Absorbable Sutures or non absorbable?

[Reds]

Which is is better to go with, I feel like absorbable is risk free, don't have to touch the sonar area again. But still need all the experts advice. more info is really appreciated

[Romeono1]

I hear disovalble stiches are a bit of a pain because they can take more than a month or longer to disolve and they can be quite messy as some of the material may hang out of your head.

[Dr. William Lindsey]

I have used all sorts of closing sutures and although there is a bit more to the story than Romeono1 says, I'd say he speaks the truth. For best results in most people, removable sutures are preferable.

 

Dr. Lindsey McLean VA

[Maxxy]

Dr. Lindsey,

 

What do you feel are the benefits of non-absorbable sutures over absorbable sutures? Also, why are these benefits noted in one type over the other?

[Sparky]

non-absorbable anyday, less chance of infection imo

[Reds]

Hey Bill, thanks for moving my post to the right category of the forum.

Thank you all for the valuable reply. Till now I was in a impression that absorb able sutures are ideal,coz they dissolve and I thought that would be easy for me to forget about taking the staples out. Well I will give a second thought about those.

[Dr. William Lindsey]

Maxxy

 

Significantly less local inflamation in the skin with MOST removable sutures.

 

Same with staples, so most studies would show they are equally effective in getting good scars.

 

For my money however, I am WAY better at suturing than stapling, so I'll only staple upon request. Plus, also in my opinion, if you are going to get a good result with sutures or staples, you have to do a deep layer of sutures to take the load off of the skin edges.

 

Dr. Lindsey McLean VA

[Maxxy]

Dr. Lindsey,

 

Thank you for the reply. Am I correct in thinking that deep layer sutures are some sort of internal suture? Also, if a clinic does not routinely use deep layer sutures would it still be wise to request them?

[Dr. Bernardino Arocha]

The secret to getting very fine scars that is minimally visible to invisible lies in the minimizing of tension vectors at the wound margins. Consequently, all my FUSS patients get two-layer closures. The deep layer, is the workhorse, it brings the wounds margins close or nearly touching by interrupted sutures. Then the superficial layer is closed with a running baseball suture. I use all kinds of sutures; always of course an absorbable suture for the deep layer, as this will stay in place. The choice of suture in closing the superficial layer is immaterial, as this suture will be removed anyway. For more information, please see: http://www.arochahairrestoration.com/en/art/104/

[Romeono1]

Nice answer Dr Bernard.

[Dr. William Lindsey]

Maxxy

 

I would guess that most of the better clinics use deep sutures, but I don't know. You can certainly ask at the consultation. If someone doesn't use them, they may have a reason that isn't obvious to me, but at least for me, that deep layer is key. In the past I have done closures without them and the "average" result is clearly better with them.

 

Dr. Lindsey McLean VA

[Maxxy]

Dr. Lindsey,

 

When I had my work done, the donor was closed using absorbable sutures along with tension stitches which were vertical stitches that ran the length of the donor around an inch or less apart and were removed after 5 days. I have already discussed the matter with my surgeon and if I have further work done by him, he is happy to use internal sutures as an addition.

[Dr. William Lindsey]

Maxxy,

 

Let me start by saying that your doc may have a perfectly good reason for what you explained; AND I am in no way saying that method is wrong.

 

But from a healing standpoint, the entire idea behind a deep closure is to take the load off of the skin edges for the first SEVERAL MONTHS after an incision was made. That is the time that collagen is being deposited by fibroblasts in the scar and the time frame the widening of the scar is most likely to occur. It would be great to leave big skin sutures in that entire time and avoid deep sutures except for 2 problems: First, patients would go crazy with big honking sutures in for 3 or 4 months. And second, the suture marks would leave a "railroad track" appearance if left in much beyond 10 days. So when you say tension sutures were removed at 5 days or so, that really doesn't help anything, in my personal opinion. And those dissolvables in the skin...if they were short lasting, they were gone quickly and with little local inflamation, if they were medium lasting, you may have had a bit more inflamation (I do use those routinely behind the ears in all of my facelifts--but not in front of the ears where people will ever see the scar...) or long lasting which can take several weeks to dissolve and almost certainly cause more inflamation than removables(I routinely use those in little kid's scalp lacerations when I think that in order to get the sutures out, the risk of anesthesia would be needed--but I don't use those on folks that I can remove sutures in).

 

Just food for thought on a bit of the background of wound closure.

 

Remember, surgeons are independent thinkers who usually think they are themselves the fountain of all knowledge. That in mind, what I use works for me...but there are lots of ways to close tissue with excellent outcomes. Your doc almost certainly has a reason for what he does if he gets good scars.

 

Dr. Lindsey McLean VA

[Maxxy]

Dr. Lindsey,

 

Sorry for the delay. Thank you for taking the time to write your detailed post and sharing your experience and thoughts. If I end up having a second transplant, I will keep your observations in mind and raise them with my surgeon.