Paucis Verbis card: Sutures

Paucis Verbis card: Sutures

2017-03-05T14:14:33+00:00

SutureSuturing is a common procedure performed in the ED, but we too often forget about the nuances of different suture materials. We get set in our practice patterns. This changed when our ED got the fast-absorbing gut suture for surface wounds, especially for pediatric patients. This makes a return visit for suture removal unnecessary because they quickly become absorbed over time. Increasingly, I have observed plastics surgeons using these for surface wound closure of the face and hands.

Has anyone else used absorbable sutures on the skin for wound closure?


With this new suture material in my armamentarium, I thought it’d be helpful to review suture types and suture removal times for non-absorbable sutures.


See other Paucis Verbis cards.

Michelle Lin, MD
ALiEM Editor-in-Chief
Academy Endowed Chair of EM Education
Professor of Clinical Emergency Medicine
University of California, San Francisco
Michelle Lin, MD
Michelle Lin, MD

Latest posts by Michelle Lin, MD (see all)

  • routinely I use the absorbable suture for the children, thus avoiding the painful trauma of removing the suture.

  • i remove the suture from the after 4-5 days andI leave for security patches for a few days. great results!!

  • sorry!!!! i remove the suture from the face after 4-5 days……….
    I’m sorry :))

  • Interesting. I just leave the sutures in, especially if it’ll be too frightening to the young child to remove them. If I plan to take them out, I use non-absorbable sutures since absorbable sutures have a slightly more reactive risk on the skin.

  • Was in the ED tonight, and was told to go sew up a face–my first All-by-myself time. After my deer in headlights look faded, I pulled out my PV cards, cheated like a champ, and managed not to mess up too badly!

    As always, thanks!

  • Hey Rick: That’s fantastic! Half the challenges is figuring out all for the suture types and brands in your ED. Congrats!

  • MichaelMD

    Here’s a question. I’m assuming people are using Vicryl Rapide or the fast absorbing gut sutures for their absorbable suture repairs. While the listed wound support is 10 days and 5-7 days respectively, the sutures aren’t totally resorbed for like a month. Two issues I see here. First, 10 days is way too long for the face if that is truly the effective wound support for vicryl rapide. Second, if these stitches don’t totally absorb for a month, conventional thought would be that there would be more “train tracking” along the wound from leaving the suture material in so long.

    I know that’s not what the literature shows, I’m just wondering why it doesn’t happen. If you left nylon in the face for 10 days, people would think you were crazy, but its ok to leave the absorbable in for a month waiting for it to absorb.

  • Hi MichaelMD: I’ve always wondered this as well. Our plastic surgeons sometimes even place chromic sutures (effective wound support 10-21 days!) on kid’s faces. The wounds turn out great. So, I don’t know the answer to your question. I polled the Twitter-universe. Let’s see what they come up with…

  • I had a patient who had NON-absorbable sutures in a forehead wound 6 months previously – the wound had healed well and the sutures were barely noticeable!
    Chris

  • Not a plastic surgeon – but I do use fast-absorbing gut, plain gut, vicryl rapide, and, yes, even chromic gut for suture repair, just about everywhere, and in a wide variety of patients – primarily excluding folks that I assess through gestalt to be at much higher risk for wound infection.

    Regarding the “train tracking” comment, my guess is that “train tracking” comes mostly from too much tension on the sutures originally (using the sutures to forcefully secure the wound edges, rather than just approximate for the body’s natural healing response). The quickly absorbing sutures will still be present in tissue for some time, but they’ll have degenerated enough that the tension will have relaxed, and they might not be contributing to the “train tracking”.

    Just my thoughts….

    • Radecki, I think you are right, that was what I was thinking, that the tensile strength is lost.

      How do you decide which absorbable suture to use? Do you use rapid abs gut on the face and plain gut on the extremities?

    • @Ryan: Interesting that you are almost primarily using absorbable sutures.

      @Michael: I primarily use only 2 types of absorbable sutures– rapidly absorbing gut (for face) and chromic gut (for all else). I generally avoid plain gut because it has a bit more tissue reactivity.

      @precordialthump: Wow, Chris. 6 months! That is amazing. Maybe it’s something in the Aussie air that improves wound healing. Perhaps I should test it out in person.

      Great discussion everyone.

    • @Michelle: The LLSA article from 2010 that looked at derm outcomes longterm compared nylon to plain gut and the outcomes were the same. I agree chromic gut makes more sense with the lower tissue reactivity, I just worry about the long absorbtion time. I’m wondering if anyone is using vicryl rapide for non-facial wounds. 10 days of wound support and lower tissue reactivity seems perfect.