Friday, September 7, 2007

Allergies from Suture Material

Recently I received an e-mailed question regarding suture allergy. I have altered some of the information: "I stumbled across your blog site... I was typing in spina bifida and suture allergy and your site came up..I am doing research for a friend that lives in ______. She has breast cancer and slight case of spina bifida. Her breast sutures have come out both internal and external. She now has a hole as the sutures wont close? K"
The choice of a particular suture material is be based on the patient, wound, tissue characteristics, and anatomic location. A surgeon's selection often is not be specifically based on scientific data, but rather, on the preferences that he or she learned from mentors and/or in training or in practice. Understanding the various characteristics of available suture materials is important to make an educated selection. No one suture possesses all desirable characteristics.

Different suture materials produce varying degrees of tissue reaction, specifically inflammation. Significant inflammation will reduce the resistance to infection and delay the onset of wound healing. The type of material and size of the suture are thought to be the major factors contributing to this reaction. Natural materials are absorbed by proteolysis, which causes a prominent inflammatory response. Synthetic materials are absorbed by hydrolysis, which produces a minimal reaction.

Multifilamentous sutures have a high degree of capillarity so there is a tendency to absorb and retain both fluid and bacteria. These materials are associated with greater reactivity and may promote infection if bacterial contamination occurs during or shortly after surgery. Tissue reactivity is also affected by the surgical trauma to tissues, so care should be taken in handling the tissues. The amount of suture placed in a wound, particularly with respect to the knot volume, affects inflammation. The suture size contributes more to knot volume than the number of throws. The volume of square knots is less than that of sliding knots, and knots of monofilament sutures are smaller than those of multifilament sutures.

Allergic reactions to suture materials are rare and have been specifically associated with chromic gut. However, Johnson and Johnson mention known triclosan allergy as a contraindication for use of certain sutures (see below). Contact allergy to triclosan is uncommon.

Surgical gut suture (Plain and Chromic) is contraindicated in patients with known sensitivities or allergies to collagen or chromium, as gut is a collagen based material, and chromic gut is treated with chromic salt solutions.

MONOCRYL Plus Antibacterial suture should not be used in patients with known allergic reactions to Irgacare MP(triclosan).

PDS Plus Antibacterial suture should not be used in patients with known allergic reactions to Irgacare MP (triclosan).

VICRYL*suture should not be used in patients with known allergic reactions to Irgacare MP (triclosan).

Photo credit

References

22 comments:

Chrysalis Angel said...

This made me wonder...How can you tell if it's the suture material the patient may be sensitive to or the Betadine, or some other alternative that's used in prepping the surgical site?

rlbates said...

Location of the rash or reaction should help. If it was the Betadine or prep solution, it should affect the entire area prepped and not just where sutures were used. Also, timing. Suture reactions are often delayed not in the first 24-48 hours, but later as the suture material breaks down.

inflamed said...

I need advice: three weeks after facelift surgery severe inflammation set in, particularly at the site where sutures were. Now scarring as well as inflammation in the sixth week. As these sutures are absorbed, will the inflammation affect my entire body? Should I have the sutures removed or try to endure this painful period of severe inflammation and scarring?

rlbates said...

Inflamed, you should see your surgeon and work with him/her to find what is correct in your case. If they sutures are easily removal, then that is an option. If removal of the sutures means more will need to be placed, well...

Take care.

Anonymous said...

I had two abdominal surgeries earlier this year. Both were laparascopic. The incisions were slow to heal and after the second one, they leaked a lot and were surrounded with a strange and itchy rash. The doctor kept telling me it was an inflammatory response to the internal sutures and it would go away after they dissolved. But a few weeks later, and ever since for that matter, I have been dealing with a rash that appears to be similar in nature, only it's all over my body. Could I be having a full-body reaction to the sutures, could something have been left inside during one of the surgeries, or could it be something unrelated altogether? It goes away with prednisone but comes back when I get down to the last couple of days of treatment.

rlbates said...

Anon, I don't have an answer for you. There aren't usually many sutures (so not much suture material) used in laprascopic surgeries.

Anonymous said...

Thank you for your response. I've been putting up with this rash for so long I've become desperate trying to find some sort of cause. Something from the surgeries was my last hope.

rlbates said...

Anon, perhaps it's time to see an allergist &/or dermatologist. I hope it resolves for you soon.

Anonymous said...

Hello I had abdominal surgery 9days ago. My incision is intact and without signs of reddness or heat. However right below and above the incision there is a large amount of swelling that started about the 2nd post-op day. I have iced the area and used hot compress and nothing seems to help. Talking with my doctor she and I don't really think it is a hematoma or seroma but are thinking it may be a reaction to the vicryl she used to close the subcutanous layer. If so would removing the suture be the best option and healing by second intention or keeping them and seeing if they will desolve???

rlbates said...

