Self-absorbing threads for sutures in surgery, gynecology, dentistry

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Consequences of late suture removal

Suturing is a surgical intervention after or instead of surgery, which serves to heal the tissue. Application is resorted to only in cases where the wound is extensive and cannot heal on its own. At the moment, there is a large amount of not only medical materials for this procedure, but also many execution techniques. The technique and materials are selected solely on the basis of the nature of the wound, location and experience of the surgeon, and neither the application nor the removal process is discussed with the patient.

Now such an intervention does not take more than 15 minutes, but recovery can last for weeks. Even if you need to have stitches removed, it is not necessary to stay in the hospital, as it is now quite common to remove stitches at home with the help of specialists.

What types of seams are there and what is their difference?

Depending on the degree of tissue damage, there are many types of sutures and methods of applying them. But they are all divided into external and internal.

External sutures or, as they are also called, superficial sutures: applied to the skin or superficial mucous membranes in one layer, the threads are removed immediately after the tissue has grown together.

Internal seams (plunging) remain deep in the fabric. Most often, absorbable sutures or sutures are used that can later exit through the genitals.

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Regardless of what type of seam is used, there are the following types:

• skin;
• muscular;
• tendon;
• capillary;
• intestinal.

The type of suture is selected depending on the depth of the wound and its location. Another important aspect is the patient’s age, since older people have a very low ability to regenerate tissue, which is why submerged sutures are most often used on them.

Requirements for surgical suture material

Back in 1966, requirements for suture material were presented by Shchupinsky, who subsequently developed quality standards for raw materials and production of threads:

• Surgical material must withstand the sterilization process by any method.
• Catgut cannot react with tissues; and must have a reversible effect when taking medications.
• Threads should not provoke the development of allergies. If the body gave such a reaction, it means that the doctor diagnosed the patient poorly by choosing the wrong type of material.
• Material of any origin must have hypoallergenic properties.
• The raw materials from which the threads are made must have increased strength, and the threads should not be deformed until the wound has completely healed.
• The knot on synthetic and natural threads should be held firmly, and done easily and quickly.
• The material is resistant to all infections, otherwise it should not be used.
• The process of resorption of all types of threads occurs without consequences for humans.
• During manipulation, the thread must have maneuverability, be elastic, plastic and not have “memory”. The surgeon should be comfortable working with it.
• Any surgical thread should be suitable for various types of operations.
• The suture material should not be electrified.

In the place where the knot is formed, the thread should not lose its properties. This is the most important requirement, since seams and knots can be made in different ways, affecting the structure and integrity of the tissues.

Stitches are also classified into different types based on the use or application of the threads.

Typically, the classification includes the following types:

• common seams;
• cardiovascular;
• valve seams;
• orthopedic;
• dental;
• gynecological sutures;
• veterinary;
• sutures for cosmetic surgery;
• ophthalmic sutures.

Different suture materials can be used for a specific application depending on the requirements.

However, the sizes, lengths, and profiles of needles can be slightly changed for a specific case:

Sharp needles pierce and spread tissue with minimal incision and are used where it is necessary to prevent bleeding. Most often, such models are used in general surgery.

Why and in what cases are stitches applied?

A large cut or wound, whether in an adult or a child, may require stitches. This is done for several reasons:

• for rapid healing of the skin;
• to avoid infection in an open wound;
• for an aesthetic appearance (when a wound has formed on the face).

Only a doctor can determine whether a wound can heal on its own. In doing so, he is guided by the following principles:

1. Depth of the wound. Are subcutaneous layers or fatty tissue visible in the wound?
2. Disclosure. Is it possible to gently close the edges of the wound?
3. Bleeding from the wound. How heavy is the bleeding and can it be stopped?
4. Location of the wound. If the wound is on the face, joints, bends of the limbs, or near (inside) the genitals.
5. Method of obtaining a wound.
6. The presence of a foreign object in the wound.

If the wound is not that serious, then doctors simply apply a bandage and write recommendations for treatment.

Technique for applying postoperative sutures

Suturing is the final chord that completes the operation and leaves behind the entire journey of saving the patient’s life. Sutures can be continuous or interrupted. The choice depends on the location of application.

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Included in the price:

• Antiseptic treatment
• Removing suture material (suture removal)
• Secondary treatment with antiseptic
• Applying healing ointment
• Applying a bandage
• Necessary materials and preparations

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A continuous suture is placed on the abdominal cavity with one thread if there is no separation of the edges. There are several types of continuous seam, each of which has its own technique:

1. Furrier. The first suture is placed with a knot near the corner of the wound. Subsequent ones are at the same distance from the edges of the wound.
2. Purse string. Applied to temporarily close natural openings in the skin.

