Improving Throughput, Pediatrics

Removing Suture Removals From Your ED.

After waiting 2 hours to get sutured at their local ED, why should patients wait another 2 hours to get their sutures removed? Wouldn’t it be awesome if there were an easier way to do this?

There have been RCT for absorbable vs non-absorbables with done by orthopaedics, plastics, colorectal surgery, and general surgery. They have found no difference in infection rate. Patients are reportedly more comfortable with the absorbables in place. They report better cosmetic outcomes.

ED studies have been done amongst all flavors of lacerations- pediatric facial lacs, pediatric traumatic lacs, and all ages facial lacs & traumatic lacs. There are no significant differences in rates of infection, wound dehiscence, or keloid formation. In terms of future preference, caregivers & parents favored absorbables.

So why don’t providers favor them?

FWIW, I recommend fast acting gut or vicryl rapide. I find it takes a little bit longer to complete suturing since the thread is clear, and sometimes it breaks easier when tying knots so I bring an extra pack.  Otherwise, they work well!

 

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Cosmetic outcome and surgical site infection rates of antibacterial absorbable (Polyglactin 910) suture compared to Chinese silk suture in breast cancer surgery: a randomized pilot research. PMID: 21528565

A Randomized, Controlled Trial Comparing Long-term Cosmetic Outcomes of Traumatic Pediatric Lacerations Repaired with Absorbable Plain Gut Versus Nonabsorbable Nylon Sutures. PMID: 15231459

Emergency department repair of hand lacerations using absorbable vicryl sutures.PMID: 9348057

Cosmetic outcomes of facial lacerations repaired with tissue-adhesive, absorbable and non absorbable sutures PMID 15258862

Does the choice of suture material affect the incidence of wound infection? PMID: 1106807

Randomized controlled trial comparing subcuticular absorbable suture with conventional interrupted suture for wound closure at elective operation of colon cancer. PMID: 24439741

Continuous Absorbable Intradermal Sutures Yield Better Cosmetic Results than Nonabsorbable Interrupted Sutures in Open Appendectomy Wounds: A Prospective, Randomized Trial. PMID: 24318410

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