Sutures can be placed underneath the skin, or in the top layer of skin itself. Some people have asked me why sutures are absorbable or permanent, and why surgeons care.
In a nutshell, absorbable sutures dissolve because the body’s cells break down the substance of the suture. Over several days to several weeks, the suture is eventually absorbed by the body. If the suture is close to the skin surface, sometimes it works it’s way to the skin and the body spits it out. These sutures are often used under the skin, but rarely used in the external skin.
Permanent suture technically will not dissolve, or will not dissolve over many years. This type of suture needs to be removed, hence the follow-up visit where I remove your sutures. Since your body does not or can not absorb them, I have to remove them.
Because permanent sutures cause little or no tissue reaction, they result in less scarring. Because the top layer of skin is the most visible, permanent sutures are generally used to at this layer. There is no possibility that the body can break down or absorb these sutures, so there will be less potential scar tissue that forms.
There are exceptions to using absorbable sutures at the top skin layer. In epidermal skin that is very difficult to see, such as inside the mouth or nose, absorbable sutures are routinely used. Children heal very well in general, and removing sutures can be difficult in screaming, moving, uncooperative kids, so absorbable sutures are used occasionally in the top skin level.
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