What Does “Spitting Stitches” mean?

Spitting Stitches

Spitting Stitches: A Complication in Plastic Surgery Recovery

While the plastic surgery procedure itself is meticulously planned and executed, the recovery process can sometimes present unexpected challenges. One such complication is known as “spitting stitches,” a term that refers to the premature dissolution or protrusion of sutures used to close surgical incisions. This phenomenon can be concerning for patients, but understanding its causes, symptoms, and proper management is important for a successful recovery.

In this blog, we will discuss the details of spitting stitches, exploring their causes, identifying symptoms, and providing valuable tips to prevent and manage this complication effectively.

Sutures in Plastic Surgery

Sutures play an important role in plastic surgery procedures, serving as the primary means of closing surgical incisions and facilitating proper healing. Here is an overview of sutures:

Types of sutures:

  • Absorbable (dissolvable) sutures: These sutures are designed to dissolve naturally within the body over time, eliminating the need for removal.
  • Non-absorbable (non-dissolvable) sutures: These sutures remain in place until they are intentionally removed by the surgeon after the incision has healed.

Suture materials

  • Natural materials: Examples include silk, catgut, and collagen, which are derived from natural sources.
  • Synthetic materials: These include materials like nylon, polypropylene, and polyglactin, which are man-made and designed for specific surgical applications.

Suture techniques

  • Interrupted sutures: Individual stitches are placed and tied off separately along the incision line.
  • Continuous sutures: A single strand of suture material is used to create a series of stitches along the incision line.

Your plastic surgeon will carefully select the appropriate suture material and technique based on the specific procedure, incision location, and your individual healing characteristics. Proper suture selection and placement are crucial for minimising the risk of complications like spitting stitches.

What Are Spitting Stitches?

Spitting stitches, also known as “stitch migration” or “stitch rejection,” is a condition where the sutures used to close surgical incisions begin to work their way out of the skin prematurely. Instead of remaining in place until they are intentionally removed or dissolved naturally, these stitches become visible or protrude through the skin, potentially causing discomfort, irritation, and compromising the healing process.

This complication can occur with various types of sutures, including dissolvable (absorbable) and non-dissolvable (non-absorbable) stitches. While spitting stitches is generally not a life-threatening condition, it can lead to complications such as infection, delayed healing, and unsightly scarring if not properly addressed.

Common Causes of Spitting Stitches in Plastic Surgery

Different factors can contribute to the development of spitting stitches after plastic surgery. Some common causes include:

  • Excessive tension on the sutures: If the sutures are placed under too much tension during the closure process, it can create a pulling force that causes them to work their way out of the skin over time.
  • Improper suture technique: Incorrect suture placement, inadequate knot tying, or using the wrong type of suture for the specific procedure can increase the likelihood of spitting stitches.
  • Individual healing factors: Certain individuals may have a higher propensity for spitting stitches due to factors such as genetics, age, overall health, and immune system function, which can affect the healing process.
  • Incision location: Incisions made in areas with increased movement or tension, such as the abdomen or joints, may be more susceptible to spitting stitches due to the constant stretching and pulling of the skin.
  • Infection or inflammation: If an infection or excessive inflammation develops around the incision site, it can create an environment that promotes stitch rejection or migration.

Identifying Spitting Stitches – Symptoms to Look For

Recognising the signs of spitting stitches is essential for prompt treatment and prevention of further complications. Here are some common symptoms to watch out for:

  • Visible sutures: If you notice sutures protruding through the skin or becoming visible on the surface, it may indicate that they are beginning to spit.
  • Redness or swelling: Localised redness, swelling, or inflammation around the incision site can be a sign of stitch migration or rejection.
  • Discomfort or pain: As the stitches work their way out, you may experience discomfort, tenderness, or pain in the affected area.
  • Drainage or oozing: If you observe any drainage, oozing, or discharge from the incision site, it could be a sign of infection or stitch rejection.
  • Delayed healing: If the incision site is not healing as expected or the wound appears to be reopening, spitting stitches may be a contributing factor.

It’s important to note that not all spitting stitches will exhibit all of these symptoms, and some signs may be more subtle than others. If you have any concerns or notice any unusual changes around your incision site, it’s best to consult with your plastic surgeon promptly.

Managing and Treating Spitting Stitches

If you suspect that you are experiencing spitting stitches, it’s important to seek medical attention from your plastic surgeon or GP. They will assess the situation and recommend the appropriate course of action based on the severity and stage of the complication. Here are some common management strategies:

  • Removal of protruding sutures: In some cases, your surgeon may simply remove the spitting stitches to alleviate discomfort and prevent further complications.
  • Incision re-closure: If the incision has reopened or the wound edges have separated, your surgeon may need to re-close the incision using new sutures or other closure techniques.
  • Antibiotics: If there is a risk of infection or if an infection has already developed, your surgeon may prescribe oral or topical antibiotics to combat bacterial growth and promote healing.
  • Wound care: Proper wound care, including cleaning, dressing changes, and the application of ointments or creams, may be recommended to support the healing process and prevent further complications.
  • Compression or immobilisation: Depending on the location of the incision, your surgeon may advise the use of compression garments or immobilisation techniques to reduce tension and movement in the affected area.

