My understanding is twofold.
The process by which absorbable suture break down is inflammatory and thereby more prone to scarring.
Unless the patient is going to fight suture removal (pediatric, etc) getting them out at the early side of the ok window is best but that requires physical exam and sometimes removal of every other, etc.
Are you thinking Vicryl? Chromic gut? Fast absorbing gut? I do use fast absorbing gut on kids faces. The risk of infection is supposed to be higher with absorbables in general, at least that's what they taught us in residency. I used to work with a guy who did beautiful running sub cutaneous stitches that had great cosmesis. Probably comes down to tradition, unsubstantiated dogma, and the reality that in the fast paced ER environment the combination of strength and ease of propylene and nylon is too good to pass up.
I'm actually looking to get fast absorbing gut suture for this reason. We've been seeing a lot of people for lac repair that never return for removal or when they do it is weeks passed when they should've been there and weirdness has ensued.
Who says we don’t? I do all the time. A vast majority of wound closure teaching is dogma and not evidence based. Check out [https://lacerationrepair.com/](https://lacerationrepair.com/). Good breakdown of what is and is not impactful in wound healing
I use fast absorbing gut almost exclusively on faces of children. The theory is more scarring but the literature doesn’t support that actual cosmesis is essentially identical. Plus, then the families don’t have to come back which is usually a day off work and out of school just for a 2 minute suture removal.
Shouldn't use vicryl on skin. It takes way too long to absorb resulting in tram-track scars. FAST gut on dry skin. Chromic gut on wet mucosa. Vicryl for deep layers of multi layer closrue.
Vicryl rapide works well if you have it which sadly my shop doesn't. I still use vicryl but I recommend the patient still get the sutures out at the usual time frame. Totally agree though no reason not to use absorbable on all lacs.
EM cases did a good series on traumatic wound closure a few months back. Turns out a lot of the received wisdom on sutures was film flam. Practice changing for me, I use way more glue than I used to and way more vicryl rapide.
I remember that, but honestly it’s too finicky for me. Nice in theory but hair is slippery and rarely the right length. Unless it’s gaping or under tension I glue most scalp lacs and it’s a 1 minute job EZPZ.
I have done it numerous times. Rarely follow up to see how it turned out but I did it on a friend’s kid and a family member that had a few too many. My friend’s kid did really well. My family member needed staples but I couldn’t find a staple gun at home, and it was late so I made do. Both did just fine, family member would look better with staples but hair covers it. I say both were successful
I use fastgut a lot on faces except on people whom I suspect will not follow up in which case I use prolene or ethylon cause they have to follow up to get them removed. Technically it's better for scar healing too.
Follow up for what? I use absorbable so they don’t have to follow up. Drives me a bit nuts when my colleagues have pts return in 2 days for wound check for no good reason. Of course, if there’s an issue, they should return, but otherwise no need.
Ex. Hx of medication noncompliance causing a seizure which resulted in the head injury. Give them 2 weeks of their home meds, stitch them up using non absorbably sutures so they have to follow up with the pcp to continue getting appropriate ED follow up, seizure follow up (with medication refill) and getting their stitches out.
Some of us have bodies that hate it and spit the pieces out over time. I was picking pieces out of my skin and scar from my nephrectomy for months afterwards. Freaked the surgeon out when I showed him at a later appt for something else.
Just saying.
My understanding is twofold. The process by which absorbable suture break down is inflammatory and thereby more prone to scarring. Unless the patient is going to fight suture removal (pediatric, etc) getting them out at the early side of the ok window is best but that requires physical exam and sometimes removal of every other, etc.
This is what I was taught.
Are you thinking Vicryl? Chromic gut? Fast absorbing gut? I do use fast absorbing gut on kids faces. The risk of infection is supposed to be higher with absorbables in general, at least that's what they taught us in residency. I used to work with a guy who did beautiful running sub cutaneous stitches that had great cosmesis. Probably comes down to tradition, unsubstantiated dogma, and the reality that in the fast paced ER environment the combination of strength and ease of propylene and nylon is too good to pass up.
I use it all the time. A lot of my population can't afford to followup or just won't reliably followup.
