Podiatrist Questions Podiatrist

Quality of stitches with Lapiplasty surgery?

I had Lapiplasty surgery on 9/29/20 to correct a minor bunion. Only seven stitches were used to close the incision, spaced very far apart/messy. These were taken out 10 days after surgery when my foot was still very swollen and painful. I am viewing other incisions that are posted online and notice the incisions healed much neater and quicker than mine. My foot is still swollen and painful although I am making progress, it seems behind where others are at my stage. I believe if the stitches were done better (more of them, neater, dissolvable used so that they could stay in longer) I would be in a much better place. I asked my surgeon about using dissolvable, to begin with and he stated he had problems with those. Looking for advice re my thoughts vs. surgeons actions.

Female | 52 years old
Complaint duration: 2 months
Conditions: bunion

6 Answers

With reference to sutures, there are various type, styles, techniques, and everyone heals differently. This question is better left to your surgeon. But why did you have the procedure for a "minor" bunion?
In my practice, sutures don't come out of the surgical incisions for a minimum of 2.5 weeks, and sometimes longer, depending on how the incision is healing. The number of sutures is inconsequential as long as the incision is well coapted internally and externally, and sometimes there are different suture techniques used which changes the number of sutures significantly (look up simple interrupted sutures; look up horizontal or vertical mattress sutures so you can see the difference in the amount of knots you might see clinically, but in actuality, you are covering more surface area with a mattress type suture, but using less knots). Regardless of the appearance of the incision, which is all you can see clinically as a patient, a certain amount of time is required for healing a bone fusion (a Lapiplasty is basically a Lapidus 1st metatarso-cuneiform fusion). The work you are evaluating visually is not at all the important part of the procedure you had done. All of this being said, it takes 2-3 months to heal a fusion in the foot and ankle, and you should have to be non-weight bearing and not walking on your foot for a minimum of one month to 6 weeks after surgery. This being said, the Lapiplasty is a procedure designed for a less confident and less well-trained surgeon, as it is basically a template for surgery. And the procedure is 'toted' as a 'better' procedure (and it is for many unskilled surgeons). It is also 'toted' as a more stable surgery, and walking early is encouraged. But to me, the surgical time should be the same, as it is the exact same procedure as a Lapidus, just comes in a kit and with cutting guides for the inexperience/less confident surgeon who doesn't really know what he or she is doing. So I don't know that focusing solely on the incision is the way to approach your healing. I would be far more concerned with what is going on with the bones and parts of the surgery you can not visually see with the naked eye.
Swelling is a variable part of surgery. Depending on the extent of work done, you can have more swelling than others with similar procedures. The swelling can also be contributing to the incision not looking as "neat" as an incision that does not have as much swelling. As long as you are making progress, you should do fine.
Please work on your innate healing/repair mechanism, thus consult Functional Medicine. Elevate extremity with 2 folded pillows at nigh while asleep. Start Alive MVI for women gummies double recommended dose for 3 months. Vitamin C 2,000 mg daily, brand Nature's Way. Vitamin D3 softgel 40,000 IU weekly, Carlson brand. Magnesium Citrate 400-800mg softgel daily, Carlson brand. May ask Surgeon to place steri-strips closely layered on wound for another 4-6 weeks.
This is in a possible question for me to answer, since I am not in involved with this treatment or the procedure itself. You need to discuss and coordinate this with your attending physician.
Skin suture is not usually self dissolving, also every individual is different. We all heal at different rates and swelling in feet can be persistent. I would recommend going back to your surgeon and discussing the outcome with him / her to see if anything can be done to augment healing and getting back to normal activities.