It’s important to follow your surgeon’s instructions carefully and attend all follow-up appointments to ensure proper monitoring and management of the spitting stitches.

Tips to Prevent Spitting Stitches after Plastic Surgery

While spitting stitches can occur despite taking all necessary precautions, there are several steps you can take to minimise the risk of this complication:

  • Choose an experienced plastic surgeon: Work with a certified plastic surgeon who has extensive experience in the specific procedure you are undergoing. Their expertise in suture techniques and incision management can significantly reduce the likelihood of spitting stitches.
  • Follow post-operative instructions: Adhere strictly to your surgeon’s post-operative instructions regarding wound care, activity restrictions, and any specific precautions related to your procedure.
  • Avoid strenuous activities: Refrain from engaging in strenuous physical activities or movements that could put excessive tension on the incision site during the initial healing phase.
  • Maintain proper hygiene: Keep the incision area clean and dry by following your surgeon’s instructions for wound care and hygiene.
  • Manage swelling and inflammation: Use cold compresses or prescribed medications as directed to reduce swelling and inflammation, which can contribute to stitch migration.
  • Protect the incision: Wear loose, comfortable clothing that does not rub or irritate the incision site, and avoid exposing the area to direct sunlight or other environmental factors that could compromise healing.
  • Monitor for signs of infection: Be vigilant for any signs of infection, such as increased redness, swelling, warmth, or drainage, and report them to your surgeon immediately.

When to Contact Your Surgeon about Spitting Stitches

While spitting stitches may seem like a minor issue, it’s important to promptly address any concerns with your plastic surgeon. Ignoring or delaying treatment can lead to more severe complications, such as infection, wound dehiscence (separation), and poor scarring.

Contact your surgeon immediately if you experience any of the following:

  • Significant protrusion or displacement of sutures
  • Excessive bleeding, drainage, or oozing from the incision site
  • Increasing pain, redness, swelling, or warmth around the incision
  • Fever or other signs of systemic infection
  • Delayed or impaired healing of the incision

Your surgeon will assess the situation and provide appropriate treatment or guidance to prevent further complications. Early intervention is key to managing spitting stitches effectively and ensuring a successful recovery.

Long-Term Care for Plastic Surgery Incisions

While spitting stitches are a potential complication during the initial healing phase, proper long-term care of your plastic surgery incisions is essential for optimal scar management and overall aesthetic results. Here are some tips for long-term incision care:

  • Follow scar management protocols: Your surgeon may recommend specific scar management techniques, such as silicone sheets, topical treatments, or massage techniques, to minimise the appearance of scars.
  • Protect incisions from sun exposure: Excessive sun exposure can lead to hyperpigmentation and compromise the healing process. Use broad-spectrum sunscreen and protective clothing when exposing incisions to sunlight.
  • Maintain a healthy lifestyle: Factors like a balanced diet, regular exercise, and adequate hydration can support overall healing and promote optimal scar formation.
  • Attend follow-up appointments: Regular check-ups with your plastic surgeon allow for monitoring and timely intervention if any issues arise during the long-term healing process.
  • Be patient: Scar maturation is a gradual process that can take several months or even years. Embrace patience and trust the healing process, while adhering to your surgeon’s recommendations for optimal results.

FAQs about Spitting Stitches

FAQs

How can I identify a spitting stitch?

  • A spitting stitch might be suspected if there is a small, localised swelling, redness, or a bump near the site of a surgical incision. Sometimes, a tiny loop of the suture material may be visible at the centre of the bump. There might also be some drainage, which is usually clear or slightly yellowish.

What should I do if I think I have a spitting stitch?

  • It’s important not to attempt to remove the stitch yourself. Contact your surgeon or your GP for advice. They can safely remove the stitch and treat the area if necessary. Keeping the area clean and monitoring for signs of infection, like increased redness, swelling, or pus, is also crucial.

How long after surgery can spitting stitches occur?

  • Spitting stitches can appear at various times post-surgery, depending on the type of suture material used and individual healing rates. Typically, they might occur from a few weeks to several months after the procedure, as the body absorbs or rejects the suture material.

Are spitting stitches a sign of infection?

  • While spitting stitches themselves are not an infection, they can be associated with minor local inflammation. Signs of an actual infection include increased pain, swelling, redness, and pus. If any of these symptoms accompany a spitting stitch, it’s important to contact a healthcare provider for evaluation.

What is the difference between spitting stitches and normal stitch removal?

  • Spitting stitches are unintended and occur when the body pushes out part of the suture material through the skin. Normal stitch removal is a controlled process performed by a healthcare provider, usually with sutures that do not dissolve and are meant to be removed after the skin has sufficiently healed.

Can spitting stitches leave scars?

  • Spitting stitches can sometimes leave small scars, especially if the area becomes inflamed or infected before the stitch is removed. Good wound care and following up with a healthcare provider can help minimise scarring and ensure proper healing.

What kind of care should I take if I have a spitting stitch?

  • Keep the area clean and dry, and follow any wound care instructions provided by your plastic surgeon. Avoid picking at or pressing on the spitting stitch. If you notice any signs of infection or if the stitch does not resolve itself, consult your surgeon or GP for appropriate management.

Further Reading about Plastic Surgery Complications

Medical References about Spitting Stitches