How are internal sutures removed?

Alsikepike

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I'm writing a story that involves a makeshift surgery on a stabbing victim and the recovery involved afterward. The event takes place in a very small community with limited medical resources and little to no contact with the outside world for long periods of time. I know most internal injuries are stitched up using absorbable sutures, but this scene involves using non-absorbable ones. I know that non-absorbable sutures are sometimes used for internal injuries in certain situations, so it's not an unlikely scenario that they could be used as a substitute to absorbable sutures if needed. But I have yet to find a solid answer on how these kinds of internal stitches are removed, or even if they should be removed at all. I could really use some help on this one. I'd settle for knowing the adverse effects of leaving non-absorbable internal stitches in for long periods of time if that's what it takes. I just need information on the subject in general, really. Hopefully you guys can help me out. Any ideas?
 
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MDSchafer

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I'm a nurse. My entire career the docs have been using absorbent sutures, so I don't have any experience with using something that wouldn't dissolve internally. Essentially two things will happen. Either it will start scarring, or, the body will push it out. Pushing out a foreign object often hurts, like having a deep splinter. You'll see it a lot with people who have been near a bomb blast, or road rash, where the embedded objects slowly start emerging from the body.
 
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Roxxsmom

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I think they're generally dissolving or absorb able material.

Though I recently discovered that my dog, who had surgery for an ingested foreign body when he was younger, still has little bits of wire under his abdominal skin from the internal sutures they used then. They removed his external staples, but they left the internal sutures in place--and they weren't the dissolving kind. I learned this when he had an X-ray for something recently, and I notices the little bright lines down his abdomen.

He's 12 and they haven't caused him any pain or problem in the 11 years since he had that surgery. When I asked the vet if there as any chance of one working its way through his abdominal wall and puncturing something, she said it was highly unlikely.

I don't know if they ever leave wire internal sutures in with humans or not. Note that dogs have thicker skin over most of their bodies than humans do, so maybe that's why the little bits of wire haven't pushed their way out.
 
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MaeZe

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Sometimes permanent sutures are used internally. They are not removed.

Suture primer
Although non-absorbable sutures remain as permanent foreign bodies, monofilament nylon, polyethylene, and steel are less likely to promote infection than catgut, or multifilament cotton, linen, or silk.

And more information on why permanent sutures might be left in:
Nondissolvable or nonresorbable sutures are either permanently implanted in the body or removed after the wound is healed [when they are on the surface]. This is the case, for example, in the heart and in blood vessels, whose rhythmic movement requires a suture which stays longer than three weeks, to give the wound enough time to close. Other organs, like the bladder, contain fluids which make absorbable sutures disappear in only a few days, too early for the wound to heal. Inflammation caused by the foreign protein in some absorbable sutures can amplify scarring, so if other types of suture are less antigenic (i.e., do not provoke as much of an immune response) it would represent a way to reduce scarring.
 
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MaeZe

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I think they're generally dissolving or absorb able material.

Though I recently discovered that my dog, who had surgery for an ingested foreign body when he was younger, still has little bits of wire under his abdominal skin from the internal sutures they used then. They removed his external staples, but they left the internal sutures in place--and they weren't the dissolving kind. I learned this when he had an X-ray for something recently, and I notices the little bright lines down his abdomen.
...
I had a cat when I was a kid that was freaked out about going anywhere in the car. After we had her spayed, which took a lot just to get her in a box and into the car, we tried to get her in the car again to get the sutures out. She went nuts and got away, ran off. We just gave up and never took her in for their removal. Nothing bad happened as a result.
 

Alsikepike

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So, generally speaking, they're safe to leave in the body? I'd imagine the worst case scenario is the growth of scar tissue obstructing or putting pressure on something, right? I know from experience that will always be a risk after surgery anyway, so I'm still in the realm of realism? I always hate when stories have important characters survive situations they really shouldn't have. Especially when it involves DIY medical care. Suspension of disbelief is inevitable, but I'd like to keep it to a minimum if possible.
 

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Yep to all of the above. (Adding: I have some permanent, non-dissolvable metal staples in my body, and I'd never know they're there.)
 
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Roxxsmom

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Sometimes permanent sutures are used internally. They are not removed.

Suture primer

And more information on why permanent sutures might be left in:

I've also wondered if they're more likely to use permanent internal sutures with a dog because they're stronger, and it's nearly impossible to keep dogs from moving around and putting stress on the wound before it's healed completely (after the worst of the pain is gone). You can't tell a dog, don't run, jump, or lift anything for six weeks the way they do people recovering from abdominal surgery. The owners are told to limit their pet's activity, of course, but owners also vary in their ability to control their dogs.

When I had abdominal surgery, there were no staples or stitches to remove. They used some kind of wound glue for the external part of the incision and (I think) dissolving sutures inside. They had this thin, plastic bandage that went over the area that allowed me to shower and that peeled off after a few days. It was a relief, because I'd been dreading the prospect of not being allowed to shower for a week (like a friend who'd had the same surgery a few years before).

But this was an incision that went horizontally and low across my abdomen. I'm guessing if they make a vertical incision that cuts across muscle fibers and doesn't go parallel to the orientation of the collagen fibers in the dermis (Langer's lines), it would need something stronger to hold it together while it heals.
 
