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Dr. Mark
Dr. Mark, Physician / Surgeon
Category: Medical
Satisfied Customers: 11946
Experience:  U.S. Surgeon / Neurological Surgery
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What happens if you have surgery and the stitches are removed,

Resolved Question:

What happens if you have surgery and the stitches are removed, however, there
were several missed and they have been there for approximately two months longer
than they should have been? The surgery was
open skulled traditional craniotomy!!
Submitted: 4 years ago.
Category: Medical
Expert:  Dr. Mark replied 4 years ago.
Well, the biggest risk of sutures that remain in too long is infection.

Because it is a foreign material to your skin, these sutures can get infected, and cause "stitch abscesses" -- and cause a localized infection in the scar of the wound.

The other issue (less important) is cosmetic, as the longer sutures are in place, the more likely it is to leave a permanent stitch mark in the skin. And it makes it harder to remove, as the skin may have grown over the stitches.

But when the remaining sutures are discovered (this, unfortunately, is not so uncommon), they are removed.

If nothing has happened by now, then there shouldn't be any bad lasting effects.
Customer: replied 4 years ago.
Relist: Incomplete answer.
What happens when the old (remaining) stitches are discovered and removed? Is there more surgery needed? This is obviously very sensitive area - the top of my head and skull. I guess my question is: Do they have to operate again - to
remove the old remaining stitches? If so, what does that entail?
Expert:  Dr. Mark replied 4 years ago.
No, they do not have to operate again.

All one has to do is lift the suture material and cut it, then it should slip right out.

This is the same type of procedure as you had done two weeks after the operation, except it may be a bit more difficult this time as the skin may have partially healed over the area.
Customer: replied 4 years ago.
Relist: Incomplete answer.
Okay, I get that, but then if the skin is partially healed over, do they have to "dig into
the skin" and make it bleed & then resuture again? I'm concerned that this is very dangerous because they told me if it got infected and they had to re-operate, they couldn't put the "flap" back for a whole year and I would have to wear the "helment"!!!
Expert:  Dr. Mark replied 4 years ago.
No, even if a stitch did get infected, this is generally a superficial infection. The type of infection they are talking about, with reoperation, is an infection in the area of the actual surgery, much deeper than the skin sutures themselves. Two separate areas of infection here.

If it did partially heal over, they still only have to cut the area of exposed suture. Cut the suture and it should pull right out. Occasionally you have to dig a bit into the skin, but there is no need to resuture.

And by the way, if you hit "relist" button -- it does not alert me that you have responded to the question. That button is intended to ask for a different expert's opinion.
Customer: replied 4 years ago.

Oh, that's cool! I've never done this before, so I'm not familiar.....thanks! I do have

another question: Is this anything "real serious"? It doesn't sound like it, but it had

me stressing out pretty much, since they had told me pre-surgery "no hair coloring

for four weeks". Hospital disharge papers said "Nothing for six weeks". That's cool,

I waited eight weeks to be sure and just used a coloring mouse that washes out

immediately in shower. When I went for my follow-up (which had been delayed an

additional 3 wks. the surgeon dr. said, "Wait another 3 wks. for hair coloring". The

nurse had said prior to him coming in, "Don't put any coloring on your hair for six wks."

I'm thinking they could tell by looking at my incision, but never said anything to me about it. I realized then (later) that they 3 or 4 sutures were never removed. I was just panicking yesterday - called the surgeon's ofc. They didn't reply, so I called my Primary Care Physician and he wasn't sure......My ins. co. nurse had called me that morning to check on how I was doing. When I relayed this information to her, she was like, "Oh, wow, I've never heard of anything like this before!" Well, needless to say, that really scared me! My PCP said I could go to ER if I was really concerned. He's kind of young, and admittedly says "This is way over my head". Very sweet doctor, but at any rate, I have been really stressing. So it sounds like you don't think it's a big deal at this point, and it can certainly wait until next week when I talk to my neurosurgeon about it?

If so, do you recommend that the old ones should be taken out right away, as soon as possible?!! Thank you!!!

Expert:  Dr. Mark replied 4 years ago.
I don't think this is a big deal at all -- IF there is no other problems with infection in that area.

Certainly, if there was pus, or redness and tenderness in the areas of the suture, that could mean a superficial wound infection, and would need to be addressed right away.

Because if you left that along for days -- it could then develop into the deeper type of infection that could possibly necessitate a surgery and removal of your bone.

As for coloring your hair -- that is just a precaution against too much manipulation of your healing scalp wound. We typically say 6-8 weeks is enough. Of course, there is no actual magic number to this -- we just want the wound to be healed nicely.

