Surgical stitches, also known as sutures, play an important role in the healing process by holding body tissues together after an injury or operation. They provide structural support, allowing the body to naturally repair itself. While many stitches are designed to dissolve or be removed, a common concern arises when a stitch is unexpectedly left beneath the skin, leading to questions about its potential effects.
Types of Stitches and Their Purpose
Surgical stitches are categorized into two types: absorbable and non-absorbable, each with distinct purposes. Absorbable sutures are made from materials the body naturally breaks down and eliminates over weeks to months. These are used for internal wounds, like deeper tissue layers or blood vessels, where removal is impractical or unnecessary. Common examples include natural materials like purified collagen (surgical gut) or synthetic polymers such as polyglactin (Vicryl) and polydioxanone (PDS), with varying absorption rates.
Non-absorbable sutures, conversely, are made from materials the body cannot metabolize, remaining indefinitely unless surgically removed. These sutures are chosen for long-term strength and support, such as repairing tendons or ligaments, or for skin closure where they are easily removed once the wound heals. Materials like nylon, polypropylene (Prolene), and braided silk are typical non-absorbable options, chosen for durability and minimal tissue reactivity. The choice depends on the wound’s location, required tensile strength, and expected healing time.
Signs a Stitch Might Be Left Underneath
Identifying a retained stitch involves visual cues or unusual sensations around the wound. One common visual sign is persistent redness or swelling that does not subside, potentially with a small, firm bump or knot beneath the skin. Sometimes, a tiny segment of suture material might become visible, poking through the skin. Pus or unusual discharge from the incision area can also indicate an underlying issue.
Sensory indicators include pain or tenderness continuing long after expected healing, or an irritating itch around the scar. Some report a feeling of something “poking” or “pulling” under the skin, causing discomfort, especially with movement or pressure. Subtle warmth around the scar, without other infection signs, might also be noticed. These signs can appear weeks, months, or even years after surgery, depending on the stitch material and individual bodily reactions.
Potential Complications of Retained Stitches
Leaving a stitch under the skin, especially if non-absorbable or if an absorbable one fails to dissolve, can lead to several complications. A primary concern is infection, as the retained suture acts as a foreign body where bacteria can colonize. This can result in increased pain, spreading redness, swelling, and abscess formation, which may require medical intervention. The immune system may struggle to clear infection when foreign material is present, potentially prolonging healing.
Another common reaction is a suture granuloma, a benign inflammatory lump that develops around the foreign material. This occurs as the body attempts to wall off the stitch with fibrous tissue. While often harmless, a granuloma can cause a palpable lump, tenderness, or discomfort, and may be mistaken for other growths. In some instances, the body might try to expel the stitch through extrusion, where the suture migrates to the skin’s surface and becomes visible or palpable.
A retained stitch can also impede the normal wound healing cascade, leading to delayed wound closure or chronic inflammation. Continuous foreign body presence can disrupt tissue regeneration and remodeling. Rarely, individuals may experience a localized inflammatory or allergic reaction to suture materials, manifesting as persistent irritation, rash, or increased sensitivity around the wound. These complications highlight the importance of monitoring wound healing and seeking medical advice for any persistent or unusual symptoms.
When to Seek Medical Attention and Treatment Options
Prompt medical evaluation is advisable if any signs suggest a retained stitch is causing problems. It is important to consult a healthcare professional for clear indications of infection, such as fever, rapidly spreading redness, significant pus discharge, or worsening pain around the wound. Any persistent lump, tenderness, or discomfort at the surgical site that does not resolve with time warrants medical attention. Visible stitch protrusion or constant skin irritation also warrant professional guidance.
A doctor will typically inspect the affected area and palpate it to assess for lumps, tenderness, or inflammation. In most cases, a physical examination is sufficient for diagnosis, though ultrasound might be considered to visualize deeper structures or fluid collections. Treatment depends on the stitch’s type, location, and whether it is causing symptoms. For minor, asymptomatic absorbable stitches that are slowly dissolving, observation may be recommended.
If a non-absorbable stitch causes issues, or an absorbable one provokes a significant reaction, removal is often the most effective treatment. This procedure is typically performed in a doctor’s office under local anesthesia, involving a small incision to extract the suture. If an abscess has formed due to infection, incision and drainage may be necessary to remove pus, often followed by antibiotics to clear the infection. Adhering to post-operative care instructions and attending follow-up appointments are important steps in preventing complications and ensuring optimal wound healing.