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Brightdreamer

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When I had abdominal surgery, there were no staples or stitches to remove. They used some kind of wound glue for the external part of the incision and (I think) dissolving sutures inside. They had this thin, plastic bandage that went over the area that allowed me to shower and that peeled off after a few days. It was a relief, because I'd been dreading the prospect of not being allowed to shower for a week (like a friend who'd had the same surgery a few years before).

But this was an incision that went horizontally and low across my abdomen. I'm guessing if they make a vertical incision that cuts across muscle fibers and doesn't go parallel to the orientation of the collagen fibers in the dermis (Langer's lines), it would need something stronger to hold it together while it heals.

Probably wandering off the original topic, but I had a vertical abdominal incision about ten-odd years back. They initially used staples to close the outer bits. Later on, they used black nylonish sutures. (In between was a span where a scheduling error led to the staples being pulled too early, followed by a few weeks of dealing with a gaping wound using saline, gauze, and Tegaderm... but that's another story.)
 

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So, generally speaking, they're safe to leave in the body? I'd imagine the worst case scenario is the growth of scar tissue obstructing or putting pressure on something, right? I know from experience that will always be a risk after surgery anyway, so I'm still in the realm of realism? I always hate when stories have important characters survive situations they really shouldn't have. Especially when it involves DIY medical care. Suspension of disbelief is inevitable, but I'd like to keep it to a minimum if possible.
If in your story they are leaving them in because they don't have proper supplies, you might note that some knowledgeable character chooses sutures that are less problematic to leave in.
 

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I know most internal injuries are stitched up using absorbable sutures, but this scene involves using non-absorbable ones. I know that non-absorbable sutures are sometimes used for internal injuries in certain situations, so it's not an unlikely scenario that they could be used as a substitute to absorbable sutures if needed. But I have yet to find a solid answer on how these kinds of internal stitches are removed, or even if they should be removed at all.

They aren't removed. They're intended to be permanent.

Jeff
 

Orianna2000

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My mom had a biopsy, at least 25 years ago, where they cut a deep incision, about an inch long. Because of its location (a part of the body that moves constantly) the stitches tore out. They told her not to worry about it, it would be fine. Well, okay, but she had a gaping, deep hole that could easily get infected, and at the least would leave a nasty scar! I put butterfly bandages on it for her, but even they wouldn't stay in place. She finally gave up and just left it alone. She's still alive, so I assume it didn't get infected. The doctor should have put surgical glue on it.

When I had laparoscopic gallbladder surgery, they used glue to close the outer incisions. (Three 1/2" incisions, plus a 1" incision leading out of my belly button.) They didn't cover the incisions with anything, probably because I told them I'm allergic to adhesive. They did use sutures on the inside, because after the glue came off, a bit of stiff thread stuck out of one of the smaller incisions. I waited until I was sure it was no longer needed, then pulled it out with tweezers. It was pretty short, which I assume is because the rest of it had dissolved.

Also, they left several metal clips inside my body. Apparently, it's the only way to remove a gallbladder laparoscopically. I was kind of ticked when I found out, but the only other option was major surgery, with a several-day hospital stay and 6-8 weeks of recovery time. As opposed to an outpatient surgery, with a 3-day recovery. (Although, it actually took two weeks before I was able to stand upright and resume normal activities. But that's probably due to having fibromyalgia, rather than the surgeon lying.)
 

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I had a cat when I was a kid that was freaked out about going anywhere in the car. After we had her spayed, which took a lot just to get her in a box and into the car, we tried to get her in the car again to get the sutures out. She went nuts and got away, ran off. We just gave up and never took her in for their removal. Nothing bad happened as a result.

I had a cat who slowly and methodically removed all her sutures herself, by hooking one of her canine teeth through them and pulling until they popped out. I tried covering her wound with bandages but she just pulled those off too. It was awful to watch but she was determined. She lived a long life after, so it couldn't have been too awful.

So, generally speaking, they're safe to leave in the body? I'd imagine the worst case scenario is the growth of scar tissue obstructing or putting pressure on something, right? I know from experience that will always be a risk after surgery anyway, so I'm still in the realm of realism? I always hate when stories have important characters survive situations they really shouldn't have. Especially when it involves DIY medical care. Suspension of disbelief is inevitable, but I'd like to keep it to a minimum if possible.

I have a few permanent sutures inside me, and one worked its way out several years after the surgery. It was like a bit of black nylon fishing thread poking out of my skin. I thought it was an ingrowing hair and pulled it out with tweezers. It had a knot in it and everything. Also, there were a couple of fragments of it a few years later, at the same spot. It didn't hurt any more than an ingrowing hair would.
 

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I had eye surgery when I was three. The silk sutures started protruding some 25 years later, and had to be removed.

They hadn't expected to need to remove them.
 

GeorgeK

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Permanent sutures are fine with one exception, that is if they will be in contact with urine in which case they will be a nidus for stone formation and are greatly at an increased risk for infection. Everywhere else permanent is fine. What is a better question is braided vs monofilament. If it's a dirty wound (it would be reasonable to assume a stabbing to be a dirty wound,) then monofilament is preferred as it has a lower risk of infection.