Print

Print


Fast Absorbing Gut by Ethicon is different than Plain Gut by Covidien. I have spoken to the companies.

Ethicon Fast Absorbing Gut actually is said to have tensile strength for about 50 days whereas Covidien Plain Gut can last 70 days.  Covidien does not make a product that dissolves as quickly as Ethicon Fast Absorbing Gut.

Since the goal is to avoid permanent "railroad track" stitch marks, ideally facial sutures should be gone by 7 days.  Often they are not. We make sure to tell families make sure sutures are gone by 7 days and to get them removed if not.

As people have said, having people rub/wash/put ointment on sutures can hasten their removal, but this does not always guarantee that they will be out by 7 days.  Using Vicryl Rapide might make it less likely that they will be gone by 7 days, but if proper instructions are given to the family to make sure if any still present at 7 days they need to be removed, it should not make much difference.

One issue is whether or not families can definitely tell if all sutures are removed. It will often depend on how skin tone and suture tone compare.

The uncertainty of knowing  if sutures are out or not, can be an issue with absorbables. With non-absorbables, one advantage is families and practitioners know exactly if and when they are out or not.

Of course in a young or anxious child, having to remove sutures can be just as difficult as putting them in in the first place, especially in a delicate wound.  Primary care physicians  sometimes send kids back to the ED if they don't have intranasal midazolam or other anxiolytics since the child won't cooperate for removal.

This can happen with absorbables also,  which can defeat the purpose of using them in the first place. Though in an anxious child, at least removal may be a bit easier since one does not need to be concerned with removing all fragments, just with reducing the contact/pressure of sutures on the skin.

Robert Finkelstein,
NY, NY


On Aug 23, 2017, at 12:47 PM, Michael Falk <[log in to unmask]<mailto:[log in to unmask]>> wrote:

Thanks for the feedback from folks.  I almost always use the fast gut.  But if I have to, I use the vicryl rapide and do as others have suggested, advise the parents to wash with soap and water.  I also advise them to keep it dry for the first 2-3 days, then use an antibiotic ointment, at bedtime at least, to help quicken the dissolving process.
Cheers,
Mike

On Aug 23, 2017, at 12:24 PM, Semple-Hess, Janet <[log in to unmask]<mailto:[log in to unmask]>> wrote:

We use fast gut but when teaching residents to suture often easier to start with vicryl rapide. This is what our Plastics people use.
However, reports from parents that vicryl rapide often takes longer than advertised to absorb, so I tell families to begin more "aggressive" washing with soap and water after 5 days if sutures still took mostly intact.


Janet Semple-Hess, M.D.
Attending Physician, Division of Emergency Medicine
Children's Hospital Los Angeles
Assistant Professor of Pediatrics
Keck School of Medicine, University of Southern California





-----Original Message-----
From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of Mike Falk
Sent: Tuesday, August 22, 2017 6:40 AM
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Facial sutures? (EXTERNAL EMAIL)

I always use "fast gut" when closing facial lacerations, but if it's not available, what would you use?  Anyone know of any reason to not use vicryl rapide?
Thanks,
Mike Falk
NY, NY

Sent from my iPhone
For more information, send mail to [log in to unmask]<mailto:[log in to unmask]> with the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
               http://listserv.brown.edu/ped-em-l.html


CONFIDENTIALITY NOTICE: This e-mail message, including any attachments,
is for the sole use of the intended recipient(s) and may contain confidential
or legally privileged information. Any unauthorized review, use, disclosure
or distribution is prohibited. If you are not the intended recipient, please
contact the sender by reply e-mail and destroy all copies of this original message.

For more information, send mail to [log in to unmask]<mailto:[log in to unmask]> with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                http://listserv.brown.edu/ped-em-l.htmlRobert Finkelstein
On Aug 23, 2017, at 12:47 PM, Michael Falk <[log in to unmask]<mailto:[log in to unmask]>> wrote:

Thanks for the feedback from folks.  I almost always use the fast gut.  But if I have to, I use the vicryl rapide and do as others have suggested, advise the parents to wash with soap and water.  I also advise them to keep it dry for the first 2-3 days, then use an antibiotic ointment, at bedtime at least, to help quicken the dissolving process.
Cheers,
Mike

On Aug 23, 2017, at 12:24 PM, Semple-Hess, Janet <[log in to unmask]<mailto:[log in to unmask]>> wrote:

We use fast gut but when teaching residents to suture often easier to start with vicryl rapide. This is what our Plastics people use.
However, reports from parents that vicryl rapide often takes longer than advertised to absorb, so I tell families to begin more "aggressive" washing with soap and water after 5 days if sutures still took mostly intact.


Janet Semple-Hess, M.D.
Attending Physician, Division of Emergency Medicine
Children's Hospital Los Angeles
Assistant Professor of Pediatrics
Keck School of Medicine, University of Southern California





-----Original Message-----
From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of Mike Falk
Sent: Tuesday, August 22, 2017 6:40 AM
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Facial sutures? (EXTERNAL EMAIL)

I always use "fast gut" when closing facial lacerations, but if it's not available, what would you use?  Anyone know of any reason to not use vicryl rapide?
Thanks,
Mike Falk
NY, NY

Sent from my iPhone
For more information, send mail to [log in to unmask]<mailto:[log in to unmask]> with the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
               http://listserv.brown.edu/ped-em-l.html


CONFIDENTIALITY NOTICE: This e-mail message, including any attachments,
is for the sole use of the intended recipient(s) and may contain confidential
or legally privileged information. Any unauthorized review, use, disclosure
or distribution is prohibited. If you are not the intended recipient, please
contact the sender by reply e-mail and destroy all copies of this original message.

For more information, send mail to [log in to unmask]<mailto:[log in to unmask]> with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                http://listserv.brown.edu/ped-em-l.html

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html