Stitches (Sutures) 101: Overview, Types, Procedures & Removal

Sutures: Are Sutures and Stitches The Same?

 We often hear people use the words “sutures” and “stitches” interchangeably, but while the two are directly related to one another, they have different meanings.

The word “stitches” refer to the technique that healthcare practitioners use to repair a wound; on the other hand, the term “sutures” points out the material used to close the incision or laceration.

To better visualise their difference, you can think of stitches as the act of “sewing” the skin. Likewise, you can say that the sutures are the “threads.”

When Do You Need Stitches and Sutures?

Now, you must be wondering: what kinds of wounds need stitches?

Surely, you must have experienced getting a cut or two, but didn’t even think about having them stitched; so does that mean that only deep wounds require stitches? According to doctors, that’s not that case. In fact, even some surface wounds also need stitches.

You may need stitches if your wound:

• Is bleeding excessively (and the bleeding is not slowing down)
• Is gaped open making applying pressure difficult
• Is so deep that the dermis (yellowish layer of the skin) is visible
• Is sustained from a possibly contaminated object, like a rusty metal
• Resulted from an impaling or high-pressure impact object (bullet)
• Happened due to an animal bite
• Cuts across a joint
• Is somewhere cosmetically significant, like the face
• Is on or near the genital area (such as when mothers experience tearing during childbirth)

Open surgeries will also most likely require suture stitches. In some cases, surgeons may use suture staples when the surgical wound is too complex for the traditional stitches.

Types of Sutures 

Sutures are classified based on their structure, what they are made up of, and whether or not they are absorbable.

Monofilament vs Multifilament

Sutures that only have one thread  are called monofilament. These single-thread sutures easily pass through the skin. Likewise, there are sutures with several threads braided together (multifilament) for better security.

To differentiate these two even further, monofilament sutures require more care in handling and probably need more knots; the advantage is that they pass through the skin easily and cause less inflammation. Multifilament sutures, on the other hand, hold knots more securely, but since they are “thicker,” they might cause more friction and lead to inflammation. To avoid this, some multifilament sutures are coated with antibiotics. 

Non-absorbable vs Absorbable

We can also identify sutures based on whether or not they are absorbable.

Non-absorbable suture

Non-absorbable sutures, the type that we remove after a couple of days, are more aesthetically pleasing for most skin wounds.

Basically, what happens is the healthcare professional stitches the skin with non-absorbable suture, waits for a couple of days to let connective tissues grow between the edges of the skin, and then remove the suture to allow the wound to heal on its own. As long as the suture doesn’t stay too long in the skin, it’ll unlikely form a permanent scar.

Absorbable suture

Absorbable sutures are those that lose their tensile strength over a certain period of time. For this reason, you can also call them “dissolvable stitches,” which means there’s no need to physically remove them. In most cases, surgeons use absorbable sutures in deep temporary closure or when removing the stitches is particularly hard.

However, using absorbable sutures on superficial skin areas increases the risk of inflammation and scarring.

Natural vs Synthetic

Sutures may also be classified based on the material they are made up of. Sutures can be made up of natural or synthetic material.

Absorbable natural sutures are often made from purified animal tissues (such as collagen) and break down through proteolysis, the process of breaking down the proteins. Non-absorbable synthetic sutures are usually made from nylon or polyester; the absorbable synthetic ones break down through hydrolysis, the process of breaking down a compound due to a reaction in water. According to studies, hydrolysis causes less of an inflammatory reaction than proteolysis.

Suturing Techniques

Just like how we have different types of stitches for fabrics, there are also a number of suturing techniques. Examples are as follows:

Simple Interrupted Suture Technique

This is one of the simplest kinds of suturing techniques. In this method, the needle attached to the suture runs through one side of the skin, across the wound, then to the other side of the skin. According to reports, simple interrupted suture technique is appropriate in most situations.

Vertical and Horizontal Mattress Suture Technique

The vertical mattress technique is widely used for poorly supported skin as it promotes skin eversion, which means that it helps the skin stay flat rather than get depressed in the middle once it’s healed. In this technique, the surgeon inserts the needle on one side across to the other edge, then insert it again on the side of emergence and then through the original insertion site.

 In the horizontal mattress method, the surgeon inserts the needle on one side of the wound across to the other side, then re-inserts slightly below the emergence site and then to the insertion site. Experts say that this technique distributes tension across the wound.

Simple Continuous Pattern

Simple continuous is one of the most common techniques in stitching. Basically, the surgeon inserts the needle from one side of the wound to the other side, makes a couple of knots, and then runs the needle continuously through the skin. Finally, they then make another knot once suturing is completed. It’s one of the fastest techniques that also hold strength, since it distributes the tension across the strand.

Note that the stitching techniques are also classified based on where the surgeon is performing the suture. Examples include:

• Deep Sutures – these are sutures deep within the skin; it can either be continuous or interrupted.
• Subcutaneous Sutures – These are stitches that the healthcare practitioner performs in your dermis, the layer before your skin’s upper layer.
• Buried Sutures – Surgeons often choose this type of suture when there are larger sutures within the skin. Basically, in this method, the knot is found underneath or within the wound.
• Purse-string Suture – This method is a type of continuous suture that can be tightened, just like the strings in the drawstring bag.