So, I would call the neurosurgeon's office on Monday and have them removed, unless there is a specific concern with infection that arises from it earlier.
Customer: replied 4 years ago.

Thank you very much!!! You have put a lot of my fears to rest for now. I do have an identation on the side of my face where they did the surgery (along my right eye). Yesterday it got really red.....it seems better now, but do you think this is any sign

of any infection? Do you think that indentation will close? (They didn't tell me about this pre-surgery either.) It seems to get worse as the day wears on.....I go to bed, get up next morning and it's down, but then gets "bigger" as the day goes on.........what do you think about that?

Expert:  Dr. Mark replied 4 years ago.
That sounds more like shrinkage of the temporalis muscle on the side of your head -a result from having to cut the muscle in surgery to access the skull. Of course, be sure to ask your surgeon about that as well.
Customer: replied 4 years ago.

Yes, that is what they told me........His nurse said it will "fill-in", but not 100% and it will take a year. She said I could have plastic surgery then if I chose! What about the

"redness" I experienced yesterday in that area? Do you think that's any sign of infection? Just to clarify, Dr. Mark, I was never concerned about the "hair coloring", only the adverse reactions to the "old stitches" not being removed. Thank you again...

Expert:  Dr. Mark replied 4 years ago.
Sorry for the delay, but I had to leave the computer yesterday night.

The redness that is temporary is likely not an infection, since an infection would be continued redness, swelling, tenderness in that area. I think it should be OK.
Customer: replied 4 years ago.

Hi Dr. Mark,

Just as info I tried to accept your answer last night but the computer had trouble switching me to the correct website. Anyway, I do thank you for your answer and yes I am going to accept your answer.

I would just like to share with you since I have this opportunity to tell you that I went down to the surgeon's ofc. today........Of course they didn't want to accept that they

were in fact old stitches...Nurse looked at it, nurse practioner looked at it, and then they called one of the drs. in to look at it. They "cleaned some of the areas where the suspected old sutures were....they were calling that area "scabs" - do you agree?

My pharmicist told me that when sutures are applied correctly, there are no "scabs". That certainly makes sense to me......after all, isn't that the purpose of sutures? Or at least one of the purposes?

 

Expert:  Dr. Mark replied 4 years ago.
Sutures are just temporary things to help keep the edges of skin closed together until it heals.

We keep these in for 10-14 days, as this is the period of time the scalp needs to heal together well.

I would not expect these areas to be scabs two months after surgery, since the incision itself should be well healed by now. Although, if there are no exposed sutures (which apparently there were not) -- then nothing else should be done at this time.
Customer: replied 4 years ago.

Would the sutures still be exposed at this time? After this long? Or could the skin have grown "over" them....covering them up?

Expert:  Dr. Mark replied 4 years ago.
Skin could have theoretically grown over them. If that is the case, then it would do more harm than good to go after them. Sutures could, but probably would not be exposed after all this time.
Customer: replied 4 years ago.

Okay, I "drilled" them for quite a while about this......I guess I didn't let up until one of them said, "If the sutures were cut, but not pulled through, so that we could see the sutures before (2 mo. ago), they said it's possible through showering, shampooing, etc. that they could have worn out.....What do you think about this? Also, could you please expound on what you mean by skin could have "theoretically" grown over them.

 

 

Expert:  Dr. Mark replied 4 years ago.
Yes, in most cases -- the sutures themselves break and fall out on their own.

Skin can grow over sutures that are tied close to the skin. However, if there are edges of the suture themselves that are far from the skin, the skin cannot grow over them.

Regardless, if there is no suture material actually seen over the skin, you are OK.
Customer: replied 4 years ago.

Ok, but isn't a suture a foreign body......and can't they cause infection? I get it that there is no infection now, but does this mean I sit and "wait" for the infection to set in, and then have my skull cut open again and exposed for a whole year before they can "put it back"? Do you get my fear?

 

Did I tell you earlier that they "cleaned out" the "scabs"? In your opinion, do you think that was a good idea?

Expert:  Dr. Mark replied 4 years ago.
Sutures are a foreign object, but they are designed to stay in as well. We use many sutures besides the ones in your scalp. They are designed to stay in.

Yes, cleaning out the scabs is a good idea, because you should not have scabs at this point in time -- and ensuring that the scabs were not hiding an underlying infection is important.

