Monday, November 07, 2011

Absorbable Sutures Q & A

What are seen as the biggest advantages in using absorbable sutures?

Absorbable sutures are used in a wide variety of surgical applications including in cardiovascular surgery, plastic surgery, veterinary surgery and dental surgery. It is also a very popular option for use in general soft tissue repair. The newer types of synthetic absorbables are increasingly popular over catgut since tensile strength and absorption profiles are highly predictable with far fewer concerns for the risk of early degradation of the suture.

The biggest advantage to these sutures is there is not need to remove them after wound healing. The body naturally absorbs the material without the patient needing to return for manual suture removal. In sutures in deeper tissue layers this is important unless continuous wound support is required for extended or indefinite periods of time.

Are there any scarring risks that are present with absorbable sutures that are not as common with nonabsorbable sutures?

Fine skin such as the skin on the face, eyelids, the lips, mucous membranes or the genital areas, particularly with circumcision, can pose an increased risk for scarring at the places where the absorbable sutures enter the skin. This occurs because the body forms a tunnel of skin and fibrous tissue around the suture. When it degrades fully, which can take two months or more, that small skin tunnel can still exist. This will leave the slight dots that can be seen along the edge of a scar. Using a nonabsorbable suture allows the doctor or physician to use a much finer diameter suture material that leaves virtually invisible skin tunnels to maintain the same tensile strength over the wound to ensure correct healing.

In addition it is important to keep in mind that the rate of breakdown of the suture is different when it is in the skin as opposed to on the skin's surface. This can also slightly increase the risk of visible marks from skin tunnels on the skin's surface. Fast absorbing sutures and the new synthetic absorbables are much less prone to this type of scarring than plain catgut.

What factors can cause a more rapid breakdown of absorbable sutures and should these be discussed with patients?

Part of after surgical wound care should include discussing proper techniques for cleaning the surface of the wound and what to watch for that may indicate a problem or concern. Patients need to be aware than absorbable sutures should be carefully cleaned if the absorbable type of suture material is used on the surface layers of skin. The use of hydrogen peroxide, a common choice in many households, can actually lead to the early breakdown and degradation of sutures. Patients need to be given information specifically on the types of antibacterial or wound cleaning solutions to use to limit any possible increase in suture degradation.

Other factors can include abrasions to the surface of the sutures, infection in wound itself that can increase blood flow and enzymatic activity as well as issues with slow wound healing because of other factors such as medications, existing health conditions or re-injury to the wound.

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