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
- 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?
How is skin closure achieved?
Most frequently, the closure of choice for the skin layer repair, is a single filament suture, meaning that it is not braided and is made of material that does not cause irritation. The two main choices are nylon and polypropylene. Staples may be used when potential scarring isn't as important and may be used in the scalp. Often surgeons who have made a long incision use staples on the abdomen, back, or extremity.
If the laceration follows the crease lines of the body (lines of Langerhans) and is not under stress or stretch, Steri-Strips or butterfly Band-Aids may be considered. Dermabond or skin glue is another potential option for repairing the skin. For this option, the wound must be superficial and run along the crease lines, not be under stress or stretch, and blood or hair may not be present at the wound site. If Steri-Strips or Dermabond are used, the principles of wound cleaning and exploration still are important considerations.
In some circumstances, very thin absorbable sutures are used to close the skin. A material made of polyglycolic acid (Dexon) or polyglactic acid (Vicryl) can be used just beneath the epidermis to allow for good skin closure. The decision to use absorbable suture in the skin depends upon the situation and the skill and experience of the provider performing the repair.
How is repair of deep tissues achieved?
If the laceration requires layered closures in which the sutures will not be able to be removed, dissolvable suture material may be used. Polyglycolic and polyglactic acid or polyglyconate (Maxon) may be considered. Other materials may include silk or catgut (chromic). Often the suture is braided, allowing some cells of the body to "invade" it and thereby allow greater inflammation to cause the suture material to dissolve over a period of time.
Depending upon the type of material and the circumstances, absorbable suture may take from three weeks to three months to dissolve.
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