stitches/sutures questions

[Take a chance]

The Doctor I am visiting uses 2 kinds of stitches, the absorbable ones that dissolve on their own after a few months, and the nylon that should be removed on day 5. My two questions are

Has anyone had the absorbable stitches put in?

How do the nylon stitches compare with the other sutures that other HT doctors use. Are they still painful when removing?

[Goldilocks]

While I cannot comment about the dissolvable sutures as I had the nylon type, I can say that I found it quite painful having them removed. I think part of it was because some of my real hair was getting pulled out at the same time as the sutures. I was clenching my fists the entire time the sutures were being removed. I know that not everyone has that same experience, but I guess I was a bit unlucky in this area.

 

(By the way, my sutures were removed on day 14 post-op.)

[youngsuccess]

I had absorbable stitches. They can take a while to dissolve, and I've also read that the suture holes often remain a bit red for longer periods after the procedure. It's no fun either way, but if you're not from out of town or can make it back to the clinic a week and a half-two weeks later, I would opt for the standard, removable stitches/staples.

[AMR1]

Hi, I just had a HT about 1 month ago and Dr Humayun used stitches that had to be removed after 10 days, though I did not stay in Pakistan for this to be done my local Doctor's nurse back in UK had no problem removing them and the pain was minimal, just the odd tug where blood and hair were dry and stuck together, but overall not as bad as I assumed, was told that the dissolve stitches are not so strong and could give way, (that's what my nurse said anyway's)

[latinlotus]

I had trichophytic closure, so therefore I had two layers of sutures. The inner layer is with dissolvable sutures (no choice here) and the outer layer is with non-dissolvable sutures. Non-dissolvable sutures are better since there is less chance of inflammation, shock loss, scar stretch etc. Even if the procedure is done out of town, you are still better off with non-dissolvable sutures. All you need to do is to take an appointment for suture removal with a local HT doctor or plastic surgeon.

 

Goldilocks:

The removal of suture should be painless, as was in my case. The person who did yours was probably not competent, or was rushing to do a botched job. It took at least 30 minutes to remove my sutures. The nurse (she works with a HT doctor) took time to moist the sutures in order to detach from the skin and hair, and also remove all scabs. Don't settled for anything less.

[Janna]

Originally posted by latinlotus:

I had trichophytic closure, so therefore I had two layers of sutures.

 

I'd like to clarify that trichophytic closure technique does not mean a two layer closure has to be performed. In fact, majority of doctors performing tricho only use the outer sutures or staples. If a subcutaneous sutures are used (dissolvable sutures), the doctor can opt for either non dissolveable sutures or staples for the outer closure. There are instances where a doctor may opt to use dissolveable sutures on the outside instead of a nylon or others types that have to be taken out. I believe I've heard Dr. Epstein using dissolveable sutures for the outer sutures so his out of town patients don't have to worry about getting their sutures/staples out in 10-14 days after surgery.

 

I think it's important to keep the donor area clean immediately following your ht surgery. The cleaner the site the easier and less pain there is when removing sutures or staples.

[Dr. Scott Alexander MD]

To get the optimal scar that is possible it is very important to have deep sutures placed with an absorbable type suture such as Vicryl, which takes the tension off the incision line for approximately six weeks. This will allow the incision to heal without being pulled upon preventing scar widening.

If your doctor is using a non absorbable suture, make sure it is as non reactive as possible to your body. A monofilament, similar to fishing line or a nylon suture, is most commonly used.

Personally in my practice I prefer to use Ethibond which is a non absorbable monofilament.

The next important step is to remove the non absorbable suture as quickly as possible, usually within 5-7 days post surgery. Sometimes 5 days may be too early, and your doctor will be able to make that case by case judgment. The quicker it's removed, the less time the body will have to react to it. This is why the deep stitches are important because they will allow you to take the suture out quicker. If you leave the sutures in up to 14 days the skin will grow around the sutures making them painful to take out, much like Goldilocks' experience. It can also form railroad tracks and possibly killing hair along the suture line.

The last step to a good closure would be using the trychophytic technique, which has been discussed a lot in the forums. Find out if your doctor uses these steps, if so you will have an excellent closure and result; if not, I would think about going to a different doctor. These steps should result in very little pain if any when you are getting your sutures removed.

[chantal]

Like Goldilocks, the removal of my sutures was painful. I had to ask for the stress ball!

 

It was done by Dr Rahal himself like Goldilocks..The reason for the pain, I think, is the fact that we both had long hair which was pulled at the same time..Dr Rahal is top notch...

[Dewayne]

Originally posted by Janna:

Originally posted by latinlotus:

I had trichophytic closure, so therefore I had two layers of sutures.

 

I'd like to clarify that trichophytic closure technique does not mean a two layer closure has to be performed. In fact, majority of doctors performing tricho only use the outer sutures or staples. If a subcutaneous sutures are used (dissolvable sutures), the doctor can opt for either non dissolveable sutures or staples for the outer closure. There are instances where a doctor may opt to use dissolveable sutures on the outside instead of a nylon or others types that have to be taken out. I believe I've heard Dr. Epstein using dissolveable sutures for the outer sutures so his out of town patients don't have to worry about getting their sutures/staples out in 10-14 days after surgery.

 

I think it's important to keep the donor area clean immediately following your ht surgery. The cleaner the site the easier and less pain there is when removing sutures or staples.

 

I had my transplant with the same Dr. Cooley, but I didn't have dissolveable sutures. I asked him about these, but I think he said because of my previous procedure / scar, that he wasn't going to use those.

 

But, I had them removed at day 14, and while it wasn't all that painful; I would have preferred some other activity at the time.

[CuriousJungleGeorge]

I think Dr. Alexander's advice is followed by most doctors, though I've heard of stitches' typically being left in a bit longer than five days (maybe about two weeks). It's give-and-take: you don't want to leave sutures in for too long, because problems may occur, but taking them out too soon, as well, can cause complications (not least of which is an opened donor region).

[Dr. William Lindsey]

As I have often posted, each of the docs has a different feeling on what works for them. I take skin stitches out at a week, because noone wants to come in on Sunday to take them out at day 5 or 6. We always do it at a week primarily for ease of schedule. Unless some unique case is occurring, we never leave them in more than 8 days or suture marks will be more likely to result. I applaud Dr. Alexander's 5 day rule and would use that except that I am sure that I would be teaching Sunday school and there would be some fellow waiting outside a locked up office for me to show....

 

Dr. Lindsey McLean VA

[Maxxy]

I had absorbable stitches, they took awhile to go but really didn't bother me. I also had 14 tension stitches which were removed by my gp after 5 days, I could feel them being pulled out but it wasn't painful.