Suture removal?

[bearsfan1]

Is ther any evidence that suggests waiting a full two weeks, as opposed to nine or ten days before suture removal will produce a thinner scar?

[bearsfan1]

Is ther any evidence that suggests waiting a full two weeks, as opposed to nine or ten days before suture removal will produce a thinner scar?

[LondonTraveller]

That is an interesting point.

 

Dr Devroye (coalition member) who did my procedure was adamant that 14 days was the minimum to wait before suture removal ( in my case tricho closure)

[Dr. Michael Beehner]

Dear Bearsfan1,

For many years we took the sutures out at around 7 days. Around 6 years ago we switched to taking most patients' sutures out at 10 days after a first session, 12 days after a second session, and if a patient had a third procedure, 14 days for that surgery.

The more important point is that for any patient with a slightly tight closure or who had "hyper-elastic" scalp tissue, we have the sutures taken out at 14 days, even for the first session. On rare occasions I have gone to 16 days, but the trouble with going past 14 is that the stitch material (or staples( start to become imbedded with skin tissue creeping over it, which makes the removal more difficult and more painful).

What is actually happening when you go those extra 4-6 days with the sutures in place, you give time for the hair-bearing scalp above and below the suture line to start to relax and stretch out. In this process the remaining hairs become infintismally further apart, which the human eye can't detect. Keeping the sutures in keeps the wound scar from being pulled apart on from above and below during those early days when the tension is the greatest.

Mike Beehner, M.D.

[djdennis]

Dr. Beehner whats your take on dissolvable sutures? My doc used these on me and Im 40-days post-op and I am curious about streching and the healing process

[Dr. Michael Beehner]

I use disolvable sutures on occasion if the patient strongly wants them. There are two kinds of disolvable sutures: there is everyday "chromic catgut" or "plain catgut," both of which start disolving pretty quickly, even as soon as 6-8 days. Then there are the longer staying sutures such as the clear Monocryl. These can stay in for several weeks and almost seem to act like permanent nylon sutures. Most of the patients are looking around about two weeks after surgery for someone to take them out because they feel tight and are uncomfortable and the patient expected them to be "disolving."

If I am closing a donor wound in a patient who is the slightest bit tight or who has really stretchy, hyperelastic skin, then I really try hard to convince him/her to accept nylon sutures (or staples would be equally appropriate in such a case). But for those men who will be in a geographic situation or are so busy they just don't want to bother with making a trip to a physician's office or back to our office, I usually use the chromic catgut suture. I give the patient a stitch kit anyway and tell him that in around ten days he can nip and cut any thread he feels back there and try to pull out what he can, as it will lessen the amount of inflammatory reaction that occurs in the skin due to the disolving process that goes with these sutures. In most cases, 90% of patients have a girlfriend, spouse, mom etc who can easily take the sutures out if they live too far from our office. Staples work fine, but we don't use them because they tend to be more uncomfortable for the patient, especially at night sleeping.

Mike Beehner, M.D.