I've had complications with dissolvable stitches. Are there alternatives methods that can be used for my upcoming Tummy Tuck?

Question

After having my breasts reduced, I ended up with complications from the disolveable stitches. Five months have past and I still have areas that are erupting with blood and puss. Then I have to go back to my surgeon to get those stitches removed surgically. Are there any alternatives to these stitches, since I am planning on a tummy tuck?

Laurence Weider, MD · Answer

From time to time I have a patient whose body does not react well to dissolvable sutures.  One alternative that I have used on occasion is a pull-out stitch.  Basically this is a running suture that is removed by your surgeon about 7 to 10 days after surgery. Nonetheless, some deeper sutures that can't be easily removed will also be necessary.  However, it is usually the superficial sutures that can cause a problem. Best of luck.

Leila Kasrai, MD, FRCSC · Answer

Vicryl/polysorb sutures are braided dissolvable sutures that can become quite inflamed when close to the surface of the skin.  My preference is to use non-braided dissolvable sutures at the skin level.   These sutures do not cause the same degree of inflammation.

Marc DuPéré, MD · Answer

Thank you for your question.We call those 'events' "stitch-spitting" when the sutures have not melted yet and your body is trying to push them out.  Vicryl sutures is notorious for this and the reaction can be quite inflammatory.  I don't use vicryl much anymore unless I am very deep into the tissues.Better ones are PDS and Monocryl.  They don't get 'rejected' as much and when they do, it is usually more benign compared to vicryl.Considering that #breast surgery and #tummytuck ( #abdominoplasty ) involve a lot of fine stitching, it is not uncommon to have 1 or 2 of those.Once the external stitches removed (when used), I then recommend my #Toronto, #RichmondHill, #Peterborough and #NorthumberlandCounty (one of the prettiest county in Ontario!) patients to massage their incisions twice daily with Vitamin E oil or Bio-Oil;  the mechanical massaging help to move your skin internal fluids around the stitches and favour their quick melting.Best of luck with your procedure!With regards,Dr. Marc DuPere, Toronto plastic surgeon, 416-929-9800

Eugene Kim, MD · Answer

Many patients can develop small wounds from sutures and knots that do not dissolve and erode through the skin.  This may be due to the type of suture used or the suturing technique.  It often occurs in large incisions seen with breast lifts, breast reductions and tummy tucks.  I recommend that you address your concerns with a plastic surgeon prior to surgery.

Jeffrey K. Scott, MD · Answer

Most of the "spitting" suture problems are related to superficially placed braided vicryl type sutures. You should discuss this concern with your PS. With a tummy tuck you will need some disolveable  sutures to be placed. Monofilament sutures placed a bit deeper and with a more buried knot will likely not cause these previous problems. Be certain your PS is aware of your past problems related to this.

Jeffrey Zwiren, MD · Answer

When dissolvable sutures erupt, get infected and cause problems it is usually due to the knots placed in the just under the skin.  Attention to detail and taking account of your previous problems may help avoid this problem in the future.  Discuss your concerns with your plastic surgeon.

Cory S. Goldberg, BSc, MD, FRCS(C) · Answer

Sometimes dissolvable sutures placed close to the surface of the skin can "spit out" after surgery. This can be due to contamination of the stitches or an individual's reaction to them. For larger procedures such as tummy tuck it us necessary to use some deep dissolving stitches to bring the deeper tissue underneath the skin together. These are rarely a problem . for the surface of the skin a pull out stich, non dissolving stitches, or even surgical clips can be used, so long as the tension on the tissue is held by deeper stitches and the skin stitches or staples are removed early - by 1 week after surgery.

Jeremy Pyle, MD · Answer

There are many different kinds of sutures. The most common that cause what you are describing are called Vicryl.  Although there are other, similar sutures, there are advantages to the Vicryl suture that are hard to come by with alternatives. I am certain, however, that your surgeon would have the same goal as you in preventing the problem you are describing.Best,Dr. Pyle

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question.  I agree with other surgeons that surgical technique is often the most important determination at of problems with observable sutures after tummy tuck.  If the sutures are placed in deep and not to close to the skin suture spitting and problems are much less common.  Monofilament sutures are less likely to submit and braided sutures.Express your concerns to your plastic surgeon and follow the surgeons advice.  There are also new absorbable staples which can be placed deeply however I have not seen long-term studies on the incidence of spitting.

Ronald V. DeMars, MD (Retired) · Answer

Braided sutures like Vicryl have that problem sometimes. The monofilaments like Monocryl almost never do.

I've had complications with dissolvable stitches. Are there alternatives methods that can be used for my upcoming Tummy Tuck?

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