sutures

Nacki, MSN, NP · Apr 17, 2016

I think this would be better in the NP forum.

Editorial Team / Admin · Apr 17, 2016

Thread moved to NP forum.

ovy32 · Apr 17, 2016

Thanks!

core0 · Apr 17, 2016

An RN at work removed suture (vertical mattress) on a patient. The patient called 1.5 months after and said that she thinks she still has some sutures in (they were nonabsorbable) because while she can not see the evidence of the remaining sutures, the area of the excision is still pink/red (although looks like it's healing nicely). The MD who did the excision is going to be out of the office the whole next week and I am a new (ish) NP who just started and who is covering for MD for the first time. Would the remaining sutures be visible on the ultrasound? I spoke to the RN when I saw the patient on the schedule and she was freaking out to the point that she was in tears because the MD/surgeon is very difficult to work with. She said she was going to lose her job if she removed the sutures incorrectly and left some behind. She asked me to help her in a ny way I can. I told her that probably MD would have to do a re-excision and remove the remaining sutures (if they are, in fact, in there and not too embedded into the skin). I am just trying to figure out how to handle the whole situation. Thanks!

The sutures won't be visible on US. Its unlikely they are there at all. More likely this is scar tissue or early keloid formation. I've never seen a vertical mattress retained if it was taken out in normal fashion.

ovy32 · Apr 18, 2016

Thanks! The RN said that the sutures were embedded into the skin and she had a hard time removing them so she cut each stitch on top and then on the bottom and removed them that way so it was not done in a normal fashion. I guess I will just see how it looks tomorrow.

offlabel · Apr 19, 2016

The sutures won't be visible on US.

Sure about that? Vicryl shows up. Worth a try.

But what if it were a retained suture...you wouldn't go and dig it out, would you?

springchick1, ADN, RN · Apr 19, 2016

An RN at work removed suture (vertical mattress) on a patient. The patient called 1.5 months after and said that she thinks she still has some sutures in (they were nonabsorbable) because while she can not see the evidence of the remaining sutures, the area of the excision is still pink/red (although looks like it's healing nicely).!

My incisions from surgery were pink/red for moths after the suture had been removed. Just because they are pink doesn't mean they have been retained. At some point, I would think, the are would either become infected or the body would try to get rid of it by "spitting" it out the skin.

core0 · Apr 19, 2016

Sure about that? Vicryl shows up. Worth a try.
But what if it were a retained suture...you wouldn't go and dig it out, would you?

I've scanned plenty of wounds and never seen suture. When we US the liver transplant you can't see the suture and that's much larger than what the OP was talking about. Also, why would you use Vicryl for a vertical mattress? Something nonabsorbable would be more appropriate. If the OP had an US in the office they could put the probe on to reassure the patient (but you had better be ready to explain everything).

If there was a retained suture I would leave it alone. Unless there are signs of abscess or infection its not clinically significant.