Suture removal caution by Dr. Lindsey McLean VA

[Dr. William Lindsey]

We've had several recent cases of patients having unremarkable strip cases at our office, staying for a few days, then returning to the UK and having difficulty getting their sutures removed.

 

On 3 of the incidents this year, the patient went to a clinic, was told by the nurse or doctor that the sutures "weren't ready to come out" and were told to come back in a few days to a week. Fortunately, all sent me a picture of their donor area which was completely normal and I simply asked them to go to another clinic...or in 1 case, to have their spouse remove the sutures. I think its likely a case of the nurse not being comfortable with removing sutures.

 

Last week however we had a nice fellow who'd had a 2500 graft case. We saw him on postop day 1, cleaned him up and he went sight seeing. On day 3, my lead tech actually drove him to the airport and saw that he looked fine.

 

On day 7, he emailed me that a nurse had taken out a few sutures and he was bleeding so badly that they had to bandage him up, and he was to come back in a week!!

 

The miracle of facetime allowed his wife to show us the suture line...which was indeed all torn up in one small area... but also showed us that the rest of the sutures looked fine. Wendy walked his wife through removing the rest of the sutures while I looked on and his wife had no trouble. I expect the nurse who cut out the first 3-5 sutures had little experience...and the supervising consultant had even less.

 

So this is a caution to our travelling patients...perhaps check with a local clinic before coming for your case to make sure someone can competently take out your sutures postop. Or simply stay and we'll do it!

 

Thank goodness for facetime in this instance.

 

Dr. Lindsey McLean VA

[Blake Bloxham]

Great information! Thank you for sharing.

[ProteinPeep]

This is exactly why I decided to visit a HTN recommended doctor (Dr. Robert Haber) to have my sutures removed. I did not want to risk injury to the donor area...too precious!

[Spanker]

Honestly, anyone as intelligent as what an average 12 year old should be, enough dexterity to thread a needle, a small and sharp set of scissors, and a pair of tweezers can remove sutures. It's really just not that hard.

 

But have a trusted clinic if you can. I just cant believe that a medical clinic can mangle you up removing sutures.

 

Maybe private healthcare is a good idea UK??

Edited January 24, 2013 by Spanker

[HARIRI]

Thanks Dr. Lindsey for the write up. You are the only surgeon I have ever known who removes the sutures in Day 7. Most of surgeons insist on waiting for 14 days. May I know why please?

[Dr. William Lindsey]

I've commented many times that putting sutures in can take a variable amount of skill depending on what you are trying to accomplish....but almost any person ( I think I may have said a variety of adjectives at different times) can take them out. Evidently I'm mistaken as we've seen a few cases where medical personnel just can't remove them without trouble.

 

Spanker sums up my thoughts pretty concisely.

 

Hariri, sutures left in longer than 7 or 8 days will almost always leave marks on the skin. That is why you never see anyone leaving face sutures in more than a week and if you do, you'll see railroad track scarring. I see it all the time in donor areas we go back on who had their original surgery elsewhere. ALL THE TIME. So unless things are really unique, we get sutures out between day 6 and 7. And if people are travelling, I guess they can wait til day 8. Interestingly, a young man we did a few weeks ago who seemed really worried about his scar...delayed getting his sutures out for some unknown reason. People are hard to figure out.

 

As I've posted a lot....if you close in multiple layers the skin sutures are really only to hold the edges together for a few days anyhow...not to hold the scalp together.

Good question. I hope this answers it ok.

 

Dr. Lindsey

[1978matt]

 

Maybe private healthcare is a good idea UK??

 

Yeah, the National Health Service generally sucks because of a huge influx of immigrants. They system can't cope with demand and you will wait hours in A&E unless it's life or death!

 

Fortunately a good friend of mine is a 5+ year qualified surgeon so he will be taking my sutures/staples out!!

[Dexter27]

Yeah, the National Health Service generally sucks because of a huge influx of immigrants. They system can't cope with demand and you will wait hours in A&E unless it's life or death!

 

I found this comment silly blaming the migrants,don't forget some of the best hair transplant surgeons are also migrants (Rahal,Feriduni,Hasson,Wong,Bisanga,Mwamba,Umar,Farjo to name a few).also a lot of GPs,Surgeons and nurses working for the NHS are migrants.yet you only see the patient migrants in waiting rooms of gps.any where in the world if you go to emergency section without an appointment you have to wait a long time.

