YOUR HEALTH - MEDICINE 101

SUTURES

The proper medical term for a stitch is the word "suture" - this comes from the Latin word to sew, and sew is exactly what we do. First, we have to figure if a cut needs stitches. We put our fingers on either side and try to spread it. It the cut spreads easily and reveals the subcutaneous tissue beneath, it's time for a little local anesthetic and a needle and thread.

Let's pretend this orange is your skin and this is the cut. The needle is grabbed in this instrument, called a needle driver, and the point is pushed into the skin away from the cut. The curve of the needle is designed so that it slips easily through the tissue and comes out the other side of the cut, well away from the edge. The thread simply follows and you're left with this. That's when we tie the knot. The most common knot is simply a series of half hitches tied with the needle driver like this. The thread is looped over the needle driver several times and then pulled tight. The aim is just to bring the edges of the cut skin together - not to bind them tightly because this will delay healing. Next we cut the thread and the finished suture looks like this. The process is repeated for the length of the cut. That's when we doctors are finished, and when the real magic begins.

Over the next week or so your body recognizes that the skin is open and it sends cells from either edge of the cut migrating towards the other side to bridge the gap. Your body also sends plasma and other fluids to form a scab on the top. That gives extra support and protects the injured area. When you come back in the office we cut the stitch like this - simply grabbing the suture by the knot and cutting the nylon thread and then pulling the cut thread out. It's very simple. All we've really done is hold the two edges together in close proximity for long enough so that your own body can join the edges and seal it more easily. Of course most wounds would heal without stitches - but the healing would be delayed and sometimes the gap is so wide that the cells cannot migrate far enough and the wound will not close.

And there it is - we do the stitching, nature does the healing and together we produce almost invisible mending.