Cautionary Observations on Stitching with Absorbable Sutures

The described technique is innovative and anything that reduces the amount of buried foreign material is to be encouraged. However, there is no detail as to the exact level within the dermis where the suture should be placed. One sees early on in wounds that should heal with almost negligible scarring (thyroid surgery, lower transverse abdominal incisions) an excellent scar with subcutaneous sutures. At 6 months onwards, however, these scars become hypertrophic and occasionally keloid. This may be due to the suture material being placed too superficially in the dermis to make sure the epidermis is well opposed. The skin closure tension should be managed with deeper dermal sutures. The epidermis may come together without any further suturing but re-enforced with tape.

There are some patients who are sensitive to the various absorbable sutures used for skin closure. The tissue reaction settles when the sutures are removed without antibiotics.

The newer suture materials (e.g. Vicryl™ rapide [Polyglactin 910]; Ethicon, Simpson Parkway, Kirkton Campus, Livingston EH54 0AB, UK) have become popular for skin stitching, particularly as it is common practice not to remove them. However, these sutures often remain longer in place than the perceived seven days. This often results in stitch marks, which should be avoided. If, however, these materials are used as skin stitches, then, particularly in children, the knots can be cut. The parents/patient can then be encouraged to rub out the remaining stitch ends over the next few days. The best time to do this is at bath time. Supportive tape can be applied if there is concern about the strength of the healing wound.