[1978matt]

I found this comment silly blaming the migrants,don't forget some of the best hair transplant surgeons are also migrants (Rahal,Feriduni,Hasson,Wong,Bisanga,Mwamba,Umar,Farjo to name a few).also a lot of GPs,Surgeons and nurses working for the NHS are migrants.yet you only see the patient migrants in waiting rooms of gps.any where in the world if you go to emergency section without an appointment you have to wait a long time.

 

Fair enough. I could have put it better. Although the rising population of the UK is an issue, regardless of nationality.

 

The same goes for our saturated transport system

[HARIRI]

Thanks Dr. Lindsey for the detailed answer. I believe in your approach. However can you tell us your opinion upon why most of top surgeons like Rahal, H&W and Shapiro insist for 14 days period before removing sutures??? Haven't they figured that this long period may leave marks? Please tell us your value able opinion.

[Janna]

Hariri, sutures left in longer than 7 or 8 days will almost always leave marks on the skin. That is why you never see anyone leaving face sutures in more than a week and if you do, you'll see railroad track scarring. I see it all the time in donor areas we go back on who had their original surgery elsewhere. ALL THE TIME. So unless things are really unique, we get sutures out between day 6 and 7. And if people are travelling, I guess they can wait til day 8. Interestingly, a young man we did a few weeks ago who seemed really worried about his scar...delayed getting his sutures out for some unknown reason. People are hard to figure out.

 

 

Dr. Lindsey

 

When our doctors do punch outs at the hairline that require stitches, we'll take them out at 6-7 days but for donor strips they are left in 10-14 days. We have yet to see any type of railroad scarring in the donor area from leaving them longer than the 7 days.

[Dr. William Lindsey]

Janna,

 

I'd defer to your knowledge of your doctors' practice and you guys have a great reputation.

 

I stand by my opinion that sutures left in longer than 8 days usually leave marks. Having done 3600 facelifts, 3000 or so eyelid procedures, maybe 1200 facial reconstructions, and perhaps 1700 hair cases, I have put in my share of sutures and done my share of scar revisions.

 

I see railroad tracks from sutures being left in longer than 10 days at least twice a month from a variety of surgeons on all parts of the head and neck.

 

What works for me is removing the sutures at day 7. If others get great results leaving them in longer or shorter, that is great and a tribute to their suturing skill.

 

Dr. Lindsey McLean VA

[Janna]

Janna,

 

I see railroad tracks from sutures being left in longer than 10 days at least twice a month from a variety of surgeons on all parts of the head and neck.

 

Dr. Lindsey McLean VA

 

Wow, really? We've not had the same experience with our sutures/staples left in longer or from other clinic's work. I'm aware of so many other physcians who use the 10-14 days. In fact, we have on few occassions when the strip width is wider than average, we adopted Dr. Bernstein's method with staple removal. At 10 days post op, remove every other staple then remove remaining half out at another 10 days. This seems to keep an extra support along the scar line while giving them some relief from irritation from the staples at 10 days post op. Again, we've never seen any remnants of rr tracks from the staples.

 

But I agree with you, a physician should use the method that gets the best result.

[Slickers]

Honestly, anyone as intelligent as what an average 12 year old should be, enough dexterity to thread a needle, a small and sharp set of scissors, and a pair of tweezers can remove sutures. It's really just not that hard.

 

But have a trusted clinic if you can. I just cant believe that a medical clinic can mangle you up removing sutures.

 

Maybe private healthcare is a good idea UK??

 

We have private healthcare. It's just that we also have an institution that anyone that cannot afford private healthcare has access to medical care as well

[Arlen]

I suppose i have got the Vitamin D inadequacy on account of i have stayed away from the sun for a considerable length of time, thinking it might age my skin, never giving a consideration to my bones, Thanks for the counsel, i am upgrading my eating regimen to assist things and i trust we get some sun this summer...

[Dr. William Lindsey]

So, This fellow sent pics over yesterday. Shown are a couple of intraop and postop pics. And then there are 3 pics of the scar. 2 look perfect. Now I say perfect, meaning that its a very fine line. Its quite red...because this guy is a very reddish skin'd patient from the UK. Redness is a problem in this guys for 8 weeks or so, and its past the maximal point, but you all are certain to notice the scar is red. NORMAL in this guy. The third scar picture shows the area that the nurse over there had trouble with, and she clearly opened the incision line and its wide and ugly where she did. Hopefully its just the top layer and there will be hair that grows through the scar. Only time will tell.

 

Dr. Lindsey McLean VA