TT 12 years ago and green sutures have been coming to abdomen surface forcing hole in skin trying to come out (Photo)

Dear Joanna2962,

I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Hi Joanna2962, thank you for your question and for sharing your history and pictures.

What you are experiencing is unfortunately not uncommon in cases where permanent sutures, like green Ethibond sutures, were used during your tummy tuck. These sutures are braided and typically used to repair the rectus abdominis diastasis or to reapproximate deeper layers of tissue, such as Scarpa’s fascia. While these sutures are designed to remain in place permanently, in some cases, the body identifies them as foreign and begins to reject them, causing them to migrate toward the surface of the skin. This process often leads to discomfort, irritation, and, as you’ve described, holes forming in the skin as the sutures attempt to push through.

Once the sutures begin to break the surface, most plastic surgeons recommend a conservative approach: removing the sutures as they emerge. This can often be done in the office under local anesthesia. Although this method is less invasive and avoids additional surgical risks, it may still leave small dimples or scars where the sutures exited.

For a more comprehensive solution, you could consider undergoing a revision procedure to remove all the visible Ethibond sutures at once. This approach involves reopening the abdomen under general anesthesia to locate and remove the sutures entirely. However, this method requires a longer recovery period—typically one to two weeks—and comes with the usual surgical risks. While it is more aggressive, it can help prevent further complications, including infection or recurring suture eruptions.

It’s critical to contact your surgeon or a board-certified plastic surgeon as soon as possible, especially since you mentioned that the most recent suture has become infected. Infection can complicate the situation and requires prompt treatment, which may include antibiotics and removal of the infected suture.

To minimize future scarring and manage this situation effectively, stay in close communication with your surgeon. Be sure to explore both conservative and surgical options based on your comfort level and the extent of the issue.

Good luck, and I hope this helps answer your question regarding your recurring suture issues.

Sincerely,
Dr. Katzen

Thanks so much for your question,

Sutures emerging from the skin many years after a tummy tuck, known as "spitting sutures" or "suture extrusion," can occur, especially with non-absorbable sutures like green-colored Prolene. These sutures are used in deeper layers during the procedure and, in rare cases, may not be fully absorbed or integrated, leading them to work their way to the surface over time.

See Your Surgeon or a plastic surgeon to evaluate the area, clean it properly, and remove any visible suture material. This procedure is usually straightforward and may provide immediate relief.

Suture extrusion after so many years isn’t common, but it can happen. With proper care and possibly a quick procedure to remove the suture, the skin should heal well.

Sincerely,
Dr. Emmanuel Mallol

Thank you for your question. This is known as suture extrusion, where non-absorbable sutures from a tummy tuck surface through the skin. Over time, the body may recognize these sutures as foreign material, leading to inflammation and gradual extrusion through the skin. The itching and pulling sensations you’ve experienced could indicate chronic irritation or a low-grade inflammatory reaction around the sutures. The best solution is to remove the remaining non-absorbable sutures through revisional surgery to identify and remove any sutures left in the abdominal wall to prevent future extrusion. A scar revision procedure can improve the appearance of the scars and treating the infection is a priority if the current suture is infected. Also, an ultrasound or CT scan may help identify the location of any remaining sutures. You should discuss suture materials with your surgeon as using absorbable sutures or newer techniques can reduce the risk of future issues.

Thank you for your query. These appear to be permanent sutures , perhaps Ethilon, and can occasionally by spit out by the skin and even cause “stitch abscesses”, however it is very unusual to happen at twelve years. I would recommend a physical examination and perhaps an ultrasound/MRI to check the condition of soft tissues. Please make an appointment with your Plastic surgeon who can help you with all your concerns. All the best!

Your deep sutures are permanent sutures, hence will never dissolve. Usually they do not cause any issues but if the suture gets infected, the infection can track along the suture and become exposed in multiple areas. Removal of exposed sutures is needed and you can choose to do it as they show up or consider revising your TT and removal of all sutures. Best wishes.

Thank you for your question and pictures. Unfortunately, years ago a number of years ago Plastic Surgeons used a suture called Ethibond and these often times spit out years later. Your options are to either have them removed one by one as they spit out and then do scar revisions of the locations where they spit out as needed or if it gets to be too often, you might need to undergo a revision of your TT in an attempt to remove then all once and for all. Be sure to see a Board-Certified PS for your consultation in case you decide to go the revision route eventually.

the visible suture looks like you have a permanent suture called ethibond or ticron for your plication sutures. These are performed in a linear fashion and once a patient has one that becomes infected it is very common that the infection can track along the entire suture line. This often results in a mild infection that results in small draining wounds. Antibiotics alone will not address this and even isolated suture removal is unlikely to completely address it. The only real solution is the undergo a revision tummy tuck and have all of the permanent suture material removed.
Sean Fisher Aesthetic Plastic SurgeonSeattle, WA

These are permanent sutures used to address the abdominal wall. They have worked their way to the surface of the skin and need to be removed. The area typically heals well once the suture material is removed and only requires minor home care. You can use scar creams to diminish the appearance of the suture sites.

Hello,
These are polyester (Ethibond) sutures used to stitch the fascia and abdominal muscles. This material is typically used for deeper sutures. In individuals with less body fat, if the knots are not buried inward, they may become superficial, irritating the skin and attempting to work their way out. Since they are not absorbed by the body, they can cause problems even long after the procedure. The treatment for this issue is surgical removal. If there are knots that have not yet penetrated the skin but have caused discoloration, they will eventually expose themselves and come to the surface, just like the previous ones.