Four things to know about dissolvable stitches

When I use stitches to repair a wound, I inevitably will be asked two questions.

1. How do I take care of them?
2. Are they going to dissolve on their own?

I previously wrote about how to take care of stitches (also known as sutures). In fact, it’s consistently the most popular page on the entire website! To check that out, click here!

People from across America have e-mailed me lots of questions about dissolvable stitches. Today we’re going to share the big things you need to know about dissolvable stitches.

My personal suture cabinet. The bigger the number, the thinner the stitch is.

1.Stitches come in different shapes and with different needle sizes. I will choose a thicker stitch if a wound has more tension on it. The idea is to have the stitch hold the edges of a wound together until it’s healed enough to not spring apart. I will routinely use relatively large, dissolvable stitches beneath the skin so that they can hold the deeper layers together as things heal over a period of weeks. I will use a smaller suture on the outer layers of skin. The sutures I use for eyelid surgery are thinner than a human hair!

2. Dissolvable stitches break down because your immune system attacks them just like they would any other foreign body in your skin, like a splinter. Splinters hurt right? And not just when they go in, they can hurt for a few days afterward. It’s because your immune system uses an inflammatory reaction to get rid of them. Inflammatory reactions cause pain! They also lead to increased scarring.

Here are before and after photos of a skin cancer I removed. I used dissolvable stitches for the deeper layers and non-dissolvable on the outer layer.

For facial surgery, I will almost never use dissolvable stitches on the outer skin because I want to minimize scarring. Except…

3. When I don’t! For little kids who won’t be able to sit still while I take out their stitches, I will use dissolvable ones. If it will be logistically difficult to get someone back to have their stitches removed, I will use dissolvable ones. And finally, while I ALWAYS care what the eventual scar looks like, if the patient insists that they won’t care, well, maybe I can be convinced to use dissolvable stitches on the surface.

4. You can care for dissolvable stitches in the same way as non-dissolvable ones. Here’s a quick summary: twice a day take hydrogen peroxide and dilute it with water. Apply this solution with a q-tip twice a day, then apply antibiotic ointment or vaseline. A recent ABC News article reports on an article that says differently, but I think the article’s methods are flawed- e-mail me if you want me to explain more.

So those are the basics of dissolvable stitches. They are convenient, but they can make scarring worse. I like to use them in the deeper layers of your skin but not on the surface (with exceptions). Finally, you can care for them like normal stitches.

I hope you never need stitches, but if you do, your doctor will no doubt keep these things in mind when they pick which type to use.