A suture, commonly known as a stitch, is a medical device used to hold body tissues together after an injury or surgical incision to facilitate healing. By keeping the wound edges approximated, sutures allow the body’s natural restorative processes to close the gap and restore tissue integrity. Sutures are meant to provide temporary support until the tissue has gained sufficient strength. Failure to remove non-absorbable sutures on schedule can lead to various complications, which this article explores.
Absorbable Versus Non-Absorbable Materials
The outcome of not removing stitches depends on the material used. Absorbable sutures, such as those made from synthetic polymers like polyglycolic acid (PGA) or Polydioxanone (PDO), are designed to break down naturally inside the body. This breakdown occurs through hydrolysis, where water in the tissues slowly dissolves the material, eliminating the need for manual removal.
Non-absorbable sutures, such as nylon, polypropylene, or silk, are materials the body cannot break down. These are chosen for extended wound support or surface closures and must be removed manually by a healthcare professional once the wound has healed.
Immediate Risks of Retained Sutures
When non-absorbable sutures remain in the skin beyond the recommended timeframe, they introduce several biological complications. The suture material acts as a foreign body, triggering a localized inflammatory response that delays the healing process. This prolonged inflammation can cause swelling, redness, and discomfort at the wound site.
Infection and Abscess
A concerning risk is the increased potential for infection, often termed a suture abscess or sinus tract. The suture material provides a pathway for bacteria from the skin’s surface to travel into the deeper tissue. The suture fiber acts as a scaffold for bacteria to colonize, creating a localized infection that may require antibiotics or surgical removal of the infected suture.
Epithelialization and Embedding
Another common issue is epithelialization, where skin cells begin to grow around and over the suture material. If the stitch is left too long, the skin can completely embed the thread beneath the surface. This embedding makes the subsequent removal process significantly more difficult, often requiring a small incision or more traumatic manipulation to retrieve the trapped material.
The Impact on Scar Formation
Delayed removal of external sutures has a direct and lasting impact on the cosmetic outcome of the healed wound. The prolonged presence of the suture material can lead to the formation of permanent markings known as “track marks” or “railroad tracks.” These are small scars that form along the path where the suture thread pierced the skin.
The pressure exerted by the tight suture causes localized tissue damage over time. Leaving sutures in place for longer than seven days significantly increases the risk of these permanent markings, especially in areas of high skin tension. The ongoing inflammation and tension caused by the retained stitch can also contribute to a wider, more pronounced scar, increasing the risk of a hypertrophic scar.
Steps to Take After Missing Removal
Discovering that a suture removal appointment was missed requires immediate action: contact the prescribing physician or surgical clinic without delay. The healthcare provider needs to know the type of suture used, the original removal date, and the current condition of the wound to determine the best course of action.
Patients should resist the urge to attempt self-removal of the retained sutures at home. Trying to remove an embedded stitch with non-sterile instruments significantly increases the risk of introducing a serious infection. Incomplete removal can also leave fragments of the suture material in the wound, leading to chronic irritation. The provider will assess the wound for infection and embedding, then use sterile tools and proper technique to safely remove the remaining stitches.