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View Full Version : Injures: Sutures vs Glue



Orianna2000
09-11-2015, 09:56 PM
So, I finished my second novel and was preparing to start the query letter, when I suddenly realized I had a problem with a pivotal scene. The morning after the MC sleeps with her love interest for the first time, the guy invites her to take a shower with him. It's both romantic and practical, because she gets to see some of his scars, and they talk about their families, they do some bonding, and pertinent backstory is revealed, all at the same time. It's a scene that works on several levels. The thing is, the day before they slept together, the guy tangled with a nasty alien and got his leg ripped open, necessitating a lot of stitches. I couldn't remember if I'd mentioned the MC seeing the rather nasty wound while they're showering, so I went back to re-read that scene. And whilst doing so, I remembered that I'd heard somewhere that you aren't supposed to get sutures wet. Which sort of wrecks the entire scene.

Now, he's exactly the sort of guy who would ignore the doctor's orders and take a shower with his girlfriend anyway. But how risky is that? Might the sutures dissolve if they get wet? Or is it just a risk of water getting in the open wound and causing infection?

I was also wondering about the possibility of the doctor using surgical glue instead of traditional sutures. When I had my gallbladder removed last summer, they didn't use sutures at all, they used medical-grade superglue to seal all four incisions. After a few weeks, the scabs and dried glue fell off, leaving bright pink scars behind. So:



Might the doctor consider using glue to fuse the gashes, instead of stitching them up? If it makes a difference, the gashes are on his thigh, several inches long, and rather deep at the middle, shallower at the end. (Claw slashes.)




Which would be considered more advanced, medically speaking--glue or sutures? I would assume glue, since people have presumably been stitching each other up since the stone ages. But then again, glue's been around for centuries, too.




Which would be less likely to rupture if this guy does something stupid, like go running?




Can you get glued wounds wet? I vaguely recall being told that it was okay to shower after my surgery, so long as I didn't scrub the incisions, or soak them. But I could be remembering wrong.




Are there any other options the doctor might use to mend his injuries? If it matters, the scene is set in modern-day London, but they have access to alien technology and advanced knowledge. However, they don't have anything that could instantly heal wounds. (Apparently, aliens tend to be rather stingy when it comes to sharing useful tech.)


Thanks in advance!

Pony.
09-11-2015, 11:23 PM
http://www.seacoastskinsurgery.com/files/dermabond312.pdf

It's usually just the skin that gets closed with CA glue,the underlying tissues are typically closed with sutures of the appropriate material. According to the pdf link its ok to gently wash the area with soap and water but no pool/hot tub time as chlorine helps dissolve the glue. And no strenuous activity for two weeks.
I don't know what that would do for or to your story line but a cleaning of the wound could be done rather sensually. If you go with sutures the wound could be seeping and she tends to it, possibly when they slept together he popped a stitch or two.

nikkidj
09-11-2015, 11:34 PM
So, I finished my second novel and was preparing to start the query letter, when I suddenly realized I had a problem with a pivotal scene. The morning after the MC sleeps with her love interest for the first time, the guy invites her to take a shower with him. It's both romantic and practical, because she gets to see some of his scars, and they talk about their families, they do some bonding, and pertinent backstory is revealed, all at the same time. It's a scene that works on several levels. The thing is, the day before they slept together, the guy tangled with a nasty alien and got his leg ripped open, necessitating a lot of stitches. I couldn't remember if I'd mentioned the MC seeing the rather nasty wound while they're showering, so I went back to re-read that scene. And whilst doing so, I remembered that I'd heard somewhere that you aren't supposed to get sutures wet. Which sort of wrecks the entire scene.

Now, he's exactly the sort of guy who would ignore the doctor's orders and take a shower with his girlfriend anyway. But how risky is that? Might the sutures dissolve if they get wet? Or is it just a risk of water getting in the open wound and causing infection?

I was also wondering about the possibility of the doctor using surgical glue instead of traditional sutures. When I had my gallbladder removed last summer, they didn't use sutures at all, they used medical-grade superglue to seal all four incisions. After a few weeks, the scabs and dried glue fell off, leaving bright pink scars behind. So:



Might the doctor consider using glue to fuse the gashes, instead of stitching them up? If it makes a difference, the gashes are on his thigh, several inches long, and rather deep at the middle, shallower at the end. (Claw slashes.)




Which would be considered more advanced, medically speaking--glue or sutures? I would assume glue, since people have presumably been stitching each other up since the stone ages. But then again, glue's been around for centuries, too. If it's a gash, the docs aren't going to use glue. It's just not strong enough to overcome the tensile strength of a gaping wound. Most likely, the physician will use a large-gauge suture, like 3-0 prolene or ethilon, or staples. If there's a LOT of gaping, they might put bury some retention sutures utilizing chromic gut before doing the sutures or staples.




