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Staples, stitches steri-strips, and tissue glue – it seems there are so many ways to close the skin after surgery today. Suturing remains one of the standard methods for closing a surgical wound or after Mohs surgery, and ensuring the skin heals well.
“It’s not exactly Cat Gut,” says Dr. Adam Mamelak, board-certified dermatologist and Mohs micrographic surgeon in Austin, Texas. “Sutures nowadays are generally made of sugars or plastic polymers that give them specific qualities such as tensile strength, tissue reactivity, and certain handling characteristics. By selecting the suture with the appropriate characteristics for the type of wound and location on the body, a surgeon can close the skin in a precise manner that optimizes healing.”
Each wound will require its own type of closure based on its specifications. For example, Dr. Mamelak sometimes uses sutures to close the skin after a biopsy. The technique used for suture a skin biopsy is different than the technique used to close a larger excision, such as the type used to remove a birthmark, cyst or skin cancer.
A “layered closure” is employed in instances where there is a large or deep enough wound that a single external layer of stitches (AKA a “simple closure”) may not offer the best environment for consistent healing. “Layered sutures are a way to have more control in securing the closure in both the epidermal and subcutaneous layers,” says Dr. Mamelak.
Many people don’t appreciate the fact that it takes a considerable amount of time for the skin to regain its strength after a surgical wound has healed. Studies have revealed that the skin has only 5-10% of its original strength at 2 weeks after a surgical wound is sutured together. This is important because this is often the time sutures are removed from the skin! The strength increases to 20% at 3 weeks, and 50% at 1 month. The skin only ever attains 80% of it’s original strength after a surgical wound is sewn together, and this only happens at 6 months after the surgical procedure.
“And people ask me why they can’t workout right after their skin surgeries…”
This is why the layer closure is so useful for reconstructive surgery. By implementing a set of dissolvable stitches in the deeper subcutaneous layer under the skin, you are able to offset the large amount of stress that would be put upon stitches that are used in the outer layer of skin. “Basically, these stitches under the skin dissolve over a period of 3-4 months. During that time, they guide the healing process, help ensure the wound stays closed, and ultimately give the best cosmetic result,” notes Dr. Mamelak.