A suture coming loose: what should you do?

A suture involves bringing the edges of a wound or surgical incision together using thread and a needle, and then securing them in place with a knot. The aim is to promote healing by closing the wound, minimise the risk of infection and make the scar as inconspicuous as possible. Stitches can be made using absorbable sutures, which will dissolve naturally, or non-absorbable sutures, which will need to be removed after a certain period of time.

Depending on the nature of the wound, the affected area, the need for strength and aesthetic considerations, there are several techniques for performing a suture. These include:

• Separate stitches: each suture is placed and knotted separately, allowing it to be precisely adapted to the shape of the wound. If one suture comes loose, the others still keep the wound closed. This technique is very common.

• Blair-Donati sutures: these combine a deep suture followed by a superficial suture in the opposite direction, using the same thread. The Blair-Donati suture forms a two-layer knot, thereby providing good strength and haemostasis (which stops bleeding). It is often used for areas subject to high tension and where the skin is thick.

• Overlapping sutures: the suture is performed using a continuous thread passed back and forth between the edges of the wound without any intermediate knots. It allows for rapid closure and good haemostasis, but if the thread breaks, the entire suture may come apart.

• Intradermal suture: the suture thread passes solely through the dermis, beneath the epidermis, either as a continuous suture or with separate stitches. The knot is hidden beneath the skin and the scar is often inconspicuous. This suture technique is preferred for areas of the body that are particularly exposed and require an aesthetic result, such as the face.

• Bourdonnet stitches: the suture is applied with local compression using a small roll of sterile gauze, and is held in place by deep stitches. They are often used to stop local bleeding.

Other methods exist for closing a wound, such as staples, skin glue or adhesive strips.

When a suture comes loose, the suture (i.e. the thread, the knot or the fastening of the thread) no longer holds the edges of the wound together properly. This situation, also known as ‘dehiscence’, causes the wound to open up. There are many reasons why a suture might come loose:

• Excessive tension on the sutured skin : if the edges of the wound are too far apart or too taut, the suture may not hold and may break.

• Local infection : an infection at the wound site weakens the tissues and the suture threads, reducing the strength of the stitches.

• Premature physical activity : playing sport or putting pressure on the operated area can cause the stitches to break. For example, chewing too soon after dental surgery or carrying a heavy load after abdominal surgery.

• Poor-quality suture material and inappropriate technique: using poor-quality sutures, sutures that are too thin for the required strength, or failing to adapt the suturing technique correctly can lead to premature tearing.

• Certain medical conditions : diabetes, obesity, immunosuppression and poor local blood supply are thought to increase the risk of suture failure.

• Certain treatments : corticosteroids, anticoagulants and chemotherapy weaken tissues and may compromise the strength of the suture.

• The type of surgery performed : the risk of suture failure is reportedly higher in abdominal and orthopaedic surgery.

A suture that has come loose can be recognised by the following:

• The wound has opened : the edges of the skin that were held together by the suture are separating. The wound has opened.

• Bleeding : the area around the stitch starts to bleed, or bleeding resumes after having stopped.

• Pain localised: pain that worsens or does not go away over time.

• Local infection: often indicated by symptoms of swelling, redness and warmth at the site of the wound.

• Discharge of pus or fluid : the presence of an abnormal yellow, greenish or foul-smelling discharge from the wound.

• Unusual sensations : a feeling of tightness, ‘cracking’ or the sensation that the suture is ‘moving’.

• Change in the shape of the scar : the scar appears enlarged, irregular or different from what was observed in previous days.

If a stitch comes loose, here’s what to do:

1. Stay calm : a stitch coming loose is rarely serious, so there is no need to panic. However, the situation should be taken seriously and assessed promptly by a healthcare professional.

2. Do not touch the area : avoid handling the wound or removing any remaining stitches, so as not to make the situation worse or introduce bacteria.

3. Gently clean the wound : use lukewarm water and mild soap to clean the wound. Gently pat the area dry with a clean towel.

4. Disinfect (if possible) : apply a suitable topical antiseptic, sparingly, to minimise the risk of infection.

5. Protect the wound : cover the scar with sterile gauze or a clean, dry plaster to prevent contamination and damage to the stitches

6. Control the bleeding : if there is any bleeding, apply gentle pressure with a clean compress.

In all cases, seeking prompt medical advice is the best course of action. Contact a healthcare professional immediately. They will be able to assess the situation, decide whether any stitches need to be re-done, prescribe treatment or antibiotics, and monitor the wound’s healing.

1. Follow the recommendations : strictly follow the instructions given by the healthcare professional who applied the stitches.

2. Keep the wound clean: clean the wound with water and mild soap, without rubbing. Avoid using irritating products, such as alcohol or hydrogen peroxide. 

3. Monitor the scar’s progress: seek medical advice promptly if you notice any redness, swelling, discharge, a feeling of warmth or unusual localised pain.

4. Limit physical exertion: avoid any movement that could put strain on the sutured area (sport, carrying heavy loads, excessive movement of the area).

5. Protect the area: keep the wound dry for the first 48 hours, then leave it exposed to the air. If this is not possible, cover it with a clean, dry dressing. Change the dressing only if it is soiled or damp to prevent maceration or skin irritation.

6. Avoid exposure to the sun : protect the wound from the sun to prevent permanent discolouration of the scar. Sun protection with a dressing is essential.

7. Avoid getting the wound wet: do not go swimming – either in a swimming pool or a bath – until the stitches have been removed.

If your stitches come loose and the wound opens up, bleeds, or shows increasing pain, swelling, redness, localised warmth or any signs of infection such as localised discharge or a fever, it is vital to see a doctor promptly. Even in the absence of worrying symptoms, medical follow-up allows for the proper healing process to be monitored and helps prevent potential complications.

Always follow your healthcare professional’s advice on what to do if a stitch comes loose.

Once the sutures have been removed and the wound has fully healed, a gentle massage using a moisturising cream in circular movements helps to prevent adhesions andimprove the appearance of the scar.

With a dual background in literature and marketing, Hélène Durand uses her writing to explore topics that are meaningful to her: natural beauty, well-being, and a healthy lifestyle. Through her articles, she aims to share a supportive perspective and practical advice.