Vicryl Sutures After Tummy Tuck - Allergic Reaction?

Vicryl sutures (made by Ethicon) are made of polyglactin 910, which is a copolymer of 90%glycolide (polyglycolic acid) and 10% L-lactide.These are braided, absorbable sutures that retain 75% of their original strength at 14 days, and 25% at 28 days. Vicryl Plus sutures have an added coating of triclosan, a broad-spectrum antimicrobial. Both absorb by hydrolysis, which causes minimal inflammation at the site of use. (Catgut, by contrast, absorbs by proteolysis, a somewhat more inflammatory response.)

These sutures are commonly used for skin closure, and are often used just below the skin surface as subcuticular or buried interrupted closures. They have been around for several decades; I used them in my plastic surgery fellowship at the Mayo Clinic 25 years ago. Many surgeons still use them; some patients have what most doctors have termed "Vicryl reactions" for the tiny, inflammatory pus pockets that develop around some of these sutures. Wait, if you are having an "allergic reaction" to these sutures, shouldn't the "allergic reaction" and red spots occur at EVERY place these sutures were used, not just some? Hold that thought for now.

When patients who have these sutures develop tiny red pus pockets just below the surface of the skin during the healing process, suture removal (where possible), warm packs, topical antibiotic ointment, and rarely oral antibiotics are used. Wait a minute, if this is an allergic reaction, why isn't the doctor using an antihistamine? Antibiotics don't work for true allergic reactions; in fact, they are worthless for this!

Ethicon does not even list "allergic reaction" in their list of contraindications (it does list a potential sensitivity to triclosan, a broad-spectrum antimicrobial present in Vicryl-Plus sutures, NOT in regular Vicryl). In fact, if you think about it, the fact that the company has a variety of their braided absorbable suture that includes an antimicrobial is a hint to what is really going on--and it's not allergic reaction to polyglycolic acid or lactic acid!

So-called "Vicryl reaction" is simply bacterial contamination of the braided suture material, likely from "normal" skin bacteria present in the sweat glands and hair follicles the suture goes directly through during your surgeon's closure. These skin bacteria are actually protected from your body's defenses--your tissues' antibodies (and antibiotic, if given)--by the tiny interstices within the braided suture. These tiny microscopic hiding places are warm, wet, and a place that bacteria can multiply, causing the tiny red pus pockets in some locations. That's also why removing the stitch, opening the pus pocket, and topical antibiotics (or just time as the suture dissolves and your body can "get to" the bacteria and eliminate them) solve this problem. That's also why Ethicon has added an antimicrobial coating to their Vicryl Plus brand of suture. That's also why many surgeons, myself included, soaked our Vicryl sutures in antibiotic irrigation fluid before use; this reduced the "Vicryl reactions" in my practice for years. And now, many surgeons. myself included, have switched to a non-braided monofilament suture like monocryl, which has no interstices for bacteria to "hide" in, and rarely see any kind of stitch abscess, for that is what is REALLY happening. I truly understand my colleagues' reluctance to tell their patients that they have a stitch abscess; too many patients "freak out" at any mention of the word "Infection." It's often easier to avoid this topic altogether and call it a "reaction" or "allergy." It's NOT, but it's not an infection that amounts to a problem in the vast majority of those who have it.

BTW, suture is a foreign body, but this is also NOT "rejection", since the components of Vicryl are substances that are simple biochemical compounds, not complex immunoreactive proteins like a kidney transplant, or even a blood transfusion. You don't reject sutures any more than you "reject" artificial hips or pacemakers. You can get an infection around them, but this is definitely NOT rejection.

Patients who have chronic problems with suture abscesses may harbor more or worse bacteria in their pores, sweat glands, and hair follicles. Showering the night before and the morning of surgery with Hibiclens (chlorhexidine) may help to reduce suture problems. I'd also avoid braided sutures, but you DON'T have to list "allergic reaction to Vicryl" in your patient intake information. It's incorrect and inapplicable.

