Plastic surgeons are known for their fine stitchery and invisible scars. When you cut yourself on the face, you immediately think of calling for the plastic surgeon, since who else can sew with such skill? At least that’s what I like to think!
Why is it that experienced plastic surgeons are able to deliver excellent results when it comes to repairing wounds? It’s more than just the stitches we use, but that’s certainly part of it. Let me fill you in on a few of the details of stitches.
• Plastic surgeons leave skin stitches in for no more than 6 days in most cases. If you leave a stitch in for a longer period of time, the points where the stitch enters and exits the skin will fill in with skin cells, leaving a scar. That’s why unsightly “railroad track” scars result where there is a central scar line and a number of points of scar on either side.
• Plastic surgeons like to use either nylon or a similar type of material for the skin stitches. These are “non-reactive” meaning that the body does not react with inflammation and resultant scarring. The older types of suture material such as silk produce more scarring and are therefore rarely used today. In some cases we will use skin sutures that dissolve rapidly, disappearing before 6 days, so that scars at their skin entry points do not result. In other cases a “subcuticular stitch” is used, this being a stitch that runs from one end of the wound to the other, but is completely beneath the skin so that it does not produce additional scarring. It takes skill to place this stitch correctly. It cannot be too deep or too superficial – the suture bites cannot be too large or too small. The beauty of this suture is that it does not need to be removed, making patients very happy!
• Plastic surgeons are very fond of internal sutures. These are made of a dissolving material and go by names such as Monocryl and PDS. They last for about 6 weeks before dissolving. These stitches are placed within the deepest layer of the skin so that they bring the skin edges together beautifully, yet never need to be removed. The beauty of these internal stitches is they continue to hold the skin edges together after the skin stitches are removed about 6 days after surgery. Were it not for these internal stitches, the skin edges might pop apart or slowly separate to produce a wide scar. A scar does not reach maximum strength for about 6 weeks, so it’s important to provide internal support to the scar by means of these internal sutures for that period of time.
• Most plastic surgeons would prefer to precisely suture skin edges together rather than use tissue glue to hold the edges. Sutures are more precise and usually give a superior result.
Hopefully this brief piece has shed some light on the art of stitchery. Should you have further questions, please contact my office.
George Sanders, M.D.