When I perform a cleft-lift, there are dozens and dozens of sutures holding the flap in place. Sutures hold tissues in position until the body’s natural healing process takes over and normal scar tissue takes their place. This healing process takes six weeks in a well nourished patient.
In general, we want suture material that completely dissolves, so that there is not any permanent suture material left in the wound. We surgeons have many kinds of dissolving sutures at our disposal, and it has taken me a while to find the suture material that provides the strength needed, but with the least problems. The sutures I use begin losing their strength after 4-6 weeks, but take as long as 6 months to completely dissolve. Unfortunately, there is no suture material that provides strength for six weeks, and then instantly disappears.
I use a synthetic (man-made) monofilament suture (smooth, single-strand, like a fishing line) which is greenish-blue in color. This type of suture material dissolves over time by the action of enzymes in the tissues.
Suture material can cause reactions long after it is done holding things together. These can cause superficial problems manifested by:
- red bumps
- areas of drainage
- areas of bleeding
- thickening of the scar
- small wound separations
In patients with pilonidal disease this can cause a lot of anxiety, as it can easily be confused with recurrence of the pilonidal disease itself. I encourage patients to send me photos of any areas of concern so I can tell them the cause of the visible change. Patients with pre-existing autoimmune diseases (especially those with hidradenitis suppuritiva) seem to be prone to having reactions to suture material. Patients who had a contaminated or infected wound are also prone to these problems, some of which are related to bacteria attaching to the suture material and then causing problems later.
These suture-related problems are always self-limiting – because the suture material eventually dissolves. If there is an area of drainage, it is OK to clean it with peroxide or soap and water, and put a dry dressing on it. If the area is down near the anus, putting a piece of gauze between the cheeks, as you may have done initially post-op is a good idea until it stops draining.
Below are a few photos of what this can look like. These patients went on to heal without any kind of surgical intervention. Typically, I recommend Vitamin C Serum to treat these which seems to speed up healing.
Here are two examples of suture reactions. You can see bumps right where sutures were placed during the operation.