Sutures, commonly known as stitches, are medical devices designed to temporarily hold the edges of a wound or incision together. Their primary function is to provide mechanical support and stability, allowing the body’s natural healing processes to bridge the gap between tissues. Timely wound closure is a fundamental step in recovery, preventing underlying tissues from being exposed to the external environment. Since sutures introduce a foreign material into the body, their presence is intended to be temporary until the wound gains sufficient strength. For certain types of sutures, removal is necessary to complete the healing process and avoid complications.
Differentiating Absorbable vs. Non-Absorbable Sutures
The consequences of not removing stitches depend entirely on the type of material used. Sutures are categorized into two major groups: absorbable and non-absorbable.
Absorbable sutures are constructed from materials like synthetic polymers or natural fibers. They are designed to be broken down and dissolved by the body through hydrolysis or enzymatic activity over weeks or months. These dissolving stitches are frequently used for internal repairs, such as deep tissue or muscle layers, and typically do not require manual removal.
Non-absorbable sutures are made from durable materials like nylon, silk, or polypropylene that resist the body’s natural breakdown processes. They are employed in areas requiring long-term strength, such as tendons, or in high-tension surface wounds. Since the body cannot dissolve them, these materials must be manually removed by a healthcare professional, usually within one to two weeks. If non-absorbable sutures are not removed, they remain intact and can lead to complications.
Localized Irritation and Infection Risk
Leaving non-absorbable suture material in the skin past the recommended window introduces the risk of a foreign body reaction. The continued presence of the material can cause localized irritation, manifesting as redness, swelling, and discomfort around the stitch sites. This persistent irritation can slow the wound healing process, as the body attempts to wall off the foreign object.
A more serious consequence is an elevated risk of infection, as the suture material acts as a direct pathway for bacteria. The external portion of the thread can harbor pathogens and wick them down into the newly forming tissue beneath the skin surface. This creates a favorable environment for bacterial colonization, potentially leading to a localized infection or a suture abscess characterized by pus formation. The longer the stitches remain, the greater the opportunity for pathogens to infiltrate the wound bed.
Scarring, Tracking, and Embedding
The extended presence of non-absorbable stitches compromises the final aesthetic outcome of the scar. When sutures are left in too long, the small openings created by the needle expand and are permanently etched into the skin. This effect is known as “suture tracking,” where the healed wound develops visible cross-hatch or “railroad track” marks perpendicular to the incision line. These marks are separate from the scar of the original injury and result from the prolonged time and tension of the suture in the skin.
Embedding
Wound healing involves epithelialization, where skin cells (keratinocytes) migrate and proliferate to restore the outer layer of the skin. If the sutures are not removed in time, the epidermal cells can grow over and around the foreign material, a process called embedding. An embedded stitch becomes much more difficult to remove, often requiring a minor surgical procedure to retrieve the material. This prevents the body from attempting to extrude the material naturally, which can sometimes result in a chronic inflammatory response known as a foreign-body granuloma. The chronic irritation and delayed removal associated with embedding and tracking result in a more pronounced and noticeable final scar.
Steps to Take If Removal is Missed
If non-absorbable stitches have been left in beyond the scheduled removal date, the first and most important step is to contact the healthcare provider immediately. The provider will need to assess the wound’s current state, checking for signs of infection or the degree of embedding. It is strongly advised not to attempt to remove the stitches at home, as this can increase the risk of infection, cause trauma to the healing wound, or result in incomplete removal.
A medical professional must determine the safest method for extraction, especially if the stitches are embedded. They can ensure proper sterile technique is used and that all material is completely removed to prevent future complications. Even if the wound appears to be healing acceptably, the potential for permanent aesthetic damage and infection risk necessitates prompt medical attention.