Can a buried suture fall out and leave only a small hole in the scar?

Can a Buried Suture Fall Out?

No, a properly placed buried (subcuticular or intradermal) suture should not fall out and leave only a hole, because these sutures are placed entirely beneath the skin surface with knots buried in the dermis or subcutaneous tissue.

Understanding Buried Suture Anatomy

• Buried sutures are placed completely under the skin surface, with both the suture material and knots positioned within the dermal or subcutaneous layers, making them physically unable to "fall out" through the skin 1, 2
• The technique specifically involves anchoring the suture deep in the wound with the knot buried beneath the epidermis, so there is no external access point for the suture to exit 1
• When absorbable materials are used (polyglactin, polydioxanone, or catgut), the suture dissolves over weeks to months rather than falling out intact 2, 3

What You're Actually Seeing

• If you see a small hole in the scar, this is most likely:

  • A suture tract from a superficial (non-buried) suture that was already removed 4
  • A small epithelialized channel where a superficial suture once passed through the skin surface 2
  • Normal scar remodeling creating a small depression or pore-like appearance 4

• The absence of suture marks is actually a key advantage of buried subcuticular techniques—they don't leave visible suture tracks because they never penetrate the skin surface 2

Common Clinical Pitfall

• Do not confuse buried sutures with subcuticular continuous sutures that have external exit points: Some subcuticular techniques have entry and exit points at the wound ends where the suture can be removed by pulling it out; these are retained subcuticular sutures, not truly buried sutures 1
• If a suture was meant to be removed (like a retained subcuticular suture with external knots), and you now see only holes at the wound ends, the suture was likely already removed as planned 1

What Happens to Buried Sutures Over Time

• Absorbable buried sutures undergo hydrolysis and are gradually absorbed by the body over 60-90 days for synthetic materials or 7-14 days for catgut 3
• Non-absorbable buried sutures (rarely used) remain permanently in place and can occasionally cause late complications like suture granulomas, but they still don't "fall out" 2
• The wound edges are held together by the buried sutures during the critical healing phase (first 7-14 days), after which the healed dermis provides structural support 4, 5

When to Worry

• If you see a hole with active drainage, increasing redness, or signs of infection, this suggests wound dehiscence or infection rather than a suture falling out 5
• True wound dehiscence (separation of wound edges) occurs in <1% of properly closed wounds with buried sutures and is usually related to infection, excessive tension, or impaired healing—not from sutures falling out 2, 3