Which would be less likely to rupture if this guy does something stupid, like go running? Sutures and staples are a lot less likely to pull open. Glue is just not strong enough if the wound is long or gapes open, or runs against the normal tensile lines.




Can you get glued wounds wet? I vaguely recall being told that it was okay to shower after my surgery, so long as I didn't scrub the incisions, or soak them. But I could be remembering wrong. You can get them wet, but not soaking or swimming, and the moisture should be kept to a minimum. Also, petroleum jelly denatures the glue, so any antibiotic ointment put on the wound would likely cause it to open.




Are there any other options the doctor might use to mend his injuries? If it matters, the scene is set in modern-day London, but they have access to alien technology and advanced knowledge. However, they don't have anything that could instantly heal wounds. (Apparently, aliens tend to be rather stingy when it comes to sharing useful tech.) As I said above, a combination of sutures and staples might be your best bet. Internal sutures don't get wet, and help hold the skin together enough that staples can hold the skin edges together nicely. Staples react a lot better to water, and would not likely be compromised by a steamy shower. Plus, staples are a LOT easier to put in than stitches, take a lot less time to place and remove, and do well with antibiotic ointment.


Thanks in advance!

I like the idea of the previous poster. You could have a hot, steamy shower scene, followed by a wound-dressing extravaganza that gets all hot and bothered. I picture cleaning gently with a cloth, blowing on the wound, kissing the wound, slathering on antibiotic ointment, etc etc etc.

Orianna2000
09-12-2015, 12:28 AM
So if someone went to the doctor with a couple of deep gashes on their leg, they would be most likely to staple them shut? I've always heard of people getting sutures at the ER--never heard of stapling, except for surgeries.

If I do go with sutures, how dangerous would the shower be?

nikkidj
09-12-2015, 04:29 AM
It depends on a lot of things. If it's a lone doc in a busy emergency department, then the expedient thing to do is staple. Suturing takes a LOT of time, and if a good cosmetic outcome isn't imperative, then staples are a great alternative. Stapled wounds do tend to scar more, but I know that if I've got a couple of huge wounds to close and minimal time to do it, then I'll discuss stapling with the patient.

Showering after getting stitches isn't necessarily dangerous, but it does make it more likely that the sutures will fall out early and/or get infected. Your character could always put an occlusive dressing on it so it doesn't get wet, then have to re-dress it later.

Maizie
09-12-2015, 10:48 AM
I just had major surgery that was closed with dissolving sutures. I couldn't shower for the first couple days at the hospital - I think it was day two or three post-op that I was able to finally shower/get my bandages off. By about day six post-op the incision was infected, so the bandages had to go back on, and I was back to a showerless existence. Like nikkidj mentions, occlusive dressings will let you shower (but not bathe). In my case, they also slowed down healing, but YMMV. For days that I was showering, the dressing was just done as normal, and then water-resistant tape (essentially) was put on top of it.

Orianna2000
09-12-2015, 07:16 PM
It's actually a private doctor, at a top-secret facility. Time isn't an issue, and the guy in question is a teensy bit vain, so I'd imagine he would prefer sutures over staples, so there would be less scarring. I will need to extend the scene a little, though, if sutures take a long time to do. I'll also have to have him put some waterproof dressing over the wound before the shower.

Lots of food for thought, thanks!

GeorgeK
09-12-2015, 09:22 PM
It depends on a lot of things. If it's a lone doc in a busy emergency department, then the expedient thing to do is staple. Suturing takes a LOT of time, and if a good cosmetic outcome isn't imperative, then staples are a great alternative. Stapled wounds do tend to scar more, but I know that if I've got a couple of huge wounds to close and minimal time to do it, then I'll discuss stapling with the patient.

Showering after getting stitches isn't necessarily dangerous, but it does make it more likely that the sutures will fall out early and/or get infected. Your character could always put an occlusive dressing on it so it doesn't get wet, then have to re-dress it later.
You can always do a running suture to save time. That also works well to reduce scarring. The only real disadvantage is if one part of the suture breaks, then the whole run breaks so I'd typically do running sections of 5-7 stitches. In my experience running stitches also seem to elicit less scarring.

I have to disagree about showering though. It reduces infection because wounds big enough to require stitches will seep serous fluid which is wonderful food for bacteria. A once a day cleansing of the wound and then letting it dry helps. It also gets the patient out of bed reducing the risk of DVT's. Soaking in chlorinated water is not an issue as long as it's not an extended soak. Soaking in a regular tub is not really clean water but better than say a pond.

