fight your knot, you’re probably dealing with higher memory. Slow down your throws and ensure deliberate, flat tensioning between throws to seat the knot securely.
Absorbable vs. Non-Absorbable Sutures: A Breakdown When to Use Absorbable Sutures (Vicryl, Monocryl, PDS) Absorbable sutures are workhorses for deeper tissues and multilayer closures. Dr. Simmons cites common choices like Vicryl, Monocryl, and PDS. Each retains strength for a defined window, then resorbs—useful when suture removal is impractical or when deeper layers only need temporary support during early healing.
Examples in context: Vicryl (a braided absorbable) is widely used for fascia and muscle approximation and retains a meaningful proportion of strength around two weeks.
Monocryl (a monofilament absorbable) degrades more rapidly after the first week, making it a favorite for delicate skin and subcuticular work where you want smooth passage with minimal drag.
Watch out Absorbable sutures can be more reactive in some tissues; keep that in mind if you’re targeting an area prone to inflammation or contamination.
The Role of Non-Absorbable Sutures in Long-Term Support (Nylon, Prolene) Non-absorbable sutures (e.g., Nylon, Prolene) shine in cutaneous closures when you want precise control over the timing of tension removal. You can decide exactly when to unload the wound by removing the sutures, which is helpful when cosmesis and scar modulation are priorities.
Quick check
- Need deep support for a finite period? Consider absorbable.
- Need to decide the day you’ll reduce tension at the skin? Consider non-absorbable.
Natural vs. Synthetic: Understanding Suture Fiber Sources The Pros and Cons of Natural Sutures (Gut, Silk) Natural materials like gut and silk tend to trigger more inflammation and, in the case of gut, are broken down via proteolysis—an active, inflammatory process. Dr. Simmons distinguishes among plain, fast, and chromic gut by their absorption rate and where they’re commonly used.
Chromic gut retains tensile strength longer than plain or fast gut—on the order of roughly 10–14 days—extending its utility when you need slightly prolonged support without return removal.
The Advantages of Synthetic Sutures in Modern Surgery Synthetic options like PDS, Monocryl, and Nylon are generally more elastic and less inflammatory than natural fibers. That elasticity can be an ally against edema-related stress in the early postoperative period. Selection still comes back to task: PDS offers durable absorbable support; Monocryl slides smoothly for delicate superficial work; Nylon provides dependable, removable strength at the surface.
From the bench to bedside, choosing fiber source is about controlling the tissue response. If minimizing inflammation is a priority, synthetic materials are often preferred.
Monofilament vs. Polyfilament: A Tale of Two Textures The Smooth Passage of Monofilaments Monofilament sutures are single-stranded, which reduces friction through tissue. That smooth passage is an advantage for delicate layers—but the trade-off is higher memory and the need for careful, deliberate knot tying. Dr. Simmons shows common monofilament examples, including Monocryl, PDS, and Prolene.
The Knot Security of Polyfilaments Polyfilaments are braided. The braid increases pliability and generally improves knot security, but the surface area increases drag. When you need forgiving handling and a knot that holds with fewer throws, a braided option can be a smart pick.
Watch out Higher friction means more potential tissue drag. Respect the tissue by using gentle, consistent motion and avoid sawing.
Decoding Suture Sizes: From 11-0 to 2 Understanding the USP Sizing System Dr. Simmons clarifies a common confusion: for sizes that include a “-0,” the bigger the number, the smaller the diameter (e.g., 7-0 is finer than 3-0). For whole-number sizes without “-0,” the opposite applies—1 or 2 indicate larger diameters. This matters when matching suture caliber to tissue strength and cosmetic goals.
Matching Suture Size to Tissue Type While the video emphasizes understanding the scheme rather than prescribing strict pairings, it does note that very fine calibers (down to 11-0) are used in microvascular or ophthalmic settings, while large sizes (1, 2) are reserved for high-load closures like abdominal or chest walls. If unsure, confirm your institution’s preferences, then scale up or down based on tension and cosmesis.
Mastering the Needle: Anatomy, Handling, and Types The Three Parts of a Surgical Needle Every needle has three essential parts: the tip (pierces tissue), the body (where you grasp), and the swage (where the suture attaches). Naming these parts clarifies your handling and your troubleshooting—especially when a needle starts to rotate or dull.
The Right Way to Hold Your Needle Driver Dr. Simmons advises grasping the body about two-thirds from the tip. Avoid grabbing the tip—it dulls; avoid the swage—it rotates. The jaw of your needle holder should be sized so that it occupies roughly a third to half of the bite width, which helps prevent deformation and unwanted spin.
