Why don’t all surgeons use dissolvable stitches? Both types of sutures are kept on the same shelf in the hospital. Here are my general thoughts about sutures.
People don’t like getting stitches out, especially toddlers
Getting stitches out can be difficult, especially if there is some scabbing over them, on a small child, who is trying to escape. Toddlers are smart so then they say they need to go potty. This is always a lie…except for that one kid…when it wasn’t.
Evidence suggests that scarring can be the same.
Would you volunteer to have your facelift done differently on each side? Not I, but some people once did!
There is a study where one side of the facelift was done with absorbable sutures, and the other with sutures that needed to be removed. The study found that final incision-line-healing was the same. Thank goodness!
I may use permanent sutures that need to be removed if I am worried about the wound
This category includes patients with rheumatoid arthritis who are on high doses of steroids. Such patients have slower wound healing. Patients who are undergoing chemotherapy are also at higher risk. Certain injuries such as to the skin below the knee have a risk of worse healing due to the characteristics of the local blood supply.
Sometimes I can place all my sutures inside the skin using a buried technique
If the incision line is jagged, from a dog bite or other accident, I will use sutures that come out through the skin to align the skin better.
If I am performing a cosmetic surgery, I am in control of the incision. Thus I can place stitches a millimeter under the skin using a running subcutaneous technique. Sometimes I can use this same technique when sewing up a laceration in the emergency room. This avoids all risk of railroad tracks, i.e. the Frankenstein deformity.
I will generally use a buried suture technique many aesthetic surgeries such as breast augmentation, breast lifts, gynecomastia reduction, and tummy tucks.