The tie that binds....thoughts on suturing.

WARNING: not for the faint of heart!!
The first two times that I ever sutured was when I was working as a body piercer. Around that time(mid to late 90's), different body modifications were coming into vogue, like branding(verrrry stinky), scarification, surface-to-surface piercing(variation on a theme), lobe enlargement by 'scalpeling', and something called 'pearling'(more on that in a minute). One of my co-workers was this very dreamy, but certifiably crazy man (lets call him Bob, for the sake of privacy). He had these huge brown eyes with thick dark lashes that could melt your heart. He also had a bum-lobe, from too much stretching too quickly. His lobe was stretched to several inches in diameter at this point, and one day it started to get sort of stinky and green. It was necrosing. Bob was they type to take matters into his own hands, and over a full pot of coffee each, we cooked up the scheme to cut out the necrosed tissue and suture it back together. It really was a brilliant plan. And so as soon as the shop closed at 11pm, I did my first suture job, without anesthetic. In all honestly it was two interrupted stitches. But the ear healed beautifully, and the necrosed, excised piece lived in a jar somewhere for a long time. Ew, huh?
My next suture job was a lot closer to a vagina. This is where the pearling comes in. Pearling entails making an incision in the skin, working the dermal layers open, and placing a sterilized pearl or surgical stainless steel ball in the pocket that you've created. It is really very simple. People were putting them everywhere from their temples to their backs, and the more adventuresome types were putting them under the skin on their penises and in their labia. The only set I did were in a friends labia, and allowed me my second suture job. Another piercer at the shop did one side, and I did the other. Mine looked prettier, but his held better. A good lesson. I think I did about four interrupted stitches that time.
Fast forward many years and I finally received some training in suture technique. I of course read everything I could get my hands on, and practiced once or twice on chicken breast, but the first formal training I had was with Aly Kuntz, Suture Goddess, at Casa De Nacimiento. We practiced on beef tongue, and we learned instrument tying(I confess, I am no good at it! I hand tie), and a really neat little mattress stitch that I love. You start at the apex, throw a few deep, and then starting at the bottom stitch vertically alternating sides so that as the suture is tightened, it pulls the edges together. Tie off at the apex. I love how tidy this turns out.
The first suture job that I ever did after a birth was on one of my final supervised primaries, and my preceptor was amazed at how steady my hands were. I like to suture.
I not only like to suture, but I want to be very good at it, and like to take whatever classes and opportunities to practice come my way. I took a 4th degree tear workshop at the ALSO course. This model was more complex, using a candy bar, sausage casing, flank steak and a condom. I absolutely would not attempt to repair a 4th degree tear at home(I sure hope to never see one at home, duh), but I learned a ton. I like suturing with doctors. They are so good at it. They are not afraid, and they get tons of practice. Whenever I transport, I ALWAYS hang over the doc's shoulder and watch, because I learn something every time(and they're so FAST!!!). I make a point of discussing it with them if I get the chance. I wish I had a doctor friend that would let me bring a beef tongue over, drink beers at the kitchen table, and suture. This is my idea of a good time. Truly.
As much as I love the aforementioned mattress stitch, I have never used it on a person. Only beef tongue. I have seen many doc's use it, and I always think that I'm going to, but I either don't need that many stitches, or, as in the case of my last suture job, it was too ragged and complicated. The trend for midwives in my area(the ones that I have grilled about it at least) is to put in as few stitches as is necessary to pull the tissue back together. The bare minimum. The doc's put in so many. But talk to a doc who has gone to a third world country to repair bad suture jobs, and you wonder which is the right way. It stands to reason that more stitches will cause more tissue trauma and swelling, and more itching and discomfort, but there is already going to be swelling, discomfort, and itching. I don't know what the answer is, but for now I do as few as I can get away with. Any thoughts? I would love to hear them.