Stitches (cont.)
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.
In this Article
- Why is wound closure important?
- How does the health-care provider 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?
- Stitches At A Glance
How is the type of closure material chosen?
The purpose of repairing a wound is to provide good cosmetic results. All wounds will eventually heal by themselves; however, bringing the edges together and without tension will allow a better result. All lacerations will leave a scar, and a good wound closure will minimize the visibility of that scar.
Since there are many layers of skin, there may need to be layers of sutures placed to bring the edges together if the wound is deep. As well, if the wound is deep and only the skin is closed, empty spaces may be formed beneath the outer skin layer. Fluid may accumulate in empty spaces, becoming a risk for infection.
For skin sutures, the hope is to cause minimal inflammation so that the scar will form nicely. If deep sutures are placed, the suture material used gradually disintegrates or dissolves as part of the inflammatory response of the body.
The strength of the suture depends upon the thickness of the suture material. Some suture materials used to repair nerves may be so thin that the surgeon needs a microscope to sew. Some suture material is as thick as string. The thinner the suture, the less tension it can tolerate and the more stitches need to be used to keep the wound from breaking open as it heals.
Different types of needles are used as well, depending upon the situation. The two major kinds are cutting and non-cutting. The cutting needles have a diamond-shaped tip and are designed to "cut" through skin. The non-cutting needle tips are circular and are meant to be used on deep tissues that do not have the resistance of skin. There are different shapes of the needle curve as well to help guide the needle and the attached suture on its path.
Almost all suture material is preloaded on a needle and does not need to be hand-threaded. The care provider will specify the type of suture, the thickness, and the type of needle when planning to repair a laceration.
http://www.medicinenet.com/stitches/article.htm
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