Can an allergy to Vicryl cause little pus blisters below the suture line?
Vicryl Sutures After Tummy Tuck - Allergic Reaction?
Doctor Answers 27
Lots of surgeons believe patients have Vicryl allergy. I believe they are wrong.
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.
Problems with sutures
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.
Suture Reaction After Tummy Tuck
Many people do get reactions to some of the dissolvable sutures.
Oftentimes the body tries to extrude (spit out) the sutures.
Your surgeon can remove any of these nuisance sutures for you. The areas will quickly rolve and heal well.
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Localized suture reaction
What you are describing, the "little pus blister below the suture line", is commonly referred to as "spitting sutures" or a "stitch abcess". This alone does not indicate a true allergy to Vicryl. If a stitch is coming up to the surface, basically your body is reacting to the presence of a foreign material and trying to get rid of it. This is more common for sutures placed close to the surface of the skin, and certain types of suture material tend to do this more than others. If there is a small amount of pus around it, you just have a small localized infection around that stitch. As soon as the stitch is removed or dissolved, the pus and redness usually resolve. Braided suture material tends to collect bacteria more easily than non-braided (or monofilament) suture. If you are having this issue, go see your surgeon and he or she can remove any sutures that are troublesome. Good luck!
TRUE Allergic Reaction to stitches are VERY RARE
Stitches are divided into several groups such as :
- Dissolving VS. Non-dissolving ("permanent)
- Smooth (mono-filament) VS Braided (like ropes)
Braided sutures are easier to tie BUT have a higher rate of being pushed out by the body . This happens more frequently the closer the stitches are placed near the surface.
Vicryl is a braided dissolving sutures that has many positive attributes but one of its weaknesses it that it tends to "spit" - be pushed out by the body when superficial. When this happens the stitch can literally be pulled out and the opening can fully heal in days.
It is unlikely that an individual is really allergic to Vicryl suture. More likely the body may try to extrude suture especially if they are close to the skin. If the suture becomes exposed it should be removed. When exposed to air the body is not able to break down the suture over time as it normally does. This is a common occurrence.
Normal Response To Foreign Material
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.
Vicryl suture reaction after tummy tuck & abdominoplasty
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.
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 after abdominoplasty (tummy tuck) can cause minor wound problems but not allergies.
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.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.