Technique for Removing Embedded Absorbable Suture Remnants
For a dissolvable stitch that is partially cut and now too close to the skin to grasp with scissors or tweezers, apply gentle traction with fine-tipped forceps while using counter-traction on the surrounding skin, and if the suture remains inaccessible, leave it in place as it will continue to absorb without requiring removal.
Optimal Removal Technique
When attempting to remove the remaining suture fragment:
Grasp the visible suture end with fine-tipped forceps (not scissors or standard tweezers) and pull gently in the direction that minimizes tissue trauma while applying counter-traction with your index finger on the adjacent skin 1
Use a slow, steady pulling motion rather than quick jerking movements to avoid tearing the suture or damaging surrounding tissue 2
Apply counter-traction by pressing down on the skin adjacent to the suture with your non-dominant index finger, which stabilizes the tissue and makes the suture more accessible 2, 1
Pull at a low angle (nearly parallel to the skin surface) rather than perpendicular, as this reduces tissue trauma and patient discomfort 2
When Direct Removal Is Not Feasible
If the suture cannot be grasped despite proper technique:
Leave the remaining suture fragment in place, as absorbable sutures are designed to dissolve completely over time and do not require removal 3
Reassure the patient that retained absorbable suture material is safe and will continue to break down naturally without causing complications 3
Monitor for signs of suture reaction (increasing redness, swelling, discharge, or a small pustule forming around the suture site), though this is uncommon with modern synthetic absorbable materials 4, 5
Critical Pitfalls to Avoid
Never cut the suture flush with the skin if any portion remains embedded, as this makes subsequent removal nearly impossible and increases the risk of suture granuloma 1
Do not use standard scissors or tweezers for embedded sutures, as they lack the precision needed for close-to-skin work and may cause unnecessary tissue trauma 1
Avoid aggressive pulling or digging into the skin to retrieve the suture, as this causes more harm than leaving the absorbable material in place 3
Do not attempt removal if signs of infection are present (erythema, warmth, purulent drainage); instead, treat the infection first and reassess 3, 1
Expected Timeline for Absorption
Rapidly-absorbing synthetic sutures (like Vicryl Rapide) typically dissolve within 1-2 weeks 3
Standard synthetic absorbable sutures (like Vicryl or Monocryl) retain 50-75% tensile strength after 1 week and fully absorb within 60-90 days 6, 5
The visible portion may dissolve faster than deeper portions, so patience is often the best approach when fragments are inaccessible 3