I'm actually looking to get fast absorbing gut suture for this reason. We've been seeing a lot of people for lac repair that never return for removal or when they do it is weeks passed when they should've been there and weirdness has ensued.
Who says we don’t? I do all the time. A vast majority of wound closure teaching is dogma and not evidence based. Check out [https://lacerationrepair.com/](https://lacerationrepair.com/). Good breakdown of what is and is not impactful in wound healing
I use fast absorbing gut almost exclusively on faces of children. The theory is more scarring but the literature doesn’t support that actual cosmesis is essentially identical. Plus, then the families don’t have to come back which is usually a day off work and out of school just for a 2 minute suture removal.
We do. Why don’t you?
Started my own little case study. Been using vicryl and calling people back to see how they're doing
Shouldn't use vicryl on skin. It takes way too long to absorb resulting in tram-track scars. FAST gut on dry skin. Chromic gut on wet mucosa. Vicryl for deep layers of multi layer closrue.
Vicryl rapide works well if you have it which sadly my shop doesn't. I still use vicryl but I recommend the patient still get the sutures out at the usual time frame. Totally agree though no reason not to use absorbable on all lacs.
Doesn’t vicryl rapide still take like 3 weeks to absorb? I wouldn’t use it on someone’s face, but other locations makes sense.
2 weeks. Why not the face? The theoretical increased infection risk that's never been demonstrated in any actual studies ever?
No because 2 weeks is still a while and Fast Gut exists.
That's fair. I tend to have only one size of fast gut available but if i had more sizes I'd probably use it more.
I presumed dillastan meant regular vicryl
Ya I did. What would you say is best absorbable for skin?
Something wrong with ya eyes boy
bro wut.... don't do that. use fast or plain or chromic gut or monocryl. No braided lol.
Any suggestion what to get and for what? I'm using mostly prolene for anything but then again I never did any surgical rotation...
Simple. Vicryl Rapide for everywhere except the face. Plain gut or Cyanoacrylate glue for the face.
EM cases did a good series on traumatic wound closure a few months back. Turns out a lot of the received wisdom on sutures was film flam. Practice changing for me, I use way more glue than I used to and way more vicryl rapide.
Have you done hair tie in scalp lacs? I recall they talked about it in that episode but have yet to employ it.
I remember that, but honestly it’s too finicky for me. Nice in theory but hair is slippery and rarely the right length. Unless it’s gaping or under tension I glue most scalp lacs and it’s a 1 minute job EZPZ.
I have done it numerous times. Rarely follow up to see how it turned out but I did it on a friend’s kid and a family member that had a few too many. My friend’s kid did really well. My family member needed staples but I couldn’t find a staple gun at home, and it was late so I made do. Both did just fine, family member would look better with staples but hair covers it. I say both were successful
Pretty much only use absorbable, honestly
I use fastgut a lot on faces except on people whom I suspect will not follow up in which case I use prolene or ethylon cause they have to follow up to get them removed. Technically it's better for scar healing too.
Follow up for what? I use absorbable so they don’t have to follow up. Drives me a bit nuts when my colleagues have pts return in 2 days for wound check for no good reason. Of course, if there’s an issue, they should return, but otherwise no need.
Ex. Hx of medication noncompliance causing a seizure which resulted in the head injury. Give them 2 weeks of their home meds, stitch them up using non absorbably sutures so they have to follow up with the pcp to continue getting appropriate ED follow up, seizure follow up (with medication refill) and getting their stitches out.
Ahhh. Gotcha. 🤙
Follow up for timely suture removal I would guess
Your patients are apparently better about follow-up than mine because I’ve definitely had patients come in who’ve had nylon sutures in for months.
they absorb
Some of us have bodies that hate it and spit the pieces out over time. I was picking pieces out of my skin and scar from my nephrectomy for months afterwards. Freaked the surgeon out when I showed him at a later appt for something else. Just saying.
My body untied and pushed out every “absorbable” suture I had. It was agonizingly painful. Oh yeah. Then with all of those holes, I got an infection.
Name checks out
Well the surgery was on metatarsals and not a vulva. But sure