Anon (Feb 6, 2009), you will need to take that up with your surgeon. If I can easily remove the suture without pulling things apart, then I do. If not, I watch it and let the body assist me.

teri.scott said...

I have had allergies to prolene and vicryl suture material requiring the surgical wound to be redone. I got to the point with multiple foot surgeries that wire was the closure of choice. I need to have my bladder "lifted" which uses a polypropelene sling. It is not sutured. Do you think my past history puts me a risk of reacting to the sling?

rlbates said...

Teri, I would have to look closer at the info that comes with the sling. For your sake, I hope not.

Anonymous said...

I had abdominal surgery 3 years ago;the incision took 9 months to heal--supposedly due to allergic reaction to sutures, and then MRSA in one of the open areas from the allery. I now need hernia surgery due to incisional hernias. How can I make sure that I am not going to be allergic, again, to the materials used? KW

rlbates said...

Anon (3-24-11), you need to discuss this with your surgeon so you know what sutures were used. You may want to see an allergist and be tested for an allergy to triclosan.

Anonymous said...

I have just gone through a Arthroscopic surgery in my shoulder. The doctor used suture anchors to fix the rotator cuff. The operation is now 9 days ago and I have red rash all over my body. In the beginning I thought it was maybe an allergic reaction to some of the medicin i received. After 2 days I stopped taking medicin and today the rash is still there. I cannot sleep during night due this rash as I need to take showers and put on cream several times during the nights. My suspicion is now that it is caused by the suture anchors. What do you think? and does anyone else have the same experience? Brgds JR

rlbates said...

JR (anon May 14), you need to discuss this with your surgeon. I have no way of knowing what suture was used by your surgeon. It's also possible that you had a more serious allergic reaction to one of your medications (SJS or TENS). Check with your surgeon or your family physician.

pheezer said...

i'm so glad i stumbled upon your blog. i am three weeks post-op from a breast reduction. long story short,i saw the surgeon yesterday, and she says i'm having an allergic reaction to the internal sutures. i'm now back to bandages, biweekly clinic visits, etc. when i asked for how long, everyone answered "as long as it takes." while i understand their reluctance to put a date on it, i'm looking for a little reassurance. how long does it generally take internal sutures to dissolve? i've read everything on the net from 2 weeks to 8 months. after reading your responses here, i trust your answer will be educated and a little more specific!

also, should i take anti-inflammatories? anti-histamines?

thanks for you time, and happy sewing.

phee

rlbates said...

phee, I'm sorry I can't give you the answers you want. I don't give individual medical advice here. Trust your doctors or get a second opinion in person.

feet on the ground said...

Hope this is useful to someone out there. I had a foot operation 18 yrs ago in which Vicryl Rapide was used to suture the skin. After some days, as the stitches began to dissolve, I got a raised solid purplish rash, very itchy and sensitive, that slowly spread up the foot, peaked just before the ankle, then gradually cleared. Have never had Vicryl since, but a different surgeon operated on the other foot 2 weeks ago and said "I just need to use an internal stitch. I'll use Monocryl, it's different chemically. Don't worry." Ten days later an area of extremely sensitive skin developed just above the surgery site, and gradually spread up my foot to the ankle. Not much to see on the surface but intensely ithcy and sore (rather like burned skin feels). It is still there, and the bottom of the foot is affected too so walking is difficult. The whole affected area is horribly over-sensitive to touch. So - be warned - if you have an allergy to one soluble stitch don't let your surgeon use another kind without some careful investigation first to see if you can tolerate it (you would need a patch test with a solution of the dissolved stitch).

feet on the ground said...

Oh - I forgot to say - thanks for this useful site, the best info I found online about this topic.

Anonymous said...

I had c section 8 months ago..after 8 weeks post op my sutures at one end started oozing with sticky yellow red liquid....I was advised to use bactroban ....within 10 days it was healed and again it got opened and started oozing...from then on it happend 5 times...my surgeon told that we have to remove internal sutures as it is an allergy or skin reaction due to prolene suture material...I got it removed and this time doctor used dissolvable monocyrl inside and black silk outside....after 20 days again blood is oozing out.....now I am very disturbed...dontno what I should do...how the wound will get healed....pls advise.

rlbates said...

Anon (10/01/13), I'm sorry but I don't give individual medical advice per my blog. Perhaps you can take the information from this post to your doctor and the two of you form a new plan. Another option would be to seek a second opinion regarding your incision from a plastic surgeon. An allergist might be able to do testing. Either way take them the information of suture allergies. Best to you.