What to do if stitches don't fall out? A patient’s guide

Dissolvable stitches, or absorbable sutures, are designed to dissolve on their own within one to two weeks, though some can take longer. So what to do if stitches don't fall out after the expected time frame? Understanding the different types of sutures and potential healing complications is key to knowing your next steps.

Quick Summary

If absorbable stitches remain visible and do not fall out within the advised timeframe, contact your healthcare provider for guidance, as it is crucial not to attempt self-removal to avoid infection or damage to the healing wound. In some cases, non-absorbable stitches were used, requiring a doctor's removal.

Key Points

• Check Your Stitches: Confirm if you have dissolvable or non-dissolvable sutures, as this determines the next steps.

• Be Patient with Dissolvable Stitches: Absorbable sutures can take longer than expected to dissolve, especially in areas of high movement.

• Contact a Doctor: If dissolvable stitches don't disappear after the expected time, or if non-absorbable ones are not removed, consult your healthcare provider.

• Do Not Self-Remove: Never attempt to cut or pull out your own stitches, as this can lead to infection and wound damage.

• Watch for Infection: Seek medical help immediately if you notice redness, swelling, increased pain, or discharge from the wound.

• Follow Doctor's Instructions: Always follow the specific aftercare instructions given by your doctor, as they know the material used and wound type best.

Understanding the Different Types of Sutures

Not all stitches are created equal, and knowing the type used is the first step in deciding your course of action. Generally, sutures can be divided into two main categories: absorbable and non-absorbable.

Absorbable (Dissolvable) Stitches

These sutures are designed to be broken down and absorbed by the body's tissues over time, eliminating the need for a follow-up removal appointment. The dissolution timeline can vary depending on the material, wound location, and the individual's healing rate.

• Common Materials: Includes materials like catgut, polydioxanone (PDS), and polyglactin (Vicryl).
• Typical Dissolution: Ranges from a few weeks to several months, depending on the material and wound depth.
• Usage: Often used for deeper layers of tissue, internal incisions, or in hard-to-reach areas.

Non-Absorbable (Permanent) Stitches

These sutures are made from materials that the body cannot break down and, therefore, must be manually removed by a healthcare professional.

• Common Materials: Includes silk, nylon, and polypropylene.
• Removal Time: The timeframe for removal depends on the wound location and type of surgery. Your doctor will provide a specific timeline.
• Usage: Typically used for closing skin, on ligaments, or in situations where long-term wound support is necessary.

Why Aren't My Dissolvable Stitches Falling Out?

If you have absorbable stitches that are taking longer than expected to dissolve, there are several possible explanations. It is important to note that delayed dissolution is not always a sign of a major problem but still warrants communication with your doctor.

• Suture Material Variation: Different types of dissolvable sutures have different absorption rates. Some can take several months to fully dissolve.
• Wound Location: Stitches in areas with higher tension or movement, like knees or elbows, may take longer to dissolve.
• Body's Reaction: Some individuals' bodies may not absorb the suture material as quickly as others. The body can also treat the sutures as a foreign object and try to push them out, sometimes causing slight irritation.
• Superficial Knots: While the internal part of the stitch may have dissolved, a superficial knot or small piece of the suture may remain on the surface of the skin.
• Infection: In some cases, delayed healing or a body's attempt to expel the suture can be a sign of a localized infection. This would likely be accompanied by other symptoms, such as redness or swelling.

When to Contact a Healthcare Professional

If you are concerned about stitches that aren't falling out, the safest course of action is always to contact your doctor or the clinic where the procedure was performed. Here are specific signs that indicate you should seek medical advice.

Call your doctor if you experience:

• Increased pain, tenderness, or swelling around the wound.
• Redness or red streaking around the incision site.
• Pus or cloudy, foul-smelling drainage from the wound.
• A fever or chills.
• If the wound has re-opened or seems to be separating.
• Significant irritation from a stitch or knot that is not dissolving.
• The wound does not appear to be healing as expected.

What to Expect During a Follow-up Visit

If your doctor decides the stitches need to be addressed, the process is typically quick and straightforward. For dissolvable stitches, they may just snip a persistent knot. For non-absorbable sutures, they will be removed entirely.

