Still Spitting Stitches 7 Mths Post-op TT, is this Normal? (photo)

Question

I have a small spot on my scar that is still spitting stitches/disolvable staples 7 mths out. I've had multiple ones removed and the spot is sore/tender. A stitch that was shaped like a loop and attached to some part inside me came out the top of the hole but isnt sliding out it is wrapped around a muscle or chunk of tissue. it almost looks like a blister with a stitch looped through it. I have an appt with my surgeon tomorrow so he can check. Is this rare to still have spitting this late?

Richard H. Tholen, MD, FACS · Answer

If only dissolving sutures are used, by 7 months they would all be long gone--any spots like this would be due to an ingrown hair or infected cyst, both of which can occur along scars.

	However, many plastic surgeons (myself included) use permanent sutures as part of the muscle plication. Braided sutures can become infected somewhat more easily than monofilament sutures, but braided sutures can allow tissue ingrowth for a more durable internal scar. Thus, there is no right or wrong, only surgeon preference based on individual patient needs and tissue characteristics. But this problem is why I prefer monofilament permanent sutures for the muscle repair; when stitch 'spitting" occurs, it is almost always with braided permanent sutures. The same even applies to dissolving skin stitches--braided sutures have a much higher likelihood for "suture reaction" (actually stitch abscess) than monofilament.

	Unfortunately, once one "permanent" (non-dissolving) suture becomes contaminated by bacteria, others nearby can also have the same issue, and neither the bacteria nor your body "wins" the battle against each other until the suture is removed. Sometimes the offending suture is removed and all is well until an adjacent suture becomes a "new" problem. The treatment is the same--removal eliminates the source, and your body quickly heals the area, usually with little additional scarring. But until it is removed, the contaminated stitch can indeed take several months to cause a tract to the skin surface

	The rest of your suture line looks great, and I see no other areas of redness or irritation similar to the one in the center just above your pubic area. Once the stitch is completely removed (either no or local anesthesia), the problem is usually solved without any additional antibiotic therapy, though this may be something your surgeon will add if needed. It should heal in several weeks either way, and the redness and blister-like swelling will resolve. See your surgeon as planned and be reassured. Best wishes!

Richard J. Bruneteau, MD · Answer

It’s not unusual for absorbable sutures to work their way to
the surface of the wound.When this
happens, they frequently develop localized infection around the suture.This is known as a stitch abscess and is
easily treated with local wound care.This requires removal of the suture and dressing changes. In some cases,
antibiotics may be necessary as well.It’s
important that you consult your plastic surgeon. Your surgeon should be able to
formulate a treatment plan that addresses your concerns.Unfortunately, this problem can still occur
several months after surgery.

Miguel Delgado, MD · Answer

A tummy tuck procedure places many sutures in at various level and many of them dissolve As they melt away they may cause a reaction the suture area open up and discharge the suture. The will heal the area.

Jed H. Horowitz, MD, FACS · Answer

sutures can be permanent or absorb able       either way..  if they continues to cause a problem   they should be removed

John Renucci, MD, FACS · Answer

What you are describing is a finding that can happen with non-dissolving sutures. Because it is located in the midline, I suspect that the suture you are seeing is the one used to plicate (repair) your rectus diastaisis. Once these sutures are involved with bacteria (colonized) the issue won't typically resolve until the definitive suture is removed. Regardless of how the suture became colonized, your experiencing an easily correctable issue. Best of luck.

Darryl J. Blinski, MD · Answer

This issue can occur over a few months to years depending upon WHICH type of suture material was used. Check with the operative surgeon and tell us the answers.

Tito Vasquez, MD, FACS · Answer

7 months is getting the long side of normal for sutures to be causing problems. If the suture is very superficial, usually warm compresses can work that suture out. If not, I recommend excision of that problem area.

Sean A. Simon, MD · Answer

Spitting sutures 7 months after surgery is certainly uncommon but not unheard of, cause may include:

	
		retained suture material (absorbable suture that has not been completely dissolved
	
		permanent suture material
	
		suture granuloma - inflammatory tissue that has formed as a reaction to the suture material
	
		ingrown hair
	
		sebaceous cyst


	if removal of the foreign material (suture) has not resolved the problem, you may need a scar revision to address the underlying problem, in other words, excise the granuloma, hair, sebaceous cyst, or remaining suture material.

Karol A. Gutowski, MD, FACS · Answer

Although not common, once in a while, a suture may work its way out. Most patients heal fine after the suture is removed.

Peter A. Aldea, MD · Answer

We often have to use non-dissolving stitches to keep structures from moving and scars from widening. Unfortunately, while these stitches are great in keeping scars from widening and elevated thighs from sliding lower, once bacteria colonize them, the body pushes the stitch out. Your wound (smooth, round, like a punched out hole) is typical of a chronic wound. Complete removal of the stitch would result in rapid wound healing in a few weeks with a reasonable scars.

	Good Luck with your appointment. It wiil NOT hurt.

Still Spitting Stitches 7 Mths Post-op TT, is this Normal? (photo)

Answers (11)