The eight year old boy who came in today to have his stitches removed still could not cooperate with the removal, so it was decided to arrange for him to have his stitches removed under general anesthesia. The parents asked why they couldn’t use absorbable sutures. Wouldn’t that eliminate the need for suture removal? A: It is possible to use absorbable sutures. 6-0 absorbable sutures can fall off on their own 7-10 days after surgery and do not need to be removed. However, because the absorbable thread will release inflammatory factors when it is degraded and absorbed, it will cause inflammatory reactions in the surrounding skin tissues, and there is a risk of stimulating scar growth in the incision. Overseas experts say that although absorbable threads have a greater skin reaction at the beginning, after six months, the effect is similar to that of applying non-absorbable threads. However, Asians are more prone to scar growth than Caucasians, so caution should be exercised when applying absorbable threads to the skin. Also, the strength of fast absorbable threads is relatively low and becomes less and less strong as the material is absorbed, so they should not be used in tensioned incisions. For example, incisions for skin implants are generally subject to greater tension, so they are not recommended. In summary, we recommend: 1. For some procedures with less tension in the incision, such as polydactyly, consider applying 6-0 fast absorbable sutures; 2. For children with a family history of keloid, it is better not to use absorbable sutures for the skin; 3. For skin grafting, it is better not to use fast absorbable sutures for the skin; 4. Absorbable sutures are only used for pediatric patients, and adults are better to apply non-absorbable sutures for the The skin should be sutured with non-absorbable threads for adults to avoid unnecessary scarring of the incision. Parents may feel that we are too concerned about scar growth. There is a reason for our concern. It is not uncommon for incisional scarring to develop and cause keloid scarring after finger merging and splitting, and there is no effective way to treat keloid scarring once it occurs, which can be tricky to deal with. In the case of non-absorbable stitches, the only thing parents care about is that their child has to endure the pain of removing the stitches. For children under the age of 8, we usually remove the stitches under general anesthesia, which is painless and does not leave a psychological shadow on the child. The general anesthesia is different from the general anesthesia during surgery, it is inhalation anesthesia, no tracheal intubation is needed, most of the inhaled drugs are excreted by the respiratory system, no liver or kidney metabolism is required, the damage to the child is negligible. patients over 8 years old can generally cooperate with the routine removal of stitches, and for older children who have poor pain tolerance, general anesthesia can also be applied to remove stitches. For adults, oral pain medication or topical lidocaine gel can be applied half an hour before stitch removal to reduce painful irritation. Recently, skin glue has been increasingly applied nationally and internationally. For some specific incisions, it is an alternative to sutures to close the skin incision, but most cases require tight subcutaneous tissue and intracutaneous layered sutures to reduce the tension of the skin incision, because skin glue is not strong in any way. In contrast, subcutaneous tissue is rarely sutured in hand surgery incisions because the blood flow in the extremities is poor and tight sutures can reduce skin blood flow and lead to poor incision healing. Therefore, skin glue is generally rarely used in hand surgery.