Can a Woman Feel V-Loc Sutures in the Vaginal Cuff at 11 Weeks Post-Hysterectomy?
Yes, it is possible for a woman to feel V-Loc barbed sutures in the vaginal cuff at 11 weeks post-hysterectomy, particularly if vaginal cuff granulation tissue has formed around the suture material or if suture ends are protruding into the vaginal canal.
Understanding the Timeline and Suture Characteristics
At 11 weeks post-hysterectomy, the vaginal cuff should be well-healed in most cases, but complications can occur:
V-Loc sutures are absorbable barbed sutures that typically take 90-180 days to fully absorb, meaning they are still present at 11 weeks post-operatively 1, 2.
The barbs on V-Loc sutures are designed to anchor into tissue without requiring knots, which means they have a different texture than traditional smooth sutures 2.
Common Causes of Palpable Sutures
Vaginal Cuff Granulation Tissue
Granulation tissue formation is more common with traditional braided sutures (like Polysorb) compared to V-Loc barbed sutures, with studies showing reduced granulomatous formation at 6 months with V-Loc 3.
However, any foreign body reaction can create palpable granulation tissue that the patient may feel as a firm nodule or irregularity at the vaginal cuff 3.
Suture End Exposure
If suture ends are exposed or protruding into the vaginal canal, they can be directly palpable to the patient, particularly during digital examination or sexual activity 1, 4.
Sexual intercourse was the triggering event for vaginal cuff complications in multiple studies, occurring as early as 47 days post-operatively, suggesting that physical contact with the cuff area can reveal abnormalities 4.
Clinical Assessment Needed
A pelvic examination is essential to determine the exact cause:
Inspect the vaginal cuff for exposed suture material, granulation tissue, or signs of dehiscence 4.
Palpate for firm nodules, irregularities, or protruding suture ends that could explain the patient's symptoms 3.
Assess for signs of infection or cellulitis, though infection rates with V-Loc are low (0.9% in one large series) 1.
Management Options
If Granulation Tissue is Present
Silver nitrate application can cauterize small granulation tissue formations that are causing symptoms.
Surgical excision may be needed for larger granulomas that don't respond to conservative treatment 3.
If Suture Material is Exposed
Trimming or removing exposed suture ends can provide immediate relief if they are protruding and palpable.
Most V-Loc sutures will continue to absorb over the next 2-3 months, so conservative management with observation may be appropriate if the cuff is otherwise well-healed 2, 3.
Important Caveats
Vaginal cuff dehiscence must be ruled out, as this is a serious complication that can occur with barbed sutures, though rates are very low (0-0.6% in large series) 1, 4.
The patient should avoid sexual intercourse until evaluated, as this was the precipitating factor in 75% of vaginal cuff dehiscence cases in one study 4.
V-Loc sutures have an excellent safety profile overall, with no increased risk of major complications compared to traditional sutures, but individual variations in healing and foreign body response can occur 1, 5, 3.