Pro tip If your needle rotates as you enter skin, check your grip location and jaw width first—small corrections here often fix big problems.
Taper vs. Cutting Needles: Which to Use and When Needles do different kinds of work. Taper tips are rounded and spread soft, elastic tissues (muscle, fat, fascia, blood vessels). Cutting tips divide tougher tissue like skin. Within cutting needles, “conventional cutting” places the third edge on the inner curve, whereas “reverse cutting” moves it to the outer curve for a stronger base and reduced risk of cutting out.
Use cutting needles for skin; rely on taper for deeper, delicate tissues to minimize trauma. For cutting needles, be intentional about your vector: excess upward traction with conventional cutting can lead to shallow bites or even avulsion; excess downward pressure with reverse cutting can sink too deep.
Quick check
- Taper = spread; think deeper, elastic tissue.
- Cutting = divide; think skin and tougher tissue.
- Conventional vs. reverse cutting = inner vs. outer third edge—mind your vector and depth.
From the comments: Real Questions, Fast Answers
- Sterilizing Prolene with plasma sterilization before use? The video does not address sterilization protocols; follow your institutional policies and manufacturer guidance.
- Requests for more OR tools content: Not covered in this video, but it’s a common ask—keep an eye on the channel for future uploads.
- “See one, do one, teach one”: The creator confirms teaching accelerates learning—this series aims to reach many learners at once.
Putting It All Together: A Simple Selection Flow
- Start with tissue and layer: Is it skin or deeper? Elastic or tough?
- Decide on permanence: Do you need removable control (non-absorbable at the skin) or temporary support (absorbable deeper)?
- Match filament and handling: Need low drag (monofilament) or easier knot security (braided)?
- Size appropriately: Use the USP scheme to scale diameter to tension and cosmesis.
- Pick the needle: Cutting for skin, taper for soft tissue; refine with conventional vs. reverse cutting based on your preferred vector and tissue feel.
Watch out Using the wrong needle or suture can increase tissue damage and compromise cosmetic outcomes. Handle the needle correctly to avoid dulling and instability.
From practice to performance, repeatable excellence lives in understanding these trade-offs—and choosing the combination that fits the tissue in front of you.
A quick analogy for tactile learners If you’ve ever aligned fabric in a frame, you already know the value of tension and smooth passage. In surgery, choosing low-drag monofilament for delicate layers is a bit like choosing the right surface for steady glide through material—controlled friction, clean lines, and fewer snags. magnetic embroidery hoop
Instruments and technique, like a well-set frame, reduce wobble. Grasping at the right spot on the needle body and entering at the correct angle minimize torque—similar to how a firm, even mount reduces distortion while you work. embroidery frame
Surface closures that you plan to remove later are about control and timing. Think of it like selecting the right framing system so you can lift tension off at the moment your piece is ready—structured, predictable, and tidy. embroidery hoops
When you’re learning, smoothness beats speed. Choose materials that behave predictably so you can focus on fundamentals—just as beginners benefit from reliable, user-friendly equipment that won’t fight them at every step. best embroidery machine for beginners
For deep support layers, prioritize strength that gradually yields as biologic strength returns—temporary structure, then a clean handoff. It’s the same mindset as using a supportive, steady mount while work is underway, then releasing once the foundation holds on its own. machine embroidery hoops
Reduce drag where it matters. In delicate tissue, lower friction helps protect the substrate—gentle in, gentle out, just like working over a surface that won’t snag or scuff as you guide each pass. magnetic hoops
Finally, be systematic. The right needle for the right tissue, the right size for the right load—technique follows selection. A consistent setup frees your attention for detail work, the way a smoothly running workstation lets your hands focus on the craft. embroidery sewing machine
References to moments in the video - Ideal suture material characteristics (00:30–02:05): absorption and strength profiles, elasticity, plasticity, and memory.
- Absorbable vs. non-absorbable (02:05–04:25): Vicryl, Monocryl, PDS for deeper or impractical removals; Nylon/Prolene for cutaneous control.
- Natural vs. synthetic (04:25–07:53): inflammatory profiles, proteolysis for gut, elasticity of synthetics.
- Monofilament vs. polyfilament (06:50 onward): friction vs. knot security.
- Sizing (07:53–08:47): how to read the USP system.
- Needle anatomy and handling (08:47–10:16): tip, body, swage; proper grasp.
- Needle tips and shapes (10:16–12:45): taper vs. cutting; conventional vs. reverse cutting; shape codes.