There are many types of sutures made of various materials. A good surgeon knows the differences and takes into account the environment that the patient will be facing so stitches dissolving too soon is a very rare occurrence.

GeorgeK
09-13-2015, 12:16 AM
It's actually a private doctor, at a top-secret facility. Time isn't an issue, and the guy in question is a teensy bit vain, so I'd imagine he would prefer sutures over staples, so there would be less scarring. I will need to extend the scene a little, though, if sutures take a long time to do. I'll also have to have him put some waterproof dressing over the wound before the shower.

Lots of food for thought, thanks!
If it's a private doctor they are not at a top secret facility

kkwalker
09-15-2015, 08:06 AM
A lot of the time, suture is saved for places that would be exposed, while staples are used other places--mostly to save time, as someone else mentioned. In both cases, the wound is still essentially open and just being held shut. Docs don't want you to get it wet (and possibly infected) until the wound is at least sealed. Some suture dissolves, but that's often used internally, such as in reconnecting torn muscle and tendon. Non-dissolving sutures are usually used on the surface--they almost force the patient to come back and let the doc have a look-see rather than the patient just disappearing and never being heard from again. When it comes to straining the suture line, both are equally likely to pull apart. Glue is right out for closing anything bigger than a centimeter or so.

As far as alien tech... could you maybe get something that speeds healing so that your wound is partially healed by the time your MC does acrobatic stuff in the shower?

GeorgeK
09-15-2015, 10:01 AM
A lot of the time, suture is saved for places that would be exposed, while staples are used other places--mostly to save time, as someone else mentioned. In both cases, the wound is still essentially open and just being held shut. Docs don't want you to get it wet (and possibly infected) until the wound is at least sealed. Some suture dissolves, but that's often used internally, such as in reconnecting torn muscle and tendon. Non-dissolving sutures are usually used on the surface--they almost force the patient to come back and let the doc have a look-see rather than the patient just disappearing and never being heard from again. When it comes to straining the suture line, both are equally likely to pull apart. Glue is right out for closing anything bigger than a centimeter or so.
?Other than "Some suture dissolves," pretty much everything else there is wrong. Tendon repair is pretty much a contraindication for using absorbable stitches. Silk is most commonly used in the gut. Internal sutures that you don't see are what keep the wound closed. The same goes with using glues and stuff like collodian. There are still stitches. The main reason for using glues is patients who are going to pick at wounds and pull on stitches, so infants and those who are not reliable for not picking at wounds.

WeaselFire
09-15-2015, 04:42 PM
Gett6ing sutures, staples or glue wet has nothing to do with the closure dissolving. It's to prevent infection, which is a higher risk in water and wet areas.

Staples are for areas where the scar won't show or won't matter. Sutures look better. Women rarely get staples in visible areas.

Glue is surface closure only. Frankly, it's not as common as it was a few years ago, because of the difficulty in diminishing lasting scars. It's much more often used in battlefield or other field expedient dressings. Secondary is small children or infants, who are also less likely to have lasting scars anyway.

But... In the environment described, anything could be done for reasons needed for the plot. It's fiction, and not reality-fiction. Why not use suture-foam, that new wonder fix for any wound? Anticoagulant, antibacterial and anti-scar in one...

Jeff

Orianna2000
09-15-2015, 08:19 PM
Jeff, I love your idea of "suture-foam"! Unfortunately, I need to send the injured guy home for a few days, so he has a chance to get romantic with my MC. He's under strict orders to stay off his leg, preferably to stay in bed--and he's not going to argue with that, LOL! If I used some advanced tech to seal his wound, he wouldn't need to be driven home by the MC, nor would she need to stay with him. But I wrote the scene so that he puts a waterproof bandage over the sutures on his leg, so they won't get wet in the shower. I think it'll work. . . .

WhitePawn
09-20-2015, 07:08 AM
Glue is usually for skin...cuts that need to be held together, but not too terribly deep. Think of glue as a more permanent version of steri-strips. Sutures for deeper stuff, or fine work by plastics. But you're forgetting staples which sounds like what your guy would have. Had a patient try to stab herself in both arms with a kitchen knife, tore herself open pretty good. She was stapled back together, the number of staples approaching 100.

Your guy would be advised NOT to run around or work out until the lacerations were healed and the staples removed. Not only would it hurt every time his legs moved and pulled at his staples, he would pop those suckers right out with the exertion of running, have to go back in, and get scowled at by all the medical professionals. Not to mention documentation of his noncompliance with medical care going into his medical record for all future medical professionals to see.