I'm not sure about your fear - -because the alternative is for them to reopen the wound and look for sutures (which may not be there), significantly increasing your risk of an actual infection many fold.
Customer: replied 4 years ago.
Okay, I guess I'm still a little confused.......I'm thinking that this foreign body - suture- even if the top part of the sutures "wears away", what about the suture that is "stitiched" underneath the skin? This is what I am talking about.........I'm thinking of that foreign body........somehow working its way down into the actual surgery part of my skull? brain? wherever they operated..............I'm not sure at this point what they did! but back to the "old" suture underneath the skin.......if that portion stays in my head "forever", can't it work its way down to the actual surgery site and then cause me huge problems, whereas I then have to be reoperated on again.........am I making myself clear or is this not making any sense to you? This is what I'm concerned about now.......that portion of the suture underneath the skin.........can it "move" down to the actual surgery site and then cause major infection? to the point where I would need another surgery?!!? I'm sorry - I don't mean to be such a pain........I am just still not really "at peace" with this yet...................
Expert:  Dr. Mark replied 4 years ago.
No, the suture does not "move down".

Surgeons have used sutures in deep wounds for years.

It seems you are a bit too worried about this. Every craniotomy has sutures placed underneath the skin (resorbable sutures) which eventually dissolve over a few months. So these sutures eventually dissolve, and no longer pose a risk for infection, but remain strong as your wound heals.
Customer: replied 4 years ago.

I guess I still haven't made myself clear.........I'm not referring to the "resorbable" sutures.........I do understand they are "allowed" to be there or supposed to be there....I'm still up on the "topical" sutures. I'm talking about the suture as they stitch with the needle?..........You know......the part that goes underneath the skin, then comes

back up on top.............like you're sewing something?

 

My question is: Is that suture (topical one) if it didn't in fact "pull out" or "wear out" itself through showering or whatever, "allowed" to stay in there (even a very small portion of it?

 

I do know there are types of sutures that "stay in", and also some that are dissolvable on their own...........again, I'm referring to the topical ones (that need to be removed)......is it okay for even a little piece or portion of that suture to end up lodged in your head or brain somewhere forever???

Expert:  Dr. Mark replied 4 years ago.
Yes, even if a piece of those get stuck somewhere -- most of them still do dissolve over time (it may take months to a couple of years) but they will get broken down eventually.

These types of sutures are routinely left in place in many different areas of the body without an issue.
Customer: replied 4 years ago.
Sooooooooooo, are you saying I shouldn't be worried? I have nothing to be fearful of at this point?
Expert:  Dr. Mark replied 4 years ago.
I wouldn't be worried.

Given that your healthcare team inspected your scalp and incision today, and found nothing alarming, there really isn't anything to worry about, even if you have "pieces" of suture underneath your skin.
Customer: replied 4 years ago.

Sorry..............I just went back and reread your last answer.............I missed that first whole sentence where you said "no, the suture does not move down". That's good news!

 

Okay, Dr. Mark (is that really you..........or am I speaking with a whole bunch of drs.?!!)

 

Are you telling me that if there is no infection now, there is no possibility of one developing later on..........as a result of "pieces" of suture underneath?

 

 

 

Expert:  Dr. Mark replied 4 years ago.
If there is no infection now, and the wound itself is closed -- there is minimal chance of infection.

The pieces of suture underneath are not themselves going to cause an infection at this point.

If your skin is broken, then an infection can develop. But that would have nothing to do with the sutures at this point.
Customer: replied 4 years ago.

Wow! You doctors really have patience - and I'm not talking about "patients"........I don't think I could have the patience to put up with a pain as big as I've been to you these last few days, but I think you have finally (and I don't mean you personally - I mean my whole team of healthcare providers as well, when I say "finally") have put my fears to rest! You have certainly answered all of my questions to great satisfaction..........I believe too, I might add, that you have given me honest answers.............that is rather difficult to find these days...... I appreciate honesty more than anything...........even if it's not good news.

 

I give you an A+++!!!

 

Expert:  Dr. Mark replied 4 years ago.
Well, thank you. It's been just me, Dr. Mark, answering your questions all along though, but hope you have some piece of mind.

Best of luck.
Dr. Mark, Physician / Surgeon
Category: Medical
Satisfied Customers: 11946
Experience: U.S. Surgeon / Neurological Surgery
Dr. Mark and 2 other Medical Specialists are ready to help you
Customer: replied 4 years ago.
Thank you immensely!!! I am going to sign off now and accept your answer........I would love to give you a bonus, but unfortunately my funds don't permit it at this time........somehow I find myself wishing you were my doctor. Goodbye........ nice chatting with you!

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