Intermittent or knotted sutures are stronger; after they are applied, several knots can be removed to administer medications or wash the wound. There are:

• simple;
• loop-shaped;
• suture with the formation of a skin fold;
• situational.

Despite the wide variety of interrupted sutures, they are applied using the same technology. It is necessary to have several threads in the needle from 15 to 25 cm. The stitches are placed 1.5 cm apart, after each stitch you need to tie a knot.

What material is it made from?

Surgical sutures are used to close most types of wounds. An ideal suture should allow the healing tissue to recover sufficiently so that the incision site remains closed after they are removed or resolved.

All types can be roughly divided into absorbable and non-absorbable materials. Each type has its own classification, where synthetic or natural suture threads are found, as well as monofilament or multifilament materials.

Regardless of the type and classification of suture materials, threads must provide a basic range of functions:

• The ideal seam is the minimum possible seam in width and depth.
• It should provide uniform tensile strength, hold soft tissue securely in the incision area for the required healing time, and then dissolve.
• It should be predictable (in the medical sense in the field of allergies), easy to use.
• The threads may cause minimal body reactions (temperature, itching or irritation).
• The material must form a knot securely.

The choice of the type of suture material largely depends on the clinical picture. For example, mass closure of a midline laparotomy may require the use of a PDS; a vascular anastomosis will likely require prolene, and manual suturing of an intestinal anastomosis may require Vicryl. But to ensure drainage, only a silk suture may be suitable.

What affects the time for suture removal?

The main indicator for removing a suture is wound healing. If the sutures are removed too early, the tissues may separate again, resulting in the need for repeated intervention or an unsightly scar that will then have to be removed. If the suture is removed too late, it can cause suppuration or inflammation of the tissue. It is believed that the optimal period for removal is 10 days after application, but the period may vary, depending on the type of operation:

• amputation of limbs - from 12 days to 2 weeks;
• abdominal surgery – up to 1 week;
• Caesarean section - on the 10th day;
• eye surgery – from 6 to 8 days;
• Chest surgery - 2 weeks.

But a specialist can determine whether to remove the stitches or not, based on the patient’s current condition. If it is necessary to hold the suture for a long time, daily treatment of the wound will be required to ensure that the wound does not become inflamed.

In addition, there are several types of postoperative sutures, which also have their own removal times. These include:

1. Primary suture - it is applied immediately after surgery. The duration of removal depends on the operation and the current condition of the patient.
2. Secondary - applied in case of consumption of the primary seam. It happens:

• early - 1-2 weeks after surgery;
• late - within a month after surgery.

It is important to remember that only a specialist can remove postoperative sutures.

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Types of postoperative scars

Before removing a scar left from surgery, you first need to understand what type it is. Scar formation is influenced by wound healing conditions. The process takes place in several stages, during which collagen proteins are first produced, and then its excess is broken down. Highlight:

• normotrophic - the healthiest type of scar. It is formed under normal healing conditions and is virtually invisible: it has a color similar to the rest of the skin and is painless to the touch.
• atrophic - sunken scar: located lower than the skin around it, close in color or slightly pinkish, often lacking elasticity. Appears with a lack of collagen.
• hypertrophic - the opposite of atrophic, protrudes above the underlying skin. Usually has a color from pinkish to dark burgundy, painless and low-elastic. This type of scar is caused by excess collagen.
• keloid - a scar similar to hypertrophic, also protrudes above the rest of the skin, has a color from pinkish to dark burgundy, but, unlike other scars, it can grow beyond the original damage and at the same time bring painful sensations. It is formed when there is a failure in the production of collagen and after the wound has healed it continues synthesis.

The formation of atrophic, hypertrophic and keloid scars is caused by complications in the form of burns, suppuration, specific immune reactions, hereditary predispositions or improper tissue joining.

What thread are used to stitch the stitches?

Now there are quite a few types of threads that surgeons use; they can be classified both by brand and by characteristics. There are these types of threads:

1. Absorbable. Able to be independently excreted from the body, incapable of rejection. These types of threads are used if the tissue is able to grow together quickly.
2. Non-absorbable. Used for stitching tissues of internal organs or if long-term (permanent) stitching of tissues is necessary.

Absorbable threads are created from materials such as:

• nylon;
• polypropylene;
• catgut;
• lavsan.

When using this type of thread, it is necessary to accurately determine the rate of tissue fusion, since if the thread is removed from the body earlier than necessary, this can cause a number of problems.

Non-absorbable threads consist of the following materials:

• cotton;
• linen;
• silk.

This type of thread has a number of disadvantages. The most important thing is the ability to form microbes in tissue. When choosing, the doctor is guided not only by the purpose of the thread, but also by his own experience, and the patient’s preferences are not taken into account.

