What suture material won't spit? (Photo)

Question

Every surgery I spit stiches. I've had several attempts to correct the scarring but each attempt I spit and scar. Two board certified Beverly Hills doctors. I spit rhinoplasty sutures too.

David C. Yao, MD, FACS · Answer

Thanks for asking. Unfortunately any buried deep suture may spit if just under the surface. Find out what particular sutures have been used. Perhaps a different type might be better. Best wishes!

William Andrade, MD · Answer

Hello, any suture can potentially come to the surface and extrude.  In my experience the slower-dissolving absorbable sutures are more likely to extrude than quicker-dissolving sutures.  Your surgeons would be able to tell you exactly what they used, and if you do require another operation the surgeon could try another suture type.

Daniel Barrett, MD · Answer

Dear betterandbetter,I close all of my incisions in 5 layers and do not use absorbable sutures because they cause inflammation and worse scarring. I tape all of my incisions in the office visits once a week for six weeks after surgery to improve the appearance. After taping, I start my patients on a scar gel therapy for 3 months that they have to put on their incisions twice dailyDaniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Chris Porter, MD · Answer

There are a number of different absorbable sutures that can be trialled, many these days are impregnated with antibiotics that minimise spitting. Sometimes sutures spit because they are too superficially tied. The other options are to use non-absorbable sutures and remove early, then reinforce with tapes and glue.

Curtis Wong, MD · Answer

can be avoided by first not using the same product again... then making sure the knots are truly deep and the ends buried.  Just these two things usually resolve any issues with spitting sutures.

R. Laurence Berkowitz, MD · Answer

Your problem is not unique and suture companies have tried to address this problem.  Sutures are either braided, smooth or barbed, each either dissolvable or permanent.  Braided sutures are softer and desirable except for a greater likelihood of bacteria being trapped in the braids that will lead to ejection by the body.  The most popular braided, dissolvable suture is Vicryl.  In an attempt to resist spitting there is a version called Vicryl Plus for the addition of an antimicrobial to the suture to reduce this problem.  It has worked well in my hands. Some dissolvable sutures such as polydioxane or PDS also can come treated as a Plus option. I can speak for rhinoplasty; most of us try to avoid any permanent sutures in the nose, smooth or braided.  Late infection and troublesome spitting can occur. PDS Plus is a favorite for rhinoplasty surgeons because of its smooth surface and resistance to infection within the knot that is tied.  Which brings me to knots--they are also  a source of the problem. Barbed sutures have largely eliminated the issue of knots but not all surgeons have made this transition.  I have found them of use in facelift, breast and body procedures, but always of the dissolvable composition (Quill PDO).  Hope this helps

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the question and sorry for your problem but all stitches can spit.  That said obtain you records and go on some complimentary consultations with experts and compare recommendations after a full examination Dr Corbin

Brooke R. Seckel, MD, FACS (retired) · Answer

I am sorry to hear of your experience.  Sutures are more likely to spit when they are placed to close to the skin surface.  In my experience a monofilament resorbable suture named Monocryl rarely spits.

What suture material won't spit? (Photo)

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