Chumplet
09-20-2015, 09:30 PM
Waterproof dressing for the shower is a good idea, but it's probably a good idea for him to replace it with clean, dry dressing afterward. Or... you could make it a sexy sponge bath!

Orianna2000
09-20-2015, 10:10 PM
Oooh, a sponge bath! The scene's already done, but I might revisit this, see how it works as her giving him a sponge bath, instead of taking a shower together. Could add some tension between them.

kkwalker
09-22-2015, 09:17 AM
@GeorgeK

Internal sutures are dissolving sutures--hence why you don't have to reopen a surgical patient to remove said internal sutures. If you use non-dissolving suture internally, the body will treat it as a foreign body and it can actually lead to problems later on, like scarring or infections. The internal sutures dissolve over a period of time, slowly, so that the wound or incision heals before the suture is completely gone. I have never used silk suture for anything but skin closure. I admit I have never actually done a tendon repair, but as part of my schooling I assisted in over 30 orthopedic surgeries which uniformly used dissolving sutures on tendon and joint capsule. Glue was used mainly for small surface wounds--that is, wounds to the skin. Can't really use it for closing up muscle or underlying fascia. The main trouble with glue is that it doesn't adhere well to moist surfaces--so if the wound is bleeding/still wet, it won't work. I don't know about using glue on infants, but on dogs and cats (neither of whom can be trusted not to lick/pick at incisions) I always used suture in the skin--the non-dissolving type.

GeorgeK
09-22-2015, 04:08 PM
@GeorgeK

Internal sutures are dissolving sutures--hence why you don't have to reopen a surgical patient to remove said internal sutures. If you use non-dissolving suture internally, the body will treat it as a foreign body and it can actually lead to problems later on, like scarring or infections. The internal sutures dissolve over a period of time, slowly, so that the wound or incision heals before the suture is completely gone. I have never used silk suture for anything but skin closure. I admit I have never actually done a tendon repair, but as part of my schooling I assisted in over 30 orthopedic surgeries which uniformly used dissolving sutures on tendon and joint capsule. Glue was used mainly for small surface wounds--that is, wounds to the skin. Can't really use it for closing up muscle or underlying fascia. The main trouble with glue is that it doesn't adhere well to moist surfaces--so if the wound is bleeding/still wet, it won't work. I don't know about using glue on infants, but on dogs and cats (neither of whom can be trusted not to lick/pick at incisions) I always used suture in the skin--the non-dissolving type. kk, I am a board certified surgeon (now retired). You clearly do not understand the variety of sutures or their indications or contraindications. I've done literally thousands of surgeries. I have no complaint about what you say about glue but as to sutures, your personal opinion as an assistant on a few cases does not make you an authority and if you actually learned this from an orthopedist and is representative of that doctor's knowledge then I feel sorry for their patients. Your opinion does not reflect what actually happens in the operating room and you clearly do not understand that there are many many types of sutures. Absorbable vs permanent is not a black/white issue. Some absorbables are more absorbable than others. Some are designed to last only a week or two, some a few weeks, some a few months. Some are braided, some are monofilament. The difference matters keenly in certain settings.

I would definitely not want you picking an absorbable suture to do an arterial repair, ever. I would definitely not want you picking an absorbable suture to repair my intestines. I definitely would want absorbable sutures when repairing anything in contact with urine.

Orianna2000
09-22-2015, 06:54 PM
I don't know about using glue on infants, but on dogs and cats (neither of whom can be trusted not to lick/pick at incisions) I always used suture in the skin--the non-dissolving type.
I'm not sure how widespread your experience is. When my cat had a malignant tumor wrapped around his spine, the vet cut him open to remove it and the incision extended from the back of his neck almost to his tailbone. (Much, much larger than I was anticipating, so it was traumatizing when I first saw our cat after the surgery.) We didn't have to take him back in to have the sutures removed, they disappeared on their own. (Although a few of them near his shoulder blades broke because he kept twisting, trying to reach them, which meant the vet had to suture it again, using smaller stitches, closer together. I don't know whether those were dissolving or not. Our cat died before his incision had fully healed.)

Also, every time we've had a female kitten who was spayed, the sutures were dissolving, because we never had to take a kitten back into the vet's office to have her stitches removed. We were told to keep an eye on them, to stop the kittens from licking or biting at their sutures, but we never had a problem with them dissolving prematurely.

I'm sure it varies in different parts of the country/world, though, depending on how the doctors/vets were trained, and what supplies are readily available.