Suture

I've been asked so many times, "How many stitches?" And it has nothing to do with anything. One running suture will close the last layer of a large abdominal incision. Several interrupted stitches can be put in one small finger incision. Says nothing about deep stitches underneath, nor the length of the wound or laceration, nor what kind of sutures were used. Irrelevant information. How many bacteria dance on the head of a pin? How many feet in a bushel?

Sutures come in several kinds, mix-n-match.

Permanent sutures must be removed from skin, or stay unless taken out in a later surgery, like silk, nylon (Ethilon) or Prolene.

Dissolvable sutures stay deep, but are degraded by the body over a week, weeks or months, from fast dissoveling Chromic to longer lasting Vicryl.

Monofilament sutures can be permanent or dissolvable, but are smooth, don't tie down as well, but don't track bacterial load from the skin into the wound. Prolene, Monocryl, PDS.

Braided sutures are more often permanent, keep their knots better, and are for deeper down inside. Fiberwire is permanent, braided, often used for tendon repairs. Eventually the body scars down, reinforcing and negating the need for the reinforcement, but the strong suture keeps everything in place until the body can do this with the tissue laid down. Vicryl is braided, but does degrade over weeks. Silk is braided, technically dissolvable, but most often used as permanent, surface stitches, or to tie drains, and removed.

So, all the fuss about President Obama getting "Twelve stitches" doesn't mean anything, really. My two visible Prolene stitches outside, matched by two (or three) dissolvable Chromic inside, with a vicryl, in unknown number of stitches for deep closure, beneath. Simple stitches vs, Mattress stitches makes a 1:2 difference, in addition to running stitches, which close a whole incision in "one" stitch. A seam vs a tied quilt, if that makes more sense, at least to those of you who sew.

One of the first jobs I had to do in my OJT (On the Job Training) for US Army, orthopedic tech, was to remove a passel of stitches from a long, and encrusted, incision on an arm. Given pick-ups (tweezers) and sharp, fine scissors, I was told to have at, without further instructions. I learned, and stayed attentive and acted confident, and tried to be gentle. Managed to perform the task without causing more harm. Got all the stitches out. Taking two fine sutures out of my own lip was comparably easy, once I remembered I had a magnifying mirror.

How long is the incision, now that is a measurable criteria.