Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Among the many methods for closing wounds of the skin, stitching, or suturing, is the most common form of repairing a wound. Other methods include surgical staples, skin closure tapes, and adhesives.
Removing stitches or other skin-closure devices is a procedure that many people dread. Understanding the various skin-closure procedures and knowing how they are put in and what to expect when they are removed can help overcome much of this anxiety.
Stitches (also called sutures) are used to close cuts and wounds in skin. They can be used in nearly every part of the body, internally and externally. Doctors literally "sew" the skin together with individual sutures and tie a secure knot. Stitches then allow the skin to heal naturally when it otherwise may not come together.
Stitches are used to close a variety of wound types. Accidental cuts or lacerations are often closed with stitches. Also, surgeons use stitches during operations to tie ends of bleeding blood vessels and to close surgical incisions.
Sutures are divided into two general categories, namely, absorbable and nonabsorbable.
Absorbable sutures rapidly break down in the tissues and lose their strength within 60 days. This type of suture does not have to be removed. These are used
Nonabsorbable sutures, on the other hand, maintain their strength for longer than 60 days. These sutures are used to close skin or external wounds and require removal once the wound has healed.
The general technique of placing stitches is simple. The "thread" or suture that is used is attached to a needle. The wound is
usually cleaned with sterile water and peroxide. Betadine, an
antiseptic solution, is used to cleanse the area around the wound. Next, the area is numbed with an
anesthetic agent such as lidocaine (Xylocaine). Then the needle with the thread attached is used to "sew" the edges of the wound together, in an effort to recreate the original appearance. Several stitches may be needed to accomplish this. Once the wound is closed
a topical antibiotic gel is often spread over the stitches and a bandage is initially applied to the wound.
All sutured wounds that require stitches will have scar formation, but the
scarring is usually minimal.
Surgical staples are also useful for closing many types of wounds. Staples have the advantage of being quicker, more economical, and causing fewer infections than stitches. Disadvantages of staples are permanent scars if used inappropriately and imperfect aligning of the wound edges, which can lead to improper healing. Staples are used on scalp lacerations and commonly used to close surgical wounds.
Skin closure tapes, also known as adhesive strips, have recently gained popularity. The advantages of skin closure tapes are plenty. The rate of wound
infection is less with adhesive strips than with stitches. Also, it takes less time to apply skin closure tape. For many people, there is no need for a painful injection of anesthetic when using skin closure tapes. Disadvantages of using skin closure tapes include less precision in bringing wound edges together than suturing. Not all areas of the body can be taped. For example, body areas with secretions such as the armpits, palms, or soles are difficult areas to place adhesive strips. Areas with hair also would not be suitable for taping.
Adhesive agents can also be used to close a wound. This material is applied to the edges of the wound somewhat like glue and should keep the edges of the wound together until healing occurs. Adhesive glue is the newest method of wound repair and is becoming a popular alternative to stitches, especially for children.
The adhesive simply falls off or wears away after about 5-7 days.