Stitches (Sutures, Wound Closures)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
- Stitches facts
- Why is wound closure important?
- How does the health-care professional assess a wound?
- How is the type of closure material chosen?
- How is skin closure achieved?
- How is repair of deep tissues achieved?
- When and how are sutures removed?
- What happens to the site after suture removal?
- Are there any special considerations regarding wound repair?
- Wounds or lacerations must be explored and thoroughly cleaned prior to closure.
- Suture materials vary in their composition and thickness, and the choice of the appropriate material depends upon the nature and location of the wound.
- Staples, Steri-Strips, Band-Aids, and skin glue can be alternatives to suture material for skin closure.
- Dissolvable suture material may be used for the repair of deep tissues.
- Most sutures are left in place for seven to 10 days.
Why is wound closure important?
The ability to close a skin wound is an important skill learned by medical care providers. Whether the skin injury was made by a scalpel in the operating room or by a fall in the street, the decision as to how and when to repair the damage needs to be individualized for each patient and situation.
The skin has many layers from the epidermis on the outside, to the deeper subcutaneous tissues and the dermis in between. Each of these layers has other sub-layers that help the skin perform its functions. The skin provides a barrier to the outside world and the dangers of infection, environmental hazards and chemicals, and temperature. It contains melanocytes that can darken or tan the skin while protecting the body from ultraviolet radiation. It also plays an important role in temperature and fluid regulation.
Different options exist for repairing lacerated skin and providing a nice cosmetic outcome. However, there are two important steps that need to occur before the skin is closed.
- Exploration: Most wounds need to be examined and explored to their full depth, looking for dirt and debris that may have entered and making certain that the anatomic structures beneath the damaged skin are intact and not injured. For example, in a hand or finger laceration, the care provider will want to make certain that the blood vessels, nerves, and tendons beneath the skin have not been cut. This is done both by physical examination of the hand and finger, evaluating their power and motion, blood supply and nerve sensation, and also by looking inside the wound, identifying the tendon and perhaps the artery and nerve bundles to make certain that they are intact.
- Cleaning: When the skin is broken, the outside world invades the body and may cause infection. Before the skin is closed, the wound must be washed out or irrigated thoroughly to prevent the occurrence of an infection. Sometimes, a small amount of dirty tissue needs to be cut out, and this is called debridement.
The purpose of wound care is not simply to yield a good-looking scar. All wounds will eventually heal over time, although closing the skin edges will make that healing time shorter. The primary purpose of seeking medical care from a health-care professional is to get the wound properly cleaned and make certain everything is in good working order beneath the damaged skin.
When a laceration occurs, there are some reasonable first aid and home-care steps to consider. Washing with tap water to clean the wound is always helpful. Studies have shown that plain tap water is as good as any special fluids that are used in hospitals for cleaning wounds. The wound should be lightly bandaged and elevated if possible.
The amount of blood supplied to different parts of the body varies. A wound on the face, scalp, or hand may bleed profusely while one on the shin or back may not. Bleeding will often stop with direct pressure at the bleeding site and elevation of the injured part of the body.
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