A “spitting stitch,” formally known as suture extrusion, is a common post-operative event where an internal suture begins to work its way out of the skin. This phenomenon occurs when the body’s natural defense mechanisms identify the suture material as a foreign object that must be expelled. It is usually not a sign of a major problem, but rather a temporary complication of the healing process. This occurrence is most often associated with absorbable sutures placed beneath the skin surface, and is a recognized part of recovery for many patients.
Why Absorbable Stitches Emerge
Sutures placed deep within the tissue are typically made from absorbable materials, designed to slowly break down through hydrolysis or enzymatic activity as the wound heals. These internal stitches provide the necessary strength to hold the incision edges together while the body forms its own connective tissue. The process of dissolution can take weeks to many months, depending on the material used by the surgeon.
Sometimes, the body’s inflammatory response to this foreign material is stronger than intended, triggering a mechanism to physically expel the stitch before it can fully dissolve. This inflammatory reaction creates a small channel in the tissue, pushing the suture material toward the surface of the skin. Patients often notice this as a small, pimple-like bump that eventually opens to reveal a tiny piece of thread or knot.
This extrusion typically happens between two weeks and three months after the operation. The stitch itself is not causing an infection, but its presence at the skin surface can create an entry point for bacteria.
The Absolute Rule About Pulling the Stitch
You should not attempt to pull out a spitting stitch yourself, even if it appears to be loose or easily accessible. The primary risk of self-removal is the introduction of bacteria from your hands or non-sterile instruments directly into the deeper tissue layers. Pulling on the suture can drag surface bacteria down into the wound, potentially leading to a localized stitch abscess or a more serious infection.
Another significant danger is that the exposed portion may be connected to a deeper, load-bearing knot that is still structurally supporting the healing incision. Applying tension to this exposed thread can disrupt the internal suture line, leading to a complication known as wound dehiscence. Dehiscence is the partial or total separation of the previously closed wound edges, requiring immediate medical attention. Since you cannot see how much of the suture remains buried or whether it is still providing structural support, it is impossible to gauge the risk of pulling it.
The force of pulling, even a gentle tug, can also cause unnecessary trauma to the delicate, newly formed tissue beneath the skin. This disruption can result in a wider, more noticeable scar than if the stitch had been managed professionally.
Safe Ways to Manage a Spitting Stitch
If a suture is protruding, the safest initial step is to maintain meticulous hygiene around the area to prevent infection. Gently wash the incision site with mild soap and water, ensuring the area is carefully patted dry afterward. You may apply an over-the-counter antibiotic ointment, such as bacitracin, to the exposed area to reduce the chance of surface bacteria entering the small opening.
If the exposed thread is causing irritation by rubbing against clothing, you may carefully trim only the visible, protruding thread or knot. This should be done using a sterilized, sharp instrument, such as small surgical scissors or nail clippers that have been wiped with rubbing alcohol. The goal is to cut the stitch as close to the skin surface as possible without pulling on the material or nicking the skin.
Trimming merely addresses the nuisance of the exposed thread and does not resolve the underlying issue. If the exposed thread continues to cause persistent discomfort or localized inflammation, contact your surgeon’s office. They can safely and completely remove the entire stitch remnant in a sterile environment, which is the definitive treatment.
Warning Signs Requiring Medical Attention
While a spitting stitch is often a minor issue, it can evolve into a complication that requires immediate professional assessment. You should contact your surgeon or healthcare provider right away if you notice signs of a developing infection. These signs include:
- Increasing pain, a sensation of warmth, or new swelling that extends beyond the immediate area of the stitch.
- Spreading redness (cellulitis), which is a serious indicator that a localized infection is expanding and needs prompt treatment.
- Any discharge that is thick, cloudy, or has a foul odor, suggesting the presence of pus and a developing abscess.
- Separation or gaping of the wound edges, especially if accompanied by bleeding or a feeling that the incision has opened.
- Developing a fever or experiencing chills, which indicates a systemic reaction that necessitates immediate professional evaluation.