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Originally Posted by Doczilla
Absorbable suture:
- To close deep layers of a wound when doing a multi-layer repair (ex: laceration to the forehead all the way to the skull). I usually use Vicryl for strength.
-Running subcuticular stitches to minimize stitch scar. Usually done with complex plastic repairs or closing surgical wounds. With the complex plastic repair, I'll revise the wound edges, close deep, do a running subcutic, and then a running 7-0 or 8-0 skin layer of absorbable sutures really close together to minimize tension on the individual sutures. Less tension = less stitch scar. Current dogma discourages subcuticular stitches in "dirty" wounds, since they may prevent draining of the wound.
- I'll use chromic gut on lips and face because there is less granulation around the suture material, leading to less stitch scar.
- If follow-up is a problem, and you don't think the patient can make it in to have their stitches removed, or if it's a child and you think they'll pitch a fit about suture removal because of where the stitches are or how they reacted to having them put in, I'll use absorbable.
Virtually everything else that is accessible: regular nonabsorbable suture, staples, "hair sutures", or superglue.
'zilla
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Ok... next question to ask, what's the average time before an absorbable becomes absorbed?
My wife did a number to her finger, and after an hour and a half in the ER with no other patients IN the ER, she had only been seen by any staff once for a betadine finger bath, when she was brought in back... She was fed up, I was fed up, so we signed the AMA and left. I superglued it back together, and it's doing rather well, although when I get back from work on wed. I get to clip her fingernail off to help relieve some pressure it seems to be causing...
The ER nurse said it would need stitches, but when I got home all we had were absorbable. I didn't know if they would make the grade, as well as without pulling the remainder of her fingernail I didn't think I could go the full circumference of the laceration... so I decided the next best thing was to superglue it.
Although I cleaned it extensively prior to the superglue, it still ended up looking rather nasty...
Diagram of injury caused by a nice sharp AXE
That was 3 weeks ago, and now she's healing up rather nicely and able to generally, although gingerly, use the finger.
I've since found out that level of care from the ER there is the norm regardless of injury type or severity, and will subsequently be taking care of things myself, or making a 30 minute dash into anchorage to Providence hospital for any severe trauma from now on.
And no, I don't let her split kindling anymore.