Pros and Cons of Permanent Vs. Dissolvable Sutures for Diastasis?

Question

I'm concerned and "creeped out" by the idea of permanent sutures for diastasis and would like to be more informed about dissolvable sutures. Is there a real, increased risk of muscles coming apart at some point? What is the impact of ab work/exercise in mitigating that risk or making it worse? Are the muscles pretty much fused/scarred together by the point that they dissolve? Any data on the prevalence of permanent vs. dissolvable? I'm 5'8" and 138 lbs, and fairly active.

S. Larry Schlesinger, MD, FACS · Answer

Correction of separated abdominal muscles (rectus diastasis) either makes or breaks a good tummy tuck.  Not only what thread the surgeon uses but what type of suturing he or she does should be very important to the informed consumer of an abdominoplasty.  Abdominal musculature, not only the rectus muscles but the obliques as well, allow us to bend and twist in all sorts of directions, therefore, the suture repair with permanent suture needs to be a figure of 8 technique interrupted, both above and below the umbilicus followed by a running locking suture to bury the figure of 8 sutures and reinforce the repair. 

	 

	I use permanent sutures because you never know how long it is going to take until scar tissue takes over the job of keeping the muscles together and correcting the diastasis recti.  Everyone's body chemistry is different and one person may dissolve the dissolvable stitches at a faster rate than another person, and since you want a permanent repair, use permanent sutures. 

	 

	Plastic surgeons are used to putting permanent things in people's bodies such as breast implants, chin implants, etc.  I can certainly understand why this might freak you out, but please understand that the body will wall these sutures off with scar tissue protecting you from these permanent sutures and increasing the necessary repair for the correction of the separated muscles.

Christopher V. Pelletiere, MD · Answer

With regards to permanent vs. absorbable sutures for diastasis repair, the problem with dissolvable sutures is that their degradation is ahrd to control from patient to patient, as well as their loss of strength. You generally need a good six months of soild healing for everything to sacr down and solidify internally, and even the best/strongest dissolving sutures are usually pretty weak at that point. They will still be there, but will not have nearly the tensile strength as the permanent sutures. I hope this helps

Vishnu Rumalla, MD · Answer

I do a two layer muscle repair. The deep layer is with permanent suture and the more superficial layer is with a long lasting absorbable suture. You should not be able to see or feel the sutures. Permanent sutures are used on most intestinal surgery, joint and tendon surgery, and in most vascular surgery without any consequence. You want a long-lasting repair, and for many plastic surgeons-that means using some permanent suture. Good luck with surgery.

Zach Barnes, MD · Answer

Its definitely an odd thing to think about, but dont let it keep you up. The sutures are really there just to hold things together while the body heals everything in place. However, many surgeons feel that in such a dynamic and often used portion of the body, if a permanent result is desired permanent sutures are better suited to that effect. To be on the safe side, I prefer permanent sutures as do most plastic surgeons. Some use dissolvable and seem to do just fine, so you could go either way.

Marc Schneider, MD · Answer

Either would be acceptable as long as each strong enough to hold during the healing phase. Some absorbable sutures lose their strength too quickly while others last an adequate time.

Peter E. Johnson, MD · Answer

There are no studies that I know of which compare dissolving and permanent sutures in tummy tuck. Some do use dissolving sutures for diastasis repair, most do not. Similar to a repair of a hernia, permanent support has been important to reduce recurrence. There is no downside or disadvantage to a permanent suture, so you shouldn't put much worry into it.
	Best of luck,
	peterejohnsonmd

Lawrence Tong, MD, FACS, FRCSC · Answer

Dear Louise 10,

	Using either type of suture will be acceptable. After a certain period of time has elapsed, the diastasis repair is healed, and does not depend on the sutures to hold thing together. This occurs well before a dissolvable suture has dissolved, so a non-permanent suture is acceptable. I have used both types of sutures in tummy tucks with no differences noted in any of my patients. Good luck.

	Best regards,

	Lawrence Tong MD FACS FRCSC

Kamran Khoobehi, MD · Answer

There is not wrong or right way. The longer lasting restorable sutures perform as well as permanent sutures without the risk of spitting out.

Steven Turkeltaub, MD · Answer

In my diastasis repairs, I always use permanent sutures because I want the security of the strength and pesistance of it as compared to dissolvable sutures. There is some variability of duration of dissolvable sutures as well as or their residual strength and if the suture strength decreases faster than the clinical need for a particular level of force, then breakage of the repair can occur. PDS suture, a dissolvable one, may last long enough in most people to not be associated with this problem but I would rather not risk it even in a few patients.

	Permanent, persistent deep sutures virtually never present a problem.

Jonathan J. Staiano, FRCS (Plast) · Answer

I would not be too concerned about this.  There is a lot of things to consider when having surgery, but this issue is something for the surgeon to decide on.  I use dissolvable (PDS) or permanent sutures for diastasis repair and I think that they both do a perfectly good job.

	The sutures will be very deep in your abdomen and you should not be able to feel them.

Pros and Cons of Permanent Vs. Dissolvable Sutures for Diastasis?

Answers (11)

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