Stitches (cont.)
How is skin closure achieved?
Most frequently, the closure of choice is suture that is a single filament,
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, for example, when a plastic surgeon makes incisions in
the operating room under controlled situations, 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.
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.
Depending upon the type of material and the circumstances, absorbable suture
may take from three weeks to three months to dissolve.
Next: When and how are sutures removed? »
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