Doc Talk: Type of sutures depends on type of wound, scar factor

11/05/2013 7:07 AM

08/08/2014 10:19 AM

As the father of six active children, I often have a teary-eyed child coming to me with an accidental cut and asking, “Does it need stitches?”

Stitches are indicated when the depth of the wound would cause a scar. Typically, scarring would occur if you can see subcutaneous tissue (the fatty layer of the skin) or if the wound gapes open when no pressure is applied to keep it closed. You don’t usually have to rush to the emergency room or the doctor’s office. If the laceration is cleaned and the bleeding stops, you can wait up to 18 hours to get the wound closed.

Cleaning a wound is extremely important. Removing visible dirt is one of the most essential aspects of preventing infection. You can clean it with mild dish soap or bar soap with warm water. Irrigate the wound thoroughly by forcing soapy water into the wound and/or scrub the area with a clean wash cloth.

If the wound is very dirty or caused by rusty metal, the possibility of tetanus increases. In general, everyone should get a tetanus immunization every five years.

The way to close a deep laceration is often debated. Growing up and working with farmers for many years, I have been told many imaginative ways to close a laceration – duct tape, super glue, heat, etc. I do not endorse any of these.

The most common method physicians use is sutures (stitches). There are two types of sutures: dissolvable and nonabsorbable (sometimes called permanent – though they are removed).

Dissolvable sutures are typically used on the inside of the body and absorb into the skin. Many patients ask me why we don’t use dissolvable sutures on the outside of the skin so a return visit to the doctor for removal of the sutures would not be necessary. There are three reasons.

First, dissolvable sutures are more likely to cause scarring because they do not dissolve for 60 days, whereas nonabsorbable sutures can be removed within 14 days. In areas of the body where scarring is a concern, nonabsorable sutures can sometimes be removed in seven days.

Second, nonabsorbable sutures are stronger and less likely to come apart.

Finally, nonabsorbable sutures cause less skin irritation that leads to itching and redness.

Surgical staples are an option for closing wounds but usually are used only on the scalp or to close surgical incisions on the chest, abdomen or hip. The physician might close a wound using a skin glue called Dermabond, which is quick to apply and requires no sedation. In general, a scar resulting from surgical staples or skin glue is similar to a scar left by sutures.

Another common question that arises is how to care for the wound. For all wounds – both those treated at home and those closed by a health professional – I recommend using antibiotic cream and keeping the wound covered with a bandage. Antibiotic creams reduce the risk of infection from 18 percent to 5 percent. Wounds covered by a bandage heal three times faster than uncovered wounds.

Wounds should be kept out of water for the first 24 hours, as this is the most important time period for healing and preventing infection. General care includes washing the wound with mild soap or a mixture of equal amounts of hydrogen peroxide and water.

Proper care of any wound is important to prevent infection and promote optimal healing. Many scrapes and small cuts can be cared for at home, but if you have concerns, give your doctor a call or go to an immediate care facility or emergency room.

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