Sutures Vs Surgical skin glue

Written By Jorele Simons

What are sutures (stitches)?

  • There are various types of sutures, broken down into natural and synthetic

    • Natural materials - like silk or catgut 

    • Silk - made from silkworm protein, often used for drains

    • Catgut – this is derived from animal collagen; this can be plain (absorbs faster) or chromic (treated with chromium salts for slower absorption)

    • Synthetic sutures – designed to break down in the body over time, these are ideal for fast healing tissues

      • Chosen for absorbability and strength

        • Polydioxanone (PDS) monofilament

          •  Longer absorption

        • Polyglactin 910 (Vicryl) 

          • Braided these are very common

        • Poliglecaprone 25 (Monocryl)

          •  Monofilament, smooth

        • Non-Absorbable – these retain strength indefinitely or for very long periods, used for tissues need permanent support

          • Nylon (Ethilon) – common monofilament

          • Polypropylene (Prolene) monofilament, inert

          • Polyester (Ethibond) Braided

          • Stainless steel – used for specific applications like bone closure

Structure Types

  • Monofilament

    • Single strand, resists infection but can be slippery

  • Multifilament (braided/twisted)

    • Multiple strands braided together for better handling and knot security, but often coated to improve passage

The choice of suture depends on the tissue type, healing speed, and desired strength and retention.  Synthetics are generally preferred for their consistency and lower risk of allergic reactions.


Sutures 

  • Used for deep, gaping or high-tension wounds (wounds over a joint or longer than ½ inch)

    • Deep or gaping wounds: 

      • Wounds that show fat muscle or underlying tissue or edges cannot be easily held together

    • High tension areas: Joints (knees, fingers, elbows).  We suture these as the wound needs to be secure to withstand movement

    • Long wounds: Lacerations (cuts) longer than ½ inch (12mm)

    • Irregular or dirty wounds: Wounds that require thorough cleaning and manual deep layer-closure

    • Timing: Ideally within 6-8 hours of injury.  If not done within this time our practitioners will discuss with you options on closing the wound

Sutures require a dressing and must be kept dry for 5 days, they need to be removed by a healthcare profession unless they are dissolvable sutures


What is Surgical Skin Glue?

Surgical skin glue is a topical skin adhesive that is a sterile liquid cyanoacrylate monomer that rapidly polymerizes upon contact with skin moisture to securely close minor wounds.  It serves as a waterproof, microbial barrier, eliminating the need for dressings or sutures.  It normally comes away naturally and can take 5 to 10 days.

  • Composition

    • Composed mainly of medical grade cyanoacrylates which are safe for human tissue

  • Uses

    • Used for closing small wounds less than 5cm long that are superficial lacerations (cuts), facial wounds and minor surgical incisions.

  • Advantages

    • This gives a rapid, painless and waterproof barrier that reduces the risk of infection and can give a good cosmetic result

  • Application

    • The liquid is applied in thin layers to bring the skin edges together, it takes approximately 2 minutes to set

  • Care

    • The wound must be kept dry for the first 24 hours, do not pick at the glue, do not use ointments or creams on the wound

  • Limitations

    • Adhesive skin glue should not be used on wounds under high tension, deep wounds that require layering, animal bites or wounds that are very dirty

If a wound reopens and/or becomes infected or continues to bleed, medical advice must be sought

  • Used on the following type of wounds:

    • Minor/Superficial cuts: Small lacerations with straight edges that easily come together

    • Low tension areas: These areas are the face, scalp or torso

    • Cosmetic areas: Preferred on the face for better less noticeable scaring

    • Paediatric cases: Skin glue preferred to avoid needles and reduce fear.  Not to be used for long, deep or gaping wounds

    • Conditions: The wound/s must be clean and dry

When skin glue cannot be used

  • Animal or human bites

  • Jagged or contaminated wounds

  • High-movement areas – joints

  • Wounds longer than 4cm

At Taylor Grey our practitioners are highly skilled in using skin glue and sutures.

We use both dissolvable and non-dissolvable sutures – the practitioner will decide on which to use.

Jorele Simons
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