When a wound is more than a superficial scrape, surgeons often close it in multiple layers. Deep sutures are stitches placed in tissue layers beneath the visible skin, such as the dermis, fatty tissue, or fascia. Because they are entirely internal, these stitches are not visible once the procedure is complete. The primary goal of a deep suture is to provide foundational support to the wound from within.
These stitches are strategically placed so the knot is buried deep within the tissue. This technique allows for the careful alignment of the deeper layers, forming the groundwork for the final surface closure. By managing the wound’s internal structure, these sutures set the stage for a more stable and aesthetically pleasing heal.
The Function of Deep Sutures
The principal reason for using deep sutures is to manage space and tension within a wound. A deep cut or incision creates a potential cavity, or “dead space,” between separated tissue layers. If this space is not closed, it can fill with fluid like blood or serum, creating an environment where bacteria can multiply and lead to infection. Deep sutures pull these internal tissue layers together to eliminate this dead space.
Another function is to reduce tension on the skin’s surface. By bearing the primary strain from below, deep sutures allow the external skin edges to be brought together with minimal force. This alignment is important for healing, as excessive tension on the skin can lead to wider, more noticeable scars or cause the wound to pull apart. This internal support gives the wound strength to heal properly, helping ensure the final scar is as fine as possible.
Suture Material and Absorption
Deep sutures are almost always made from absorbable materials that the body breaks down over time, so they do not require a follow-up appointment for removal. Common materials include polyglactin 910 (Vicryl), poliglecaprone (Monocryl), or polydioxanone (PDS). The material used depends on the location of the wound and the surgeon’s preference.
The process by which these materials disappear is a chemical reaction called hydrolysis. The suture material reacts with water in the body’s tissues and slowly breaks down into smaller molecules that are metabolized. This gradual process provides support to the wound during the initial, fragile stages of healing. Complete absorption time varies from a few weeks to several months, depending on the material, suture location, and the patient’s health.
Wound Care and Healing
Proper care of the surgical site is important for ensuring the wound heals correctly. Patients should adhere to the specific instructions provided by their healthcare provider, as aftercare can vary based on the surgery and incision location. Guidance often includes keeping the external wound area clean and dry and avoiding activities that could place stress on the healing tissues, such as heavy lifting.
During the initial phase of healing, it is normal to observe some redness, swelling, and mild tenderness around the incision site. These are signs of the body’s natural inflammatory response and diminish over the first week or two. As the wound continues to heal, the deep sutures work internally to provide support while the surface incision closes.
Recognizing Potential Complications
While the healing process is usually straightforward, it is helpful to be aware of signs that may indicate a complication. One common occurrence is suture “spitting” or extrusion. This happens when a piece of the dissolving suture material makes its way to the skin’s surface before it has fully broken down, looking like a small pimple or a piece of string. It is best to contact a doctor rather than attempting to pull it out.
More serious signs to watch for are those of a potential infection. These include:
- Increasing pain or tenderness at the wound site
- Spreading redness or a feeling of warmth around the incision
- Any discharge of pus
- A fever, which can indicate a systemic infection
Another less common issue is a suture granuloma, a persistent, firm lump of inflamed tissue that forms in reaction to the suture material. If any of these symptoms appear, seek medical advice promptly.