Do permanent sutures ever get rejected from the body as they are a foreign substance?

Question

If the literature shows that it's not the sutures but the scar tissue that holds the diastasis repair together, why aren't more surgeons using long term dissolvable sutures? Permanent sutures or dissolvable

Peter D. Geldner, MD · Answer

Thanks for your question. You are completely correct. The scar tissue which forms after abdominal plication holds things together. After some time, the permanent sutures become superfluous, or worse, a nidus for infection. Sutures should function like a house painter. They should do their job and then leave. Over the years, my practice has changes such that I prefer PDS sutures. They remain strong for months and slowly degrade. But in reality, surgeon preference is a personal thing, based on continuous study, and experience. I would not fault my colleagues for holding a different preference. If you are in search for a plastic surgeon to perform your abdominoplasty, feel free to ask their preferences and why they hold them. They should be frank.

Leland Deane, MD, FACS · Answer

All suture types come with a price that the body must pay. Permanent sutures are not 'rejected' in the immunologic sense, but can erode through adjacent tissues, either above or below the sutures. Absorbable (non-permanent) sutures may not hold for long enough for a good tissue bond to form, and they may also cause an inflammatory reaction that causes its own problems.In my diastasis repair, I use both types of sutures, because this has given me the best results over the last thirty years. Hope this helps.

Yannis Alexandrides, MD, FACS · Answer

I believe this problem refers to rectus abdominis muscle, and due to the tension that can be applied to the muscle during exercise and lifting, a lot of surgeons believe that permanent stitches will be more suitable.

Richard Nadal, MD, FACS · Answer

Hi and welcome to our forum!
Debate continues over the years regarding suture selection in rectus muscle repair.
Non-absorbable sutures are usually reliable, maintaining tensile strength until scarring strength has reached its maximum. However, in some patients, an indolent infection may cause the suture to "spit". An inflammatory reaction drives the suture to the surface unless tethered by a deep structure in which case, there may be development of a sinus tract from skin to suture, requiring manual extraction. 
Absorbable sutures are somewhat unreliable as dissolution rates may vary from individual to individual. Rapid absorption before wound strength is sufficient may result in suture line disruption.
Plastic surgeons are divided as to which is best...They base their decisions upon their lifelong experience.
Visit a board certified plastic surgeon for evaluation and discussion.
Best wishes...

Kenneth Hughes, MD · Answer

I use a combination of permanent and absorbable sutures for the diastasis repair.  Other surgeons will have preferences based upon their experience.  Trust your board certified plastic surgeon to perform the surgery and oversee your post-operative care.

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question.  Each surgeon uses the suture material they feel is best and this comes from the inherent properties of the suture, as well as practice-based learning.  That said, any suture material can be rejected, usually due to proximity to the skin surface, or infectious contamination.  Hope this helps.

Harry T. Haramis, MD, FACS · Answer

Having spent years training in and achieving board certification in general surgery, permanent sutures consistently gave best, long lasting results with little complications for abdominal closure vs. absorbable sutures. Permanent sutures have been used for decades, they are inert and do not reject- but they do hold.Following this, in my plastic surgery training and career, symposiums, working with colleagues, etc- the overwhelming majority also use permanent sutures for diastasis recto repair during tummy tuck. The abdominal muscles are very strong and to avoid dehiscence, reoperation, bulges, etc, in my experience, permanent sutures give consistent results on this important part of the tummy tuck including the 4-6 weeks of healing.

Samuel Lin, MD, FACS · Answer

Great question  - there are long term absorbing sutures (PDS) that is used during surgery  or others that are permanent.  Indeed, permanent sutures are used for various types of procedures and for diastasis repair, however on occasion will cause a reaction to try to make their way to the surface.. there are other strategies to help with this..

Daniel Barrett, MD · Answer

Dear maglaw,
permanent sutures are used to maintain diastasis recti repair until the body create tissues which will do that instead of sutures. With the use of dissolving sutures, there is a risk that it will break before the body manages to create strong tissue. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD

Erik Miles, MD, FACS · Answer

When possible, absorbable suture material is generally preferable.  However the suture must hold long enough for scarring or fibrosis to occur so that the desired result is maintained.   With an abdominoplasty, the abdominal muscles can create significant forces on the muscle sutures.   In my opinion, even the longest acting absorbable suture material will probably not last long enough to reliably maintain the repair.  I use a permanent barbed suture that requires no knotting and I have never seen one of these deep sutures extrude.  Discuss this with your surgeon. Best wishes to you.

Do permanent sutures ever get rejected from the body as they are a foreign substance?

Answers (16)

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