Iatrogenic Snapping of Sutures on a Wound is Called "Spitting Sutures"
Iatrogenic snapping of sutures on a wound is referred to as "spitting sutures" in medical terminology. This phenomenon occurs when suture material breaks through the skin surface during the wound healing process.
Understanding Spitting Sutures
Spitting sutures represent a specific type of wound complication that can occur during the healing process:
- Spitting sutures occur when suture material that was intended to remain buried beneath the skin works its way to the surface and protrudes through the epidermis 1
- This phenomenon is distinct from wound dehiscence, which refers to the separation of wound edges after closure 2
- Spitting sutures are considered a minor complication but can cause patient discomfort and potentially lead to infection if not properly managed 1
Mechanism and Risk Factors
The process of suture extrusion through the skin surface can occur due to several factors:
- Excessive tension on the suture material causing pressure necrosis of overlying tissue 2
- Inflammatory reaction to the suture material, particularly with non-absorbable sutures 1
- Inadequate burial of subcuticular sutures during wound closure 1
- Poor wound healing conditions that delay proper tissue incorporation of suture material 3
Clinical Significance
Spitting sutures have important clinical implications:
- They can be a source of patient discomfort and cosmetic concern 1
- Protruding suture material can serve as a potential entry point for bacteria, increasing infection risk 1
- In a prospective study, spitting sutures were documented as a distinct complication from suture abscesses 1
- One study noted a case of spitting suture at a site without adhesive strips, suggesting this complication can occur regardless of dressing technique 1
Management Approaches
When spitting sutures occur, appropriate management includes:
- Careful removal of the extruded portion of the suture material using sterile technique 1
- Assessment of the wound for signs of infection or other complications 3
- Continued monitoring of the wound healing process 3
- Consideration of alternative closure methods in patients with previous history of spitting sutures 1
Prevention Strategies
Several approaches may help reduce the risk of spitting sutures:
- Using appropriate suture material and technique for the specific wound location 1
- Ensuring proper depth of subcuticular sutures to avoid superficial placement 1
- Considering triclosan-coated sutures which may reduce inflammatory response 1
- Avoiding excessive tension when tying sutures to prevent pressure necrosis 2
- Using continuous subcuticular sutures rather than interrupted sutures when appropriate, as they may provide better wound support 1
Differentiation from Other Complications
It's important to distinguish spitting sutures from other wound complications:
- Unlike wound dehiscence, spitting sutures do not typically involve separation of the wound edges 2
- Spitting sutures differ from suture abscesses, which involve infection and purulent drainage 1
- While retention sutures may reduce wound dehiscence in high-risk patients, they do not necessarily prevent spitting sutures 4