Lifting with non-absorbable threads

Non-absorbable threads are thin and strong, usually made of polypropylene. They are administered at the level of subcutaneous fat. The threads create a supporting frame. Introducing them into the superficial as well as middle tissues helps to effectively tighten the facial skin without compromising the integrity of the main vessels and nerves.

At first, the threads were smooth, and return knots were made to fix them in the tissues. Then polypropylene threads with cones and notches appeared, and the cones were made of absorbable material. They help fix the thread in the desired position and dissolve over time.

Non-absorbable sutures are placed under the skin and secured in invisible places. And to fix the tissue, small incisions are made at the level of the temporal fascia and scalp, then the thread is attached to the bone structures and the incision is sutured in layers. Only a surgeon (but not a cosmetologist) can do this.

Lifting with non-absorbable threads helps to cope with severe manifestations of ptosis:

• restores the lines of the cheekbones and cheeks,
• reduces nasolabial folds,
• raises the corners of the lips,
• makes the lower jaw line clearer,
• reduces the “double” chin,
• corrects eyebrow ptosis.

The result looks natural - without the “mask effect”.

How long does it take for threads to dissolve after surgery?

Absorbable threads are used both in surgical operations on the face and in deep tissue layers, and are also used in organ transplants. The main function is to maintain tissues in a stable state until they grow together.

The main factors due to which material can be excreted from the body include:

• chemical reactions of the body when interacting with protein;
• contact with water in the body.

The rate of removal of threads from the body is influenced by the material from which it was created:

1. Catgut begins to dissolve after one month, and is completely eliminated from the body after 4 months.
2. Lavsan dissolves within 12-13 days, but dissolution may take 1-1.5 months. Most often this material is used in cosmetology.
3. Vicryl begins to be eliminated from the body after 2-3 months.

In this case, it is necessary to follow all the rules for wound treatment, since the healing process can not only be delayed, but also cause inflammation or suppuration.

When should stitches be removed?

The main indicator for removing stitches is wound healing. Factors such as:

• presence of complications;
• patient's age;
• Current state;
• nature of the surgical intervention.

The location of the seam plays a special role; depending on it, the timing of thread removal is set:

• areas of the body with active blood supply - 5-6 days after application;
• shins, feet, arms, knees - approximately on day 10-12, since in such areas there is a slower recovery rate;
• infected wound - the sutures are removed the next day, as treatment and openness are necessary for speedy healing;
• clean wound - a week after application.

Only a surgeon can determine whether removal is necessary at the moment or not during an examination. In addition, for elderly people, sutures are removed no earlier than after 2 weeks, since they have a very low ability to regenerate.

HOW TO CARE FOR DISSORBABLE SUTURES

Having dealt with the question of how long it takes for the threads to dissolve, it is important to understand how to properly care for the suture after surgery so that healing proceeds safely, the threads are safely torn away, as quickly as possible, and there are no scars left at the site of the intervention.

Please pay attention to the following most important rules for caring for postoperative sutures:

• The most important point is the sterility of all manipulations performed. Before treating a wound, be sure to wash your hands and thoroughly disinfect all instruments.
• Depending on the nature of the sutured wound, it must be treated with an antiseptic - brilliant green, Fukortsin, potassium permanganate solution, hydrogen peroxide, medical alcohol. It is better to check with the supervising surgeon what exactly to use. You may have to combine medications and use them together with anti-inflammatory ointments.
• During water procedures, avoid friction; the wound can only be washed with warm water or a decoction of herbs.
• If we talk about postpartum sutures, then it is imperative to maintain intimate hygiene - this will prevent complications.

So, in order to find out how long it will take for the sutures to be successfully absorbed after surgery, you must first find out the material from which they are made. It is also worth taking into account the individual characteristics of the body: if you have a tendency to long-healing wounds, then be prepared for the fact that complete resorption of postoperative threads can take up to six months, especially if organic materials were used during suturing of the wound.

Suture removal technique

Following the correct algorithm for removing sutures and maintaining sanitary conditions allows you not only to avoid infection of the wound, but also to speed up healing. Specialists explain the procedure to the patient before performing it and place him on the couch. The procedure has the following algorithm:

1. Removing the protective bandage.
2. Inspect the wound and determine the number of stitches to remove.
3. Treating the wound with an antiseptic. It must be carried out 2 times to prevent infection, near the wound and inside.
4. The suture knot is grabbed with tweezers and lifted.
5. The thread that appears after pulling is cut.
6. The suture is pulled back with tweezers and the knot is removed.
7. Checking the integrity of the skin.
8. Treating the wound with an antiseptic.
9. The area is covered with a sterile napkin and then fixed with either a bandage or adhesive tape.

This procedure is performed in a hospital, but it is now quite common for postoperative sutures to be removed at home by a specialist.