Over the last few months I have received several e-mails from patients with suture reactions, possibly allergic reactions (photo credit). I say possibly because not being their treating physician I can't verify them, but by the descriptions they seem real. I reviewed this topic last year, but felt the need to revisit it. Hope you don't mind me sharing with you.
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).
Surgical Stainless Steel Suture may elicit an allergic response in patients with known sensitivities to 316L stainless steel, or constituent metals such as chromium and nickel. Skin staples are surgical steel so should be used with the same precautions.
Dermabond -- Tissue glues should not be used in patients with a known hypersensitivity to cyanoacrylate or formaldehyde.
SO WHAT IS LEFT TO USE
So what is left to use in a patient who may have or has a proven allergy to suture or closure material?
Silk, Dexon, Nylon(monofilament or braided), Prolene, INSORB (absorbable staples), and any of the above listed (in the allergy section) to which the patient in question doesn't react negatively.
The choice of a particular suture material will have to based further on the wound, tissue characteristics, and anatomic location. Understanding the various characteristics of available suture materials will be even more important to make an educated selection.
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.
REFERENCES
- Allergic Suture Material Contact Dermatitis Induced by Ethylene Oxide: G. Dagregorio, G. Guillet; Allergy Net Article
- Johnson and Johnson Product Information
- Current Issues in the Prevention and Management of Surgical Site Infection - Part 2; MedScape Article
- MECHANICS OF BIOMATERIALS: SUTURES AFTER THE SURGERY; Raúl De Persia, Alberto Guzmán, Lisandra Rivera and Jessika Vazquez
- Materials for Wound Closure by Margaret Terhune, MD; eMedicine Article
- Product Allergy Watch: Triclosan; MedScape Article by Lauren Campbell; Matthew J. Zirwas
4 comments:
Thanks for the info! I have sensitivities, (I won't call them allergies) to some suture materials. I was kid when I got stitches, two different times, and in both cases they wouldn't heal, got really flaky and itchy, until some of the stitches popped open. The resultant scars are atrophic, with the whole cigar paper thing going on. My daughter has hypermobility syndrome, so I don't know if my scarring is connected to that or not. I have a couple of big scars.
I've had stitches for episotomy 3 times, I think my doc used vicril, with no problems what so ever with healing.
I do think I'm allergic to stainless steel, although I've never had staples. When I was a kid, I tried to wear various stainless steel posted earrings, and withing a day or so I would have pus in my ear lobes. So I thought I must be getting infection, and I stored them in isopropyl alcohol. I still got infected looking earlobes within about 24 hours. I can wear high quality gold earrings with no problem, so I figure I'm not a good candidate for staples.
Hope I didn't share too much randomness, but I appreciate your post. It's nice to know there are options.
Thanks, that was pretty informative for someone like me who is a newbie in the field of medicine.
Thank you so much for posting this! I recently had a finger laceration stitched in the ER, and after five days, the sutures really started to burn. Everything looked fine except for the area right around the stitches. I have a lot of allergies, and it occurred to me that this looked very much like that kind of reaction, so I Googled and found your article. Seems to me I've had this reaction before, but also had stitches with no reaction (I get a lot of basal-cell carcinomas removed). Now I'll know to ask for whatever suture material is least reactive. Can't tell you how much I appreciate this information.
Happy (belated) Birthday!
I just had my 5th ankle surgery, which the reason was due to some type of fluid building up and coming out of my ankle over the past 7 months. When my Dr. opened me up 2 days ago, he was shocked to inform me that I was having an allergic reaction to the sutures that he had put in me last September. He said that he has never seen this before and conferred with other Doctors whom also had never seen this before....just my luck!
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