Mohs surgery is a precise technique used to remove skin cancer layer by layer, minimizing the removal of healthy tissue. The resulting wound often requires closure using multiple layers of stitching. Surgeons frequently use absorbable sutures to provide temporary support to the deep layers of the repair, as the body is designed to break them down over time. Understanding the timeline for these internal stitches to dissolve is a common concern during recovery.
The Typical Dissolution Timeline
The time it takes for absorbable sutures to disappear depends primarily on their placement. Mohs repair typically involves placing stitches in two areas: the deep, structural layers beneath the skin, and sometimes the superficial layer on the skin’s surface. External sutures are designed for rapid dissolution, often starting to fray and fall off within one to four weeks.
The deep, buried sutures hold the wound edges together under tension as the tissue regains strength. These structural stitches maintain integrity for a longer period to prevent the wound from opening. Internal sutures commonly take between three and six months to be fully absorbed. This gradual process involves the suture material being broken down through hydrolysis, slowly losing strength before it is completely gone.
Variables That Affect Suture Absorption
The rate at which a suture dissolves is influenced by biological and material factors. The chemical composition of the suture is a determinant, as synthetic materials like polyglactin 910 (Vicryl) and polydioxanone (PDS) break down at different speeds. Vicryl may lose half of its initial strength in a few weeks, while PDS provides extended tissue support for a longer duration.
The environment of the healing wound plays a role in the breakdown process. Suture degradation through hydrolysis can be affected by factors like local temperature, pH levels, and the presence of enzymes. A local infection or inflammatory response can accelerate the breakdown of the material. The location of the wound is relevant, as areas with reduced blood flow or constant movement, such as the lower legs or joints, may experience a slower healing and dissolution process.
Monitoring the Healing Site
During dissolution, it is helpful to distinguish between expected post-operative changes and signs that may indicate a complication. Normal healing includes a temporary raised, red, or bumpy appearance along the incision line, which is due to the underlying stitches and the body’s response. Mild swelling, bruising, and a sensation of tightness or itching near the site are common and typically resolve within a few weeks.
Certain signs warrant prompt medical attention, such as pain that worsens after the first few days or excessive, persistent warmth and swelling. A foul odor or purulent drainage suggests a potential infection. Patients may also experience “suture spitting,” where the body expels a small, undissolved piece of the material that might look like a tiny pimple. If this occurs, the remaining exposed portion may need to be trimmed by the surgeon to prevent irritation.
Wound Care During Dissolution
Active patient care supports the dissolution process and promotes the best cosmetic outcome. After the initial 24 to 48 hours, when the surgical dressing is removed, the wound site should be gently washed daily with a mild cleanser and water. Following cleaning, a thin layer of petroleum jelly or a prescribed antibacterial ointment should be applied, and the site covered with a fresh, non-stick bandage.
Patients should avoid activities that place excessive tension on the internal repair, which could disrupt the dissolving stitches before they lose strength. This includes avoiding heavy lifting, strenuous exercise, or activities that cause bending or stretching of the surgical area for the period recommended by the surgeon. Protecting the healing scar from direct sun exposure is necessary, as ultraviolet light can cause hyperpigmentation, leading to a darker, more noticeable scar. Patients should avoid soaking the wound in bathtubs or pools until the skin surface is completely healed.