Surgery
We spoke to Dr Philippus Nel, a surgeon at Mediclinic Kloof in Pretoria, about modern surgical sutures.
How do absorbable stitches work? And what are the pros and cons?
Unlike polypropylene or nylon stitches, which will be in the body in the grave if they aren't physically removed, absorbable stitches break down naturally over a period of time. Absorption occurs through a process called hydrolysis - each stitch is broken up into smaller components when it reacts with water molecules. Absorbable stitches are often used internally so that no post-operative surgery is required. The most common absorbable stitches take 10 to 14 days to break down. Resorption (the stitches are assimilated and used in the body) is needed, however, and this process can cause local inflammation and itching.
What kind of procedures would you use surgical staples for?
There is a large range of stitches for every procedure and tissue type. I've used everything from catgut to braided sutures. Non-absorbable stitches are best for a hernia and major blood vessel repair, for example, as they prevent leaking. Surgical staples are best for bowel surgery. I've used clips in mastectomies (breast removal) and laparotomies (incision through the abdominal wall). Unlike regular sutures, which still require a primitive process to administer, a stapler is used to insert metal clips.
What are tissue adhesives? Are they as strong as regular sutures?
Tissue adhesives are basically glues. They are gaining in popularity for minor skin lacerations that are tension free. You cannot use them on an area with high tension, however, such as the back- the wound could pull apart. Tissue adhesives are ideal for use on face as they leave a nice scar. They are also useful for laparoscopic hernia repairs - you are less likely to damage an artery or nerve as you might do with a needle. The best part is no anaesthetic is needed and they can also be used at home for small cuts.
