This is a summary of all info I found and/or
received on sutures used in circumcisions:
In general, sutures can be divided into
absorbable and non-absorbable:
Non-absorbable sutures:
Generally used to close skin, and must be
removed after wound healing is complete. These sutures are fine/thin,
hassle-free, unlikely to leave marks, unlikely to get infected, and may be
removed by the patient (on the 7th or 8th day.). The non-absorbable
sutures are "non- reactive" to the body's immune response, so they
need to be removed when placed through the skin. Types of non-absorbable
sutures include: synthetic (nylon and polypropylene, which are inert),
silk (animal protein) and cotton. Non-dissolving stitches are usually
coloured blue or black to make them more visible against the blood red
of a wound. They have a smooth surface that usually allows them to be
removed easily.
Absorbable (self-dissolving)
sutures:
These are degraded by the body's enzymatic
pathways through a reaction against "foreign" material.
Phagocytes carried by the blood- stream attack and destroy the stitch material.
They are not intended to be used on the surface of the skin. Absorbable
sutures can also be used to close skin but only in a subcuticular or
completely buried pattern. Absorbable sutures should not be exteriorized.
They work better when used on internal surgery (buried inside) where the
body can break them down easier, and if scar tissue should develop, it is
not visible. In circumcisions, the problem with self-dissolving
stitches is skin tunnels, which are like piercings, that never go away.
When used for a circumcision, the stitch passes through the dry outer
layer of skin where the blood-stream cannot reach the stitch, so a hole
remains. If the dissolving process is relatively slow, the natural healing
process forms a tunnel around the stitch. A stitch scar (or tunnel) internally
is no problem, but at the site of a circumcision it is unsightly. The
probability of scarring or tunnels if the stitches are left in longer than
needed leads to the advice to remove them at about 7 days after
circumcision, by which time the two cut surfaces of skin will have joined
together sufficiently. It is quite possible to manage without any stitches
for a circumcision, so there is plenty of safety margin in the 7-day
recommendation. Removal of the stitches eliminates a source of irritation and
increases comfort noticeably.
Some urologists may prefer self-dissolving stitches
simply because then they don't have to go necessarily through the
procedure of removing them afterwards.
Types of self-dissolving sutures:
* Catgut (old technology):
Natural fibre made from the submucosa of the bovine intestine. Excites
considerable inflammatory reaction and tends to potenciate infections. It
loses strength rapidly and it's of little use in modern surgery. Plain
catgut dissolves more quickly than the type treated with chromium salts.
* Vicryl / Dexon (Polyglactin):
Dissolves slower than catgut, but causes less of a reaction on
implantation. Used below the surface of the skin. Also used in areas where
suture removal might jeopardize the repair such as with small children who
might not easily cooperate with suture removal.
* Vicryl Rapide: Similar
substance to Vicryl, but absorbed in a shorter period (5 days). Recent
development, worth asking your surgeon about.
* Monocryl: The least reactive
substance of this group, and should leave least scarring. Unfortunately
this is not a very soft material and may be slightly irritating while the
stitches are in place.
Sutures also come either as monofilament
or braided:
* Monofilament sutures cause
less reaction than do braided sutures but require more ties to assure an
adequate maintenance of the knot compared to braided suture. Monofilament
sutures are usually non- absorbable.
* Braided suture usually
incites a greater inflammatory response but requires fewer ties to
maintain the knot integrity. These include silk, cotton and Mersilene.
The strength of the sutures varies according
to their size, which can be determined by a uniformly applied number. For
example, a 6-0 suture is more delicate and has less strength than a 4-0
suture.
The surgeon uses as many stitches as necessary to approximate the wound edges. Every stitch becomes a foreign body and becomes the source of an additional wound, so one must use what is required and no more.
When I had my circ, my doctor recommended to bathe my penis in warm camomile tea for 15-20 minutes several times a day until all stitches have dissolved and fallen off. I did so (using a toothbrush glass, by the way), and there are no stitch marks or even tunnels left.
I highly recommend this to all other members undergoing circumcion or - like Riaan from South Africa - those who are just in the process of healing. If you have problems getting camomile tea, even warm water will do. Camomile, however, has an additional anti-inflammatory effect.
Martin
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Mine was done with soluble sutures, too, with no adverse effects, but the fact remains that non-dissolving ones are less likely to leave a mark, and less likely to get infected. I recently had a minor op. on my arm which was sutured with non-soluble ones and they were quite hassle-free and left no mark at all. (Actually my wife took them out - it doesn't need a doctor to do it!)
In cosmetically sensitive areas such as faces non-dissolving sutures are always used. Why does the medical profession think that the penis is not cosmetically important?
