Have you ever tried to remove sutures from a child’s face? I’m pretty sure it should qualify as an Olympic sport. It requires so much strength, patience, and hand-eye coordination that when completed, it definitely warrants a medal.
A while ago, I wrote a blog about the benefits of tissue adhesive. I mentioned that I often push the boundaries with adhesive and will use it whenever I can. But unfortunately, not all lacerations meet the adhesive criteria.
Irregularly shaped lacerations, lacerations extending through eyebrows, and lacerations extending through the dreaded vermilion border all require sutures instead of glue. And while I could write an entire blog on tips and tricks for suturing a kid (and I quite possibly will in the future), I want to discuss a simple way to remove sutures from a child’s (or adult’s) face.
The trick to easy removal? You don’t remove them. That’s right. Now, I know what you’re thinking: Won’t patients be mad when they are walking around with nylon stuck in their face for the rest of their lives? And yes, I’m sure they would, if you used nylon.
But what about absorbable sutures? Temple University School of Medicine performed a study comparing the outcomes between nylon and fast-absorbing cat gut when used to repair facial lacerations in children. The results were astounding. There really was no difference between scarring, infection, wound dehiscence, or keloid formation. There was one very big difference though – the cat gut did not have to be removed. This provides benefits in many ways.
First of all, patients do not have to make appointments to come back to the emergency department or primary care office, so it saves them both time and money.
Secondly, with proper care the sutures will absorb in a timely fashion, thus avoiding the dilemma of when to remove the sutures, as removing them too early can cause wound dehiscence and removing them too late can increase scarring.
Thirdly, it prevents the child from experiencing further trauma. Children often don’t understand the idea that suture removal is quite different from suture placement, and they often present with fear that there will be more needles involved. This often causes a lot of screaming, squirming, and tears from both the practitioner and the patient. While the aforementioned study focused only on the face, I plan to further incorporate the practice of absorbable sutures into lacerations on different parts of the body that are under low amounts of tension.
Further, I will use it in both my adult and pediatric populations. I have some patients that do not follow up in a timely fashion for suture removal, and they often return months later or after they’ve tried to remove the sutures themselves and have caused further complications. I hope that using absorbable sutures will eliminate these problems entirely. Until then, I would like to leave you with one further word of advice: Regardless of what type of absorbable suture you are using, be careful with casually throwing the phrase “cat gut” around in front of a child. This may send them into a completely new set of hysterics.
Jillian Knowles, MMS, PA-C, is an emergency medicine physician assistant in the Philadelphia area.
- Luck R et al. Pediatric Emergency Care. 2008; 24(3), 137-141.