1. Assessment: The doctor will examine the wound to ensure it is fully healed and free of infection before proceeding.
2. Preparation: The area will be cleaned thoroughly with an antiseptic solution.
3. Removal: Using a sterile pair of tweezers and scissors, the doctor will gently snip the knot and pull the stitch out. This should not be painful, but you might feel a slight tugging sensation.
4. Aftercare: Your doctor may apply a small bandage or adhesive strips to protect the area as it continues to heal.

What to Absolutely NOT Do When Stitches Don't Fall Out

Taking matters into your own hands can cause serious complications and should be avoided at all costs. Following these rules will protect your healing wound.

• Do not pull or cut the stitches yourself. You risk reopening the wound, causing bleeding, or introducing bacteria that could lead to an infection.
• Do not use unsterilized tools. Attempting to remove stitches with non-sterile tweezers or scissors is a major risk for infection.
• Do not use household cleaners. Applying hydrogen peroxide or alcohol to the wound can damage healthy tissue and slow down the healing process.
• Do not ignore signs of infection. If you see redness, swelling, or drainage, do not assume it will get better on its own. Contact your doctor immediately.

Understanding Suture Differences: A Comparison

To help you better understand the distinction, here is a comparison table outlining the key differences between common suture types.

Feature	Absorbable Sutures	Non-Absorbable Sutures
Material	Natural (catgut) or synthetic (PDS, Vicryl)	Synthetic (nylon, polypropylene, silk)
Body Reaction	Broken down and absorbed by the body	Remains intact; must be manually removed
Typical Use Case	Internal stitches, deep layers of tissue	Skin closures, high-tension areas, ligaments
Removal Method	Dissolves on its own over time	Requires removal by a healthcare professional
Risk if Not Removed	Can cause minor irritation if a knot remains	Higher risk of infection, rejection, or skin growing over the suture

For more information on suture care and potential complications, consult a reputable medical source like the Mayo Clinic's Guide to Stitches. This provides additional resources for general wound care.

Conclusion

While it can be frustrating if your stitches don't fall out as expected, patience is the best approach. Delayed dissolution is often normal, but it's essential to monitor your wound for any signs of infection. If you have concerns, especially if your stitches are causing irritation or you have reached the estimated timeline for removal, contact your healthcare provider. Never attempt to remove or adjust the stitches yourself. A quick visit to the doctor's office can provide peace of mind and ensure your wound continues to heal properly and safely.

Frequently Asked Questions

How long do dissolvable stitches typically take to fall out?

Most dissolvable stitches are gone within one to two weeks, but some can take longer, from a few weeks to several months, depending on the suture material and the location of the wound.

What happens if you leave dissolvable stitches in for too long?

If dissolvable stitches are left in too long, the body might start to reject the material, pushing it to the surface, which can cause irritation or localized infection. In some cases, the skin can grow over the sutures, making eventual removal more difficult.

Is it normal for a knot from a stitch to remain after the rest dissolves?

Yes, it is common for the knots from absorbable stitches to remain on the skin's surface after the internal part has dissolved. These knots often fall off on their own within a couple of weeks.

How do I know if my stitches are absorbable or non-absorbable?

Your doctor or surgical team should inform you what type of stitches you have. If you are unsure, you can refer to your aftercare paperwork or contact your doctor's office to find out.

What should I do if a small piece of a dissolvable stitch is poking out?

If a small piece of a dissolvable stitch is poking out and causing irritation, contact your doctor. They may advise you to leave it alone to fall out, or they may recommend coming in to have it snipped.

Can I get an infection if my stitches don't fall out?

Yes, a localized infection can occur if stitches are left in too long, especially if the body is rejecting them. Signs of infection include redness, increased swelling, or drainage.

What is the difference in feel between absorbable and non-absorbable stitches?

You likely will not feel a difference, and you cannot tell the difference by touch alone. Absorbable stitches may feel like small, white strings or knots at the surface. Always rely on a professional to determine the stitch type.