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Most of those on the list circumcised as adults report having had dissolving (absorbable) stitches, which are obviously more convenient than ones which have to be removed. If my experience is any guide, removable ones may be less inclined to leave stitch marks. They are much finer and they can be removed as soon as they are no longer required (a week or thereabouts) whereas dissolving stitches may persist for considerably longer. My "second circumcision" (actually, although this is the popular and convenient terminology for such a procedure, I believe a person can only be circumcised once and all subsequent procedures are remedial or "revisions") was performed by a plastic surgeon. It was a botch job (got to love that word "botch" -- so apt and descriptive for a circumcision gone wrong), unsatisfactory enough to necessitate yet another revision; the result of mistakes on the part of several people. First, my GP for referring me to a plastic surgeon to do something right out of the specialist's field of competence. Second, me for not knowing better; I simple-mindedly thought that if anyone could do a neat cosmetic job, it would be a "plastic surgeon". Third, and most culpable, the surgeon himself, for agreeing to perform a procedure he knew fuck-all about. (That's why I suggested earlier engaging a surgeon who performs circumcisions for a living. It's not a guarantee of a high quality result, but it's probably a better bet than having it done by someone who does rhinoplasties day in and day out.) But, getting back to the subject of stitches, he used silk stitches and, I have to admit, did a great job with them, leaving no stitch marks at all.--------------------------
The stitch marks will never go away completely. The big problem with disolving stitches are skin tunnels, which are like piercings, they never go away either. My first circ left both tunnels and stitch marks. On my second circ and third partial circ, I had the stitches removed after a week and no mark or tunnel was left. The dotor told me just to let them disolve, but I insisted that he remove them. The results were great.
Sam
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The doctor did not cut my frenulum, so no sutures were required in that area.. There were 13 soluble sutures around my shaft, the last of which I removed on the 10 days after the operation (May 19th 1978 to be precise!) Instinctively I knew they would cause scarring if left in too long, and I did get one small tunnel which has gone now.
If I have a regret it is that my scar is a thin white line, just a boundary between the two skin colours. I always wanted a nice brown ring, which I realize now is usually caused by the Gomco or TaraKLamps. I was circumcised freehand.
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I had skin tunnels which lasted several years after I was circumcised (at age 20) though I had non-dissolving stitches for the sutures. I finally treated it myself - I boiled a blade to sterilise it, swabbed my scar area with savlon, and for each tunnel, I inserted a needle down through the tunnel, and ran the blade down along shaft of the needle, quite safely removing the skin on top. It all healed nicely with the tunnels disappearing completely, though the stitch marks are quite visible. This alone, seems like a good argument to support routine infant circumcision. Have you ever seen a guy who was circumcised at birth that has skin tunnels?
Paul
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Dissolving stitches aren't generally a major problem in adult circumcisions.
Dissolving stitches (sutures) have developed considerably in the past 5 years. Each different dissolving stitch has slightly different properties, the three main suture types in the UK at present are as follows:
Catgut (been around for ages) Natural fibre made from sheeps stomachs (hope you don't mind me telling you that). Plain catgut dissolves more quickly than the type treated with Chromium Salts.
Vicryl / Dexon (Polyglactin) Dissolves slower than catgut, but causes less of a reaction on implantaton.
Vicryl Rapide (TM) Similar substance to Vicryl, but absorbed in a shorter period, say 5 days. Quite a recent development, but worth asking your surgeon about.
Monocryl (TM) The least reactive substance of this group, and should leave least scarring. Unfortunately this is not a very soft material and may be slightly irritating while the stitches are in place.
While non-dissolving stitches are an option. It's not wise to disregard the dissolvable ones - at least you won't normally need to have someone remove them from your newly cut skin.
Colin (UK)
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Regarding self dissolving stitches; my surgeon who did my original circ put dissolving stitches in and told me to soak bandages off in a warm bath with some Savlon** in it. He said to take a daily bath and soak for a good 15 minutes, this caused the self dissolving stitches to keep soft and come out fairly quickly and leave no holes as some of you seem to have had. Perhaps you might like to try this and see if it helps.
(** this is a British personal disinfectant so you can use any brand common in your own country. its use is basically to prevent circ site getting infected.)
Brian (UK)
The Wall Street Journal of December 28, 1998, page B1 has an article entitled: "Surgical Glue Removes Much Pain and Time From Closing Wounds". It goes on to tell about how doctors are now using a surgical glue. It states in part, "Doctors say Dermabond is different in several important ways. It is sterile and doesn't contain the basic chemicals found in some common fast-drying glues, which, if applied to an open wound, could irritate or lead to infection. It takes about 50 seconds to set - just enough time for a doctor to manipulate the skin edges so they fit together well."
"The surgical glue goes on bluish purple and is applied in at least three thin layers. After about two and a half minutes, it is said to be as strong as week-old sutures. It sloughs off in five to 10 days, meaning patients don't have to return to the doctor to have stitches removed."
"The glue is applied from a small plastic tube that looks similar to the ones used for fast-drying household products such as Krazy Glue."
"Although Dermabond isn't sold directly to consumers, a Johnson & Johnson unit licensed to market it is believed to be considering an advertising campaign urging people to ask doctors for adhesive instead of stitches. But he warned: the glue isn't always an option. It can't be used on elbows and knees - where children often get cuts and scrapes - because the excessive motion would probably cause it to peel too soon. For similar reasons, it isn't a good choice for hands and feet, and it can't be used in the mouth, groin or other moist areas."
"Next year, Atrax Medical Group Ltd. has plans to release a surgical "zipper" - polyster strips attached to either side of a wound and then joined with a zipper."
Maybe in a few years, we'll have glue or zippers to hold the new circumcisions together instead of the stitches. I would like to hear comments from any of you.
Hal
Wound Approximation with Tissue Glue in Circumcision.
Ozkan KU, Gonen M, Sahinkanat T, Resim S, Celik M.Results: There was no difference between the two groups in the rates of wound inflammation, infection, bleeding and dehiscence, although cosmetic appearance was better in the tissue glue group. The operation time was also shorter in this group.
Conclusion: Using tissue glue for wound approximation in circumcision is a feasible alternative.
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