It’s not unusual for plastic surgeons to utilize buried
absorbable sutures when they perform abdominoplasty surgery. These sutures are
placed in the dermis to provide strength to the wound closure.Depending
upon the specific type of suture utilized these sutures typically resorb in two
to three months following surgery. At this point the wound has gained most of
its tensile strength and scars are less likely to spread.Unfortunately,
these sutures are a foreign material and for this reason your body has a
tendency to work them to the surface before they’re totally dissolved. This
doesn’t represent a true allergic reaction, but instead a normal response to a
foreign material. When sutures break through the skin; they can sometimes
become infected and form a stitch abscess.This is
a common occurrence when this type of suture is utilized. When these sutures
protrude through the skin, they should be removed to avoid secondary problems.
If the sutures are buried and not causing problems they should be left alone to
dissolve on their own.

many patients develop strong reaction to Vicryl sutures and develop areas of suture abscess which look like small pimples with puss drainage. the best treatment is to wash them, and keep them clean and not to let them get to moist. Hydrogen peroxide or alcohol can help.

Absolutely! Suture reactions to vicryl is very common and manfests as small suture abscesses. Typically the vast majority of sutures are resorbed by 3 months.

Tummy tucks typically involve the use of a number of different sutures including those that dissolve and permanent ones.  Some surgeons have also started using dissolvable staples.  Any time a dissolvable suture is used just below the skin there is a chance some of the stitch might not dissolve completely and become exposed.  Most surgeons refer to this as "spitting."  This process almost never involves an allergic reaction.  The treatment is usually very straight forward and involves the removal of the suture in the office most times without the need for any anesthesia.  In frequently sutures can become infected and present as a pustule.  This is referred to as a stitch abscess.  The treatment is similar, but typically involves the use of antibiotic to treat any infection.

An abdominoplasty contains many sutures.  Spitting of a suture through the skin may not necessarily reflect an allergic reaction, but rather, a normal process of rejection of foreign bodies by the body.  Fortunately, long term outcome is not affected. 

Vicryl sutures are removed by the body via an inflammatory reaction.  These "dissolvable" sutures are very useful and have been around for decades.  Occasionally the inflammatory response can create a small sterile abscess around the suture.  It looks like a pimple in the wound.  Your surgeon can retrieve this with a pair of sterile pickups and the small hole will close in a day or so.

What you are describing is more likely a not uncommon stitch reaction that causes a small collection of fluid to form around the ends of stitches. The fluid usually causes a small opening in the skin to drain. Once the drainage is complete the small hole usually closes (this can take some time). If the stitch is not completely absorbed the fluid may remain and the small opening may not close for a long time. In some cases the small piece of stitch material needs to be removed. In most cases these problems resolve on their own.

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I hope this info helps...

It is rare to have an allergic reaction to Vicryl.  What you are describing is likely "spitting" sutures or a suture abscess.  Vicryl sutures are designed to dissolve over a period of time.  This dissolving process occurs as your body reacts to the suture and walls it off while breaking it down.  If the suture is close to the skin, this process can lead to a suture abscess as bacteria can contaminate the walled off suture.  Removal of the offending suture will usually resolve the problem. 

Vicryl is a common absorbable suture used to close the deep layers below the skin surface.  It is expected to hold the tension on the deeper layers during the critical first 6 weeks of the healing period to allow less tension on the skin closure and thus a better scar. 

Sometimes vicryl sutures as swell as other absorbable sutures work there way to the surface rather than dissolving deeply and can present as inflammation, redness, pain, drainage and localized infection at the suture line.  Usually treatment is quite simple for a "spitting suture", involving simply removing the suture at the surface, then allowing the small opening to heal spontaneously with lots of soap and water washing.

Antibiotics are rarely needed and usually the process is well-localized so there may be no long term consequence for the scar.