Potential Complications of Incomplete Suture Removal from a Digit
The most serious complication of an incompletely removed 2mm stitch from a digit's ventral surface is wound dehiscence, which can lead to infection, scarring, and impaired function of the digit.1
Immediate Complications
- Foreign body reaction: The retained suture material can act as a foreign body, triggering local inflammation and tissue irritation 1
- Localized infection: The retained suture material can serve as a nidus for bacterial growth, potentially leading to superficial surgical site infection 1
- Pain and discomfort: The patient may experience persistent pain, tenderness, or a sensation of something "poking" in the wound area 1
- Wound dehiscence: Incomplete suture removal can lead to partial wound breakdown, especially if the suture material creates tension on one part of the wound while another part remains unsupported 1, 2
Long-term Complications
- Suture granuloma: A chronic inflammatory reaction can develop around the retained suture material, forming a small, firm nodule that may be painful 1
- Scar formation: Abnormal or excessive scarring may occur due to prolonged inflammation or improper wound healing 1, 3
- Digit function impairment: Particularly concerning for ventral (palmar) surface involvement, as this is the functional gripping surface of the digit 4
- Suture extrusion: The body may attempt to expel the foreign material, causing the suture to gradually work its way out through the skin surface 1
Risk Factors That Increase Complication Severity
- Location on ventral (palmar) surface: This area experiences more friction and pressure during daily activities 4
- Monofilament vs. multifilament suture: Retained multifilament sutures pose a higher risk of harboring bacteria compared to monofilament sutures 1
- Suture material type: Non-absorbable sutures that remain in place can cause more complications than absorbable ones that would eventually dissolve 2
- Patient factors: Immunocompromised status, diabetes, or poor circulation can significantly increase infection risk 1
Management Recommendations
- Complete removal: The retained suture fragment should be completely removed as soon as possible to prevent complications 5
- Proper technique: Use appropriate instruments (fine forceps, suture scissors) and good lighting to ensure complete removal 5
- Wound assessment: After removal, evaluate the wound for signs of infection or dehiscence 1
- Follow-up care: Monitor the wound for proper healing and address any complications promptly 6
Prevention Strategies
- Use proper suture removal technique: Ensure complete visualization of all suture material during removal 5
- Consider suture type: For digits, monofilament sutures are generally preferred as they are easier to remove completely 1
- Patient education: If patients are removing their own sutures, provide clear instructions and proper tools 6
- Appropriate timing: Remove sutures at the optimal time—not too early (risking dehiscence) or too late (risking tissue embedding) 5, 6
Special Considerations for Digital Sutures
- Ventral surface complications: Retained sutures on the ventral (palmar) surface of digits can interfere with grip function and cause more discomfort due to pressure during normal hand use 4
- Small stitch considerations: Even a small 2mm stitch fragment can cause significant issues due to the highly sensitive nature of fingertips and the constant movement of digits 4