Frequently Asked Questions About Suture Care

The good news is, no matter the type of suture or technique, the instructions for caring for sutured wounds are basically the same. Here are the answers to some of the most commonly asked questions regarding suture care:

How Do I Take Care of Stitches?

The first rule in taking care of your sutures is to keep them clean and dry. Never apply any cream or lotion unless your doctor approves of it. Likewise, if your stitches require bandaging, you must also keep the bandage clean and dry; if they get wet, change them immediately. Here are some additional guidelines:

Protect Your Stitches

For the first 2 days after getting your stitches, try not to engage in activities that may reopen the wound. Likewise, do not perform activities that will soak, wet, or contaminate the affected area. For instance, you should avoid activities such as swimming or washing dishes if the wound is on your hand.

If your child has stitches, be sure to remind them not to play during their Physical Education class until their wound has completely healed. In particular, keep an eye on younger kids as they may be curious and venture into playing in the mud or sandpit, which may impede wound healing.

Wash the Area Twice a Day

Washing the site gently (and as much as possible, quickly) prevents the buildup of debris that may lead to infection. You can shower or clean your stitches after 24 to 48 hours unless otherwise instructed by your doctor. An additional tip would be to avoid soaking in tubs. Likewise, do not use hydrogen peroxide and alcohol in cleaning the affected area.

Relieve Pain

Despite the fact that stitches are meant to close the wound and allow it to heal on its own, the affected area may hurt from time to time. Don’t panic. Taking a pain reliever approved by your doctor can help to relieve the pain and discomfort.

Watch Out for Signs of Infection

Keeping the wound site clean and dry prevents infection; on the other hand, knowing the signs of infection makes it easier for you to stop an infection from worsening. Below are the common signs of infection:

•  Redness and swelling on the site
•  Warmth on the affected area
•  Increased pain
• Pus or bleeding coming from the wound site
• Swollen glands
• An unpleasant smell coming from the wound site
• Separation of the wound
• Fever

Know When to Call the Doctor

First, if you notice any sign of infection, call your doctor right away. If it’s difficult for you to get to a clinic or hospital, you can consider getting a house call doctor to check on your wound.

Additionally, call the doctor if:

• The wound is deep and does not stop oozing with blood, especially if the wound is in an aesthetically significant area, like the face.
• You notice that the sutures are unintentionally or accidentally removed.
• The doctor advised you to have your sutures checked after a certain number of days.
• The wound looks the same even after 5 days have passed since you got the stitches.

How Long Does It Take For Sutures to Heal?

Usually, non-absorbable sutures heal after 5 to 10 days, but it still depends on several factors, like the affected area and how deep the wound is. Your doctor will give you detailed instructions when it comes to removing your stitches.

Absorbable sutures, on the other hand, usually dissolve after a week or two. However, please note that some absorbable stitches take several months to completely heal.

Do Stitches Heal Faster Covered?

Not all stitches need to be covered. Some of the instances when your stitches need dressing are when:

• The wound is leaking.
• You need to protect the area from getting contaminated.
• You need to prevent the stitches from coming in contact with your clothing.

In case your doctor deems that your stitches need covering, he or she will give you instructions about the type of bandage you need and when to replace them. Most of the time, you can apply a thin layer of petroleum jelly on the wound and then cover it with a non-sticky bandage. You also need to replace bandages every 24 hours and each time it gets wet.

Here’s a useful tip: there are waterproof dressings which you can use while showering. 

Suture Removal

Your doctor will tell you when your stitches can be removed. Absorbable sutures don’t need to be removed as they dissolve on their own, but you will still most likely visit your doctor so that they can check how well your wound is healing.

Do not remove non-absorbable sutures on your own. Removing it too early can delay wound healing or reopen the cut. Removing it too late can make the removal process difficult and increase the risk of scarring.

If, for some reason, you cannot go to the clinic or hospital for the removal of your sutures, you can count on Homage’s 24/7 home nursing services.

Care After Suture Removal

Once the healthcare professional removes your stitches, don’t forget to care for the affected area by doing the following: 

• Wash the area with mild soap and water and gently pat dry. If the site often comes in contact with objects and clothes, you can consider covering it with a dressing for about 5 to 7 days or as per your doctor’s instructions.
• Apply a thin layer of Vaseline as it may reduce scarring. You can also talk to your doctor about scar-reducing products.
• Protect the wound from the harsh sunlight.
• Refrain from activities that may re-injure the wound.
• Observe for signs of infection and call the doctor for any sign that the site is infected.

Medical stitches are effective in closing gaping wounds. Your doctor will select the appropriate type of stitch and suture for maximum wound healing process. After getting your stitches, remember the general rule: keep it clean and dry, and observe for signs of infection. Finally, do not remove sutures on your own; allow healthcare professionals to do it.

If you need professional support to wound care, stitches removal or other nursing procedures at home, Homage Nurses can help.