Dr. Troy Madsen talks about how he makes his decisions for what suture tool to use.">

Oct 9, 2017 — Staples, stitches, and even super glue are all options for treating large cuts. But how do emergency physicians decide what to use to get wounds back together? Emergency room physician Dr. Troy Madsen talks about how he makes his decisions for what suture tool to use.

Interview

Interviewer: You get some sort of a cut and you go to the emergency room. What determines whether you get stitches or staples? Find out next on The Scope.

Announcer: This is From the Front Lines with emergency room physician, Dr. Troy Madsen, on The Scope.

Interviewer: Dr. Troy Madsen is an emergency room physician at University of Utah Health. So if something happened and I end up in the emergency room, I've heard that somebody can maybe get stitches, maybe somebody gets staples, but how do you as an emergency room physician decide what it's going to be? Or do I get to choose?

Dr. Madsen: I kind of just randomly pick and then I just go for it.

Interviewer: I don't believe that. I don't think that's really what goes on.

Dr. Madsen: Yeah. No. I think of different things for different parts of the body. So you're right. We've got staples. We've got stitches. And we've got glue. So we got all kind of choices.

Interviewer: Oh, there are three. It sounds cooler though, I think, if I could tell my friends, "Yeah, I had 16 staples." as opposed to, "They glued me up."

Dr. Madsen: Oh, I know. Oh, yeah. Someone's like, "They put superglue on you. You weren't hurt."

Interviewer: Yeah.

Dr. Madsen: They're all options. They all work great for different types of scenarios. So the times I use staples are on the scalp. That's where it really comes in helpful. And the reason I use it there is because the scalp is really thick skin. Those staples hold it together really well. And scalp wounds bleed like crazy.

Sometimes people come in, they just think they're bleeding to death. You clean their head up, you look there and you see a wound that's maybe an inch long. But they just bleed a ton. And the best thing you can do sometimes is just staple it up right there. Like, we might even throw three staples and not even numb it up because the numbing medication is going to hurt more than the staples are. And I always tell patients that if you want me to numb it up, I can, or we can just get this done really quickly. So that's where staples are great.

Interviewer: All right. I have put a staple through my finger, those kind of hurt though.

Dr. Madsen: They do hurt. I'm not going to say it doesn't hurt. I'm just saying the lidocaine, the numbing medication hurts worse.

Interviewer: Okay. So in the scalp, you do staples because it's good thick skin and it really seals things up better than stitches.

Dr. Madsen: It does. It just brings it together so quickly. It's nice and tough. That scalp skin is really thick skin, so it just pulls it together and holds it there really well. And you're not as concerned about scarring there. On the face, you put a bunch of staples on the face, you're going to look like Frankenstein versus on the scalp, unless you're bald and you're really concerned about how your scalp looks, it's not a big deal.

Interviewer: All right. So then, what about stitches?

Dr. Madsen: So stitches are kind of our go-to. Pretty much anywhere else we're going to use stitches. And then it becomes what kind of stitches. On the face, we use really thin sutures, really thin stitches because they lead to less scarring. They're tougher to handle, tougher to work with, but you want them really thin and very close together, versus someone comes in with a laceration in their leg, on their lower leg. I'm going to use a thicker suture there just because I want it to hold together that skin, particularly, say over their knee, over their joint. Something that's going to be tougher, and you're not as concerned about cosmetic issues there.

Interviewer: Got you. And then glue. How long has glue been around as an option?

Dr. Madsen: Well, glue has been around . . . it's funny. It really started to be used about 10 to 15 years ago. So when I was in training, I actually had one of my attending physicians, I remember, ask me how to use glue. He was like, "What's this new stuff?" [inaudible 00:03:05] So it just kind of really came out around then. But glue works great. It's essentially just superglue. And it's changed a little bit, so it doesn't sting like superglue does. But when you look at the formulation, it's very similar to superglue, just a medical-grade sterile superglue.

And it works great for wounds that are not super big, something where it's not a gaping wound, where you really need to get that wound together. I find it works really well for kids because you don't have to try and sedate them and numb them up. You can just put some of this glue on. Personally, for me, when I travel, that's my go-to. I carry it with me because I figure if I have a laceration, it's easy enough to use. I can wash that off, glue it up. It's quick. It does a great job.

Interviewer: As a patient, if you end up in the ER, can you request glue or stitches?

Dr. Madsen: Sure. Absolutely.

Interviewer: You could always request.

Dr. Madsen: You can always ask for it, yeah. And the doctor may tell you, "Hey, this is a wound I'm concerned about. It's a gaping wound. I think we need to use sutures." But sometimes, I'll even use, say, one or two absorbable sutures, dissolvable sutures just to get that wound together. Once it's together, then I just do the superglue, just the medical glue over the top of that. And it's a nice combination, a little bit quicker. It avoids a lot of the pain. And [inaudible 00:04:20]

Interviewer: What about scarring? Does glue scare even less than sutures?

Dr. Madsen: It's similar. Studies that have been done that looked at outcomes after gluing versus suturing showed similar cosmetic outcomes. I can't say . . .

Interviewer: Oh, really? Okay.

Dr. Madsen: Yeah. People would be a little more concerned, maybe the stitches are going to hold the wound together better, but the studies that looked at outcome showed that it was similar.

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