Can absorbable (dissolving) sutures cause an abscess?

Can Absorbable (Dissolving) Sutures Cause an Abscess?

Yes, absorbable sutures can cause abscesses, though this complication is relatively uncommon when proper surgical technique and appropriate suture selection are employed.

Mechanism of Abscess Formation

• All suture materials are foreign bodies that can serve as a nidus for infection and abscess formation, regardless of whether they are absorbable or non-absorbable 1, 2
• The risk of abscess formation is directly related to the duration the suture remains in tissue—absorbable sutures have a clear advantage here because they eventually dissolve, whereas non-absorbable sutures persist indefinitely 3
• Multifilament (braided) sutures carry higher infection risk than monofilament sutures because bacteria can harbor within the interstices of braided material 1

Risk Factors That Increase Abscess Formation

• Contaminated or infected surgical fields significantly increase the risk of suture-related complications including abscess formation 1
• Inclusion of non-tissue material (such as hair or excessive adipose tissue) in the suture line dramatically increases abscess risk and compromises wound healing 2
• Poor surgical technique that includes fat and muscle tissue rather than just aponeurosis creates tissue compression, devitalization, and infection risk 1, 2
• Large bite technique that incorporates excessive tissue increases the foreign body burden and tissue trauma, promoting infection 1, 2

Prevention Strategies

• Use monofilament absorbable sutures rather than multifilament materials to minimize bacterial colonization risk 1
• Select slowly absorbable sutures (such as poliglecaprone or polyglactin) that maintain 50-75% tensile strength after 1 week while eventually being absorbed 2, 4
• Employ triclosan-coated antimicrobial sutures in clean-contaminated and contaminated fields, which reduce surgical site infections with an odds ratio of 0.72 (95% CI 0.59-0.88) 1, 2
• Use the "small bite" technique (5mm from wound edge, 5mm between stitches) that includes only aponeurosis and avoids incorporating fat or muscle tissue 1, 2
• Maintain proper wound preparation with thorough irrigation and removal of any hair or debris from the surgical field 2

Clinical Presentation and Monitoring

• Suture abscesses typically present with localized pain, erythema, swelling, warmth, and purulent discharge at the suture site 2
• Symptoms usually develop within the first 7-10 days postoperatively, though they can occur later if infection is indolent 2
• The presence of infected urine (especially with Proteus species) can accelerate degradation of synthetic absorbable sutures and increase complication rates 3

Common Pitfalls to Avoid

• Never use rapidly absorbable sutures for fascial or deep tissue closure, as they lose tensile strength before adequate healing occurs, increasing both hernia and infection risk 1, 4
• Avoid multifilament sutures when monofilament options are available, particularly in contaminated fields 1
• Do not incorporate adipose tissue or muscle into fascial closure—include only the aponeurosis to minimize tissue devitalization and infection 1, 2
• Never leave non-absorbable sutures in the urinary tract or other fluid-filled cavities, as they predictably promote stone formation and infection 3