8 years post otoplasty my doctor removed 1 suture that caused problems. Will this have negative effects?

Question

had otoplasty 8 years ago. For a few years behind my ear has been red and swollen and bleeds when touched too hard. There is also drainage. I've been too scared to see the doctor for these years but finally went. He found & removed a suture today, but he didn't know if this was the one causing the problem. If it is the one, how long will it take for my ear to be healed? Also, could this have any long-term negative effects on me? I am very nervous.

Thomas T. Le, MD · Answer

Otoplasty involves the placement of sutures to pin back an overprojected ear. These sutures are typically the nonabsorbable permanent type. Usually these sutures are encapsulated in scar if placed correctly. However, it is well known that they may work themselves out and potentially become infected. Fortunately, I have not had this occur in my own patients, but have seen it happen from other patients anywhere from 6 months to 10 years after their surgery. If the infected suture was effectively removed, then no further action is needed. If the suture was present in your ear for at least several months before being removed, then it is unlikely that your ear will snap back to it pre-surgical position. Hope this helps!

Richard J. Bruneteau, MD · Answer

Complications associated with the
use of permanent sutures during setback otoplasty are fortunately rare.  The vast majority of these
complications occur early in the post-operative course, but rarely they may occur
in the late post-operative period.

When infection is associated with
deep buried sutures, the process typically starts with a suture eroding through
the over lying skin.  This opening
represents a portal for bacteria, which then sets up and grows
around the suture. It’s not unusual to have redness, inflammation and purulent
drainage in the area.

When this situation arises, it’s
impossible to eradicate the infection without removing the infected
suture.  Although topical
anesthesia may be used, most people don’t require anesthesia.  Once the suture is removed the patient
is usually given a short course of antibiotics.

The vast majority of patients do
well when infected sutures are removed. Rarely infection recurs because
adjacent sutures also become infected. 
When patients develop this type of complication in the late
post-operative period, suture removal doesn’t impact the ear contour because
healing has already taken place.

It’s important that you contact
your surgeon immediately.  Ear
infections should be treated early and aggressively before infection can spread
to the cartilage.

Ivan Wayne, MD · Answer

As some of the other posters pointed out, suture extrusion is really the only long term complication. After the infected suture is removed the ear should be fine.

Nia Banks, MD, PhD · Answer

What you described is not uncommon. We generally use 3-5 permanent sutures during an otoplasty to bend the cartilage. When one suture extrudes, we remove the offending suture. The others should be left unless they are causing a problem. Once the irritating suture has been removed, the skin should heal quickly. Avoid traumatizing the area and keep it clean.

Mark Domanski, MD · Answer

Sounds like an inflamed sutures, good news is that it is now out!
When I have a patient that is nervous, I try to make them feel more comfortable by some self-deprecating humor.  "You are making me nervous." or "I am going to have to go and take a smoke after this one."  (I don't smoke).  Usually this gets a smile.  I hope your surgeon was able to make you feel more at ease.
There is no way to know 100% if something is causing a problem.  We are not all-knowing sentient beings.  Sounds like your surgeon was honest with their opinion.
After removal of an inflamed stitch, it generally takes a couple of days for the inflammation to get better and the site to heal.
The long term negative effects are unlikely.  But I hope you are feeling better by the time you read this.
Best of luck on your journey and please see your doctor for specific advice.

Andrew B. Denton, MD · Answer

The skin on the back of your ear was being irritated from the undersurface by one or more of the permanent sutures used during otoplasty. Unfortunately, we all see this occasionally in our patients. Removing it was the only thing to do. Time will tell whether or not other sutures are involved. The good news for you is that after 8 years, your ear cartilage no longer depends on the sutures to maintain its shape and structure.

Barry L. Eppley, MD, DMD · Answer

The only long-term complication that can occur from an otoplasty is the one you have experienced....suture extrusion. Because permanent sutures are used to hold the new cartilage shape as it heals, and the thin skin and tissue on the back of the ear, it is always possible that the knots of one of the sutures may eventually work its way through the skin. This can occur years to decades later. Several years ago, I removed an extruding suture from a 68 year old lady that had an otoplasty in 1968! How that presents is exactly what you have experienced....soreness and then drainage from a spot on the eare. While annoying it is not a major problem and removed the knot or suture is the solution to this minor long-term postoperative problem. Whether you will have more or not is unknown but it is always possible.

Richard P. Rand, MD, FACS (retired) · Answer

The permanent sutures use in otoplasty can occasionally work their way out. It should have been pretty obvious to the doctor which was the involved suture and removing the correct one should result in healing in around 2 weeks or so.

Donald Nunn, MD (retired) · Answer

I have seen infected sutures from otoplasty that required removal. Usually it is sooner than 8 years post op. Probably the suture erroded through the skin and became infected. That does not mean that other sutures will do the same. If the offending suture was removed, it should heal quickly. Also there should be enough scar tissue to prevent relapse at this time. Donald R. Nunn Plastic Surgeon

Kimberley Lloyd O'Sullivan, MD (retired) · Answer

The otoplasty is a wonderful procedure and actually it is one of my favorites because it is a very artistic surgery. The surgeon must recreate the convexities & concavities of the ear to establish the normal form. Also, in most cases, the ear must be set back towards the scalp. Combining these two techniques, will allow the ear to set back in a normal position. In order to maintain the correction, it is necessary to use a suture that will never dissolve because the cartilage has "memory" to bounce back to original shape or position. The cartilage will not stay in the new position or shape unless a permanent suture is used. I will use a clear suture for this procedure to both hold the ear back and to create the curves of the ear. The other issue to understand is that the cartilage has a very limited blood supply which may delay healing, and the skin overlying the cartilage of the ear is quite thin. Therefore, it is not too surprising that the irritation that you have been experiencing over the past 8 years was due to a suture that needed to be removed. Most likely, the suture material was a little too shallow, or shifted so that it could irritate the skin from under neath. There should be no major concerns for you at this time, since the irritating suture has been removed. The area should heal now. You can apply ointment and saline compresses to the area in order to allow the area to heal over well. If you have ongoing problems, I recommend you be seen sooner than later. Many things can occur in a suture line, such as a cyst, keloid, hypertrophic scar etc. It is always best to be seen by the doctor who did the surgery, or if you are no longer near by, another Plastic Surgeon. It is better to treat the issue than to hope it goes away. Had you gone back to your doctor initially and been upfront with your problem & concerns, the stitch may have been removed 8 years ago and obviated all the ongoing discomfort. At this point, I recommend you continue to follow up with a Plastic Surgeon until the wound is fully healed, because a wound that has not healed over an extended period of time is at risk for other problems. If you are followed closely, you can address any other concerns or possible consequences of delayed wound healing. Best! Dr. Kimberley O'Sullivan

8 years post otoplasty my doctor removed 1 suture that caused problems. Will this have negative effects?

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