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Spitting a Stitch



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Sutures (mostly the dissolvable ones) will work themselves to the surface of the incision.  This happens quite commonly, and actually when a stitch does pop out, it can come to the surface with an inflamed red spot.  Usually you can feel something like ‘fishing line’ around this area.  It is best to call the plastic surgeon when any suture makes it way to the surface for removal.  You really do not want to attempt to do this yourself, as this is way that infections can start, and you have to make sure you are removing a suture that is not something that is permanent.  Dissolvable sutures are usually clear color (like fishing line), and permanent sutures are dark blue in color.

There are various types of suture material that is used in closing an incision.  Some patients do have problems with sutures, and some sutures are more likely to cause this than others.  Braided sutures (such as Vicryl) can cause this and, for that reason, many surgeons have switched to monofilament (unbraided) sutures, such as Monocryl or PDS.  

Vicryl is an excellent and strong suture material, but it has been associated with "spitting”





Non-Absorbable Sutures are used in the following way:

  • Non-absorbable sutures are normally used to close skin.  

  • These sutures must be removed after the wound or incision has healed completely.

  • Sutures are fine and thin

  • Non-reactive to the body's immune response, so they need to be removed.

  • Non-absorbable sutures are colored either blue or black.

  • Consist of a smooth surface that allows easy removal.


Types of Non-Absorbable Sutures:

  • Synthetic (nylon and polypropylene)

  • Silk (animal protein)

  • Cotton





                                          2010 Copyright

                                    Breast Reduction patient "spitting a stitch"




The following is true of absorbable suture material:

  • Absorbable sutures are degraded by the body with an immune response against "foreign" material.  The phagocytes which are carried by our blood stream destroy the suture material.

  • Generally, these sutures are not intended to be used to close skin - not unless the closure is in a sub-cuticular or a buried type of pattern.

  • Absorbable sutures work best when applied internally, where the body can break the stitch material down over a period of time.

  • If the dissolving process is slow, then the body can start rejecting these - causing a suture to come to the surface or "spitting a stitch".

  • Removal of the sutures that come to the surface will help reduce any irritation.




Catgut:  This suture material is made from bovine intestine.  Although catgut is the oldest technology with dissolvable sutures, it can tend to create an inflammatory reaction which can lead to an infection.  Catgut loses strength quickly - and has little use in modern surgery.

Vicryl / Dexon (Polyglactin-910):  Vicryl tends to dissolve slower than catgut - however, it has less of chance of an inflammatory response. This suture material is intended for use below the surface of the skin.

Vicryl Rapide: Similar substance to Vicryl, but absorbed in a shorter period (5 days). Recent development, worth asking your surgeon about.

Monocryl:  The least reactive suture material of this group, and should leave least amount of scarring. Unfortunately this is not a very soft material and may be slightly irritating while the stitches are in place.




Silk sutures - are a natural protein with 80 - 100 tensile strength lost by 6 months.  Silk is absorbed slowly over one to two years.  Moderate to high tissue reaction.

Linen sutures - long staple flax fibers - 50 tensile strength lost by 6 months with 30 tensil strength remains at 2 years. Non-absorbed sutures with moderate tissue reaction.

Nylon sutures - polyamid polymer material with 15 - 20% tensile strength lost at a year.  Nonabsorbed with low tissue reaction - no contraindications.

Chromic catgut sutures - made from collagen which is derived from healthy sheep or cattle tanned with chromium.  Tensile strength lost by 21 - 28 days.  Absorbable sutures with moderate tissue reaction.  Not advised for tissue with slow healing which will need prolonged support.

Vicryl - polymer of polyglycolic acid.  80% tensile strength lost by 3 weeks.  Absorbed completely by 60 - 90 days.  Minimal tissue reaction.  Not advised for tissues with slow healing which needs prolonged support.

Polyglycolic Dermal Suture (PDS) - absorbable polyglycolic dermal suture (PDS) is best in areas in which long term tension strength is required.  85% tensile strength lost by 8 weeks.  Absorbed completely at 180 days.  Mild tissue reaction - not advised for tissue with slow healing that needs prolonged support.






                                             2010 Copyright

              Patient with Dissolvable Sutures working their way through the incision line.

                                                The area has inflammation and redness.

                         Patient had a Full Modified Anchor Lift and Breast Augmentation




It is very important that if you see any discharge around this area, if the area feels inflamed or is hot to the touch.  Please call your Plastic Surgeon immediately, as this could mean that you have an infection started, and you will need to start on antibiotics immediately.






                                                 2010 Copyright


           Patient with Dissolvable Sutures working their way through the incision line

     which created a slight infection.

   Patient had a Full Anchor Lift and Breast Augmentation








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