Sutures, commonly known as stitches, are medical devices used to hold tissues together after injury or surgery, providing temporary support until the wound heals. Concerns arise when a stitch remains in the skin past its intended removal date, especially those left on the surface. Understanding the consequences of this overlooked material is important for managing potential complications and ensuring a complete recovery.
Understanding Suture Materials and Function
Sutures are categorized based on whether the body can naturally break them down. Absorbable materials, such as synthetic polymers, dissolve harmlessly within weeks or months. These are typically used for internal closures or deep tissue layers and do not require manual removal.
Non-absorbable sutures, made from materials like nylon or polypropylene, cannot be metabolized by the body. They maintain their strength indefinitely and are used for superficial skin closure. The problem of a “left-in stitch” almost exclusively involves these non-absorbable materials, which healthcare providers usually schedule for removal within 5 to 14 days.
Short-Term Consequences: Acute Inflammation and Infection
When a non-absorbable suture remains in the skin past the recommended period, it triggers an acute inflammatory response. The foreign material causes localized irritation, resulting in redness, mild swelling, and tenderness around the site.
A greater concern is the increased risk of localized infection, often called a suture abscess. The suture material can act as a protected surface where bacteria adhere and colonize, shielded from the immune system. Signs of acute infection appear soon after the intended removal time, including worsening redness, warmth, increased pain, significant swelling, and purulent discharge. Untreated, a suture abscess delays wound healing and compromises the final cosmetic appearance.
Long-Term Complications: Foreign Body Reactions
If a non-absorbable suture is left in for an extended time, the body mounts a chronic immune response to the retained foreign material. The immune system attempts to isolate the material it cannot eliminate, which can lead to a suture granuloma over months or years. A granuloma is a firm, localized lump of tissue composed of immune cells that have surrounded and encapsulated the stitch. This is the body’s method of walling off the material to prevent chronic irritation. Unlike an abscess, a granuloma is a sterile, immune-driven reaction.
Another long-term complication is suture extrusion, or “spitting sutures.” Here, continuous inflammation causes the body to physically push the material out through the skin surface, resulting in a small, non-healing opening or a visible piece of suture working its way out.
Identifying Symptoms and Medical Intervention
Recognizing the signs of a problematic retained suture involves watching for symptoms that persist long after the wound should have stabilized. Indicators include persistent localized discomfort, the formation of a new, firm lump along the incision line, or any non-healing area that discharges fluid. A visible white or dark speck protruding from or sitting just beneath the skin surface is also a direct sign of a retained suture fragment.
The necessary medical course of action is simple removal of the retained material. A healthcare professional can retrieve the stitch using fine forceps, even if it is partially encapsulated or buried beneath a thin layer of skin. If an infection or abscess is present, the removal of the stitch is often combined with draining any accumulated pus. Antibiotic treatment may also be prescribed to clear residual bacterial colonization.