As a plastic surgeon, I often encounter patients who are concerned about spitting sutures—a minor yet worrisome phenomenon during the healing process. In Episode S05E92 of Three Plastic Surgeons and a Fourth, I had the pleasure of discussing this with my esteemed colleagues Dr. Sal Pacella (San Diego Plastic Surgeon), Dr. Sam Rhee (Bergen Cosmetic), and Dr. Lawrence Tong (Yorkville Plastic Surgery). Together, we dissected the causes, prevention strategies, and practical tips for managing spitting sutures.
If you’ve ever wondered why sutures might “spit” or what to do when it happens, this blog post will give you all the answers.
What Are Spitting Sutures?
Sutures are an essential tool in plastic surgery to hold tissues together as they heal. As Dr. Pacella explained during our conversation, spitting sutures occur when buried sutures work their way up to the surface of the skin. These sutures, often absorbable, are meant to dissolve over time but may instead become exposed due to the body’s natural inflammatory response.
This can result in symptoms ranging from a minor annoyance—a small knot poking through the skin—to localized infections. While spitting sutures are not typically a medical emergency, they can understandably alarm patients.
Why Do Sutures Spit?
During the episode, my colleagues and I dove into the factors that can lead to spitting sutures. Dr. Rhee broke it down into several contributing elements:
- Type of Suture Material:
- Absorbable sutures, such as Vicryl, PDS, or Monocryl, are commonly used for their dissolvable properties. However, as Dr. Rhee noted, the inflammatory reaction that breaks these sutures down can sometimes push them to the surface.
- Braided sutures, like Vicryl, are particularly prone to spitting because they act like a wick, attracting bacteria and increasing infection risk if exposed near the surface.
- Placement and Depth:
- Sutures placed too close to the skin surface or with excessive knots are more likely to spit. As I explained, using monofilament sutures deeper in the tissue can reduce the risk.
- Patient Factors:
- Healing varies greatly among patients. Individual biology, skin tension, and postoperative care all play a role.
Dr. Tong emphasized that spitting sutures are not an allergic reaction, contrary to what some patients might believe. Instead, they result from the body’s attempt to expel foreign material.
How to Handle Spitting Sutures
When a patient experiences a spitting suture, reassurance and proper care are critical. Here are the management tips we shared during the podcast:
- Keep It Clean: Hygiene is paramount. As Dr. Tong advised, cleaning the affected area with diluted hydrogen peroxide or an antiseptic can help prevent infection.
- Don’t Panic Over Pus:
A small amount of pus or redness at the site is common and does not always indicate a severe infection. As Dr. Rhee noted, good wound care can often resolve these minor issues without the need for antibiotics. - Remove the Suture Material:
If a portion of the suture is visible, trimming it flush with the skin using clean scissors or tweezers can alleviate the problem. However, patients should avoid digging into the wound, which can cause further irritation or infection. - Use Antibiotic Ointment:
Applying a topical antibiotic for a few days can promote healing and reduce inflammation. - Consult Your Surgeon:
While spitting sutures are usually minor, it’s always a good idea to consult your plastic surgeon if you’re unsure about managing them. Remote communication, such as sending photos, can often provide enough information for your surgeon to guide you.
Preventing Spitting Sutures
As surgeons, we aim to minimize the likelihood of spitting sutures through careful technique. Here’s how my colleagues and I approach suture placement:
- Strategic Closure Techniques:
- Dr. Pacella shared his method of using deep layers of PDS sutures for tension-bearing areas and Monocryl for superficial layers. This approach avoids placing knots too close to the skin.
- I use a similar strategy, ensuring that the most superficial sutures dissolve quickly to minimize the risk of spitting.
- Avoiding Braided Sutures Near the Surface:
- Dr. Tong emphasized avoiding braided sutures like Vicryl in superficial layers to reduce infection risks.
- Using Adhesive Devices:
- Dr. Pacella and I often use Prineo, a combination of tape and glue, for longer incisions. This technique helps distribute tension evenly and reduces the need for excessive suturing.
What Patients Should Know
We understand that spitting sutures can cause anxiety for patients. During the episode, we all emphasized the importance of patient education and reassurance. Here are the key takeaways:
- Spitting sutures are common and not a sign of surgical failure.
They are a normal part of the healing process for some patients. - Good hygiene and wound care are your best defense.
Keeping the incision site clean and following your surgeon’s instructions can prevent minor issues from escalating. - Stay in touch with your surgeon.
Whether through an in-office visit or remote consultation, your surgeon can provide personalized advice and address your concerns promptly.
Frequently Asked Questions
Q: Are spitting sutures dangerous?
A: No, spitting sutures are generally not dangerous. They are more of a nuisance than a serious problem and can usually be managed with basic wound care.
Q: How can I tell if I need antibiotics?
A: A small amount of pus or redness does not always require antibiotics. However, if you experience significant swelling, worsening pain, or systemic symptoms like fever, consult your surgeon immediately.
Q: Can I remove a spitting suture myself?
A: If you’re comfortable, you can gently trim visible suture material flush with the skin. Avoid digging into the wound. If in doubt, consult your surgeon.
Closing Thoughts
At the end of the episode, each of us summarized spitting sutures in three sentences or less. Here’s my take:
“Spitting sutures are really common, a nuisance, but not a major problem.”
This sentiment was echoed by Dr. Pacella (“a minor annoyance”), Dr. Rhee (“understandable if patients are concerned”), and Dr. Tong (“no big deal”).
As surgeons, we’re here to guide you through every step of the healing process, including addressing minor complications like spitting sutures.
For a deeper dive into this topic, watch the full episode of Three Plastic Surgeons and a Fourth on YouTube here. If you have questions or concerns about your healing journey, never hesitate to reach out to your plastic surgeon. We’re here to help!
