How is the suture reapplied after a mastectomy?

A mastectomy is an effective way to eliminate cancer by removing the mammary glands of the breast. The operation is performed surgically, which involves suturing incisions in the chest or armpit. The suture is reapplied after a mastectomy if the suturing site pulls, swells, does not heal, or comes apart.

Patients should be aware of all the nuances, so a plastic surgeon and specialist in the field of aesthetic medicine talks in detail about the reasons for re-suturing.

Why does the suture pull after a mastectomy?

Pain and pulling sensations in the postoperative period are considered a natural reaction of the body to surgical intervention, but sometimes it is a reason to consult a doctor.

This is due to the following reasons:

• Increased sensitivity of the skin due to damage to nerve fibers;
• The appearance of discomfort due to contact of the wound with clothing;
• Overstrain of internal muscles, stretching of soft tissues;
• Inflammatory processes or rejection of threads by the body.

Types of operations for osteoplasty and sinus lifting

As already written above, sinus lifting is a type of osteoplasty, but in addition to this type of surgical intervention, there are also techniques that are often used in traditional maxillofacial surgery. Bone grafting techniques are divided into two large groups:

1. Transplantation of an autogenous or other type of implant. As a result of this type of osteoplasty, the height and/or width of the alveolar ridge can be effectively increased.

1. Splitting technique on the mandibular or maxillary bone when the width of the bone tissue is insufficient. This operation is less traumatic and has another advantage, as it allows you to simultaneously install an implant for an artificial tooth.

Whatever the operation, minimally invasive or conventional, soft tissues are still injured, which subsequently need to be sutured. Maxillofacial surgeons mainly use synthetic, especially strong threads that can either dissolve within 2-4 weeks or not. Non-absorbable threads are made from silk, polystyrene and polytetrafluoroethylene.

Silk threads have proven themselves to be durable and mobile in terms of tying knots. But there is a drawback: they contain a protein that can cause an allergic reaction. Polystyrene threads are as strong as silk, but do not cause any allergic or inflammatory reactions and are a good choice for use in maxillofacial surgery. Polytetrafluoroethylene or monofilament threads are also widely used in surgery and have good anti-inflammatory and adaptive abilities. They are often used to secure periodontal membranes. But they are quite rigid at the edges, and they should be covered with bandages so as not to cause trauma to the soft tissues of the cheeks and lips.

Absorbable ones include natural (catgut) and synthetic (Dexon, Vicryl).

These threads have anti-inflammatory properties and are widely used in surgery, but they require special knowledge in tying knots.

When does a stitch not heal after a mastectomy?

The speedy healing of wounds depends on the progress of the operation, the location of the tumor and the degree of its development, the professionalism of the surgeon and compliance with his instructions.

What to do to make the scar heal:

1. Wear compression garments and change bandages regularly.
2. Use only medications prescribed by a specialist.
3. Avoid overheating, hypothermia, swimming, sunbathing, overload.
4. Treat wounds with antiseptic agents and sterile materials.

Degrees of seam divergence

We have figured out whether the stitches can come apart after surgery and for what reasons this happens. However, in the field of medicine there is a special term that is used for a ruptured surgical wound - eventration. It has four degrees:

1. The first degree is characterized by the divergence of all layers on the abdominal wall, with the exception of the skin - subcutaneous eventration.
2. The second degree is called partial everration. In this case, the bottom of the damage is the stomach, intestines, and some other internal organs.
3. The third degree is called complete eventration, when absolutely all layers on the abdominal wall diverge, and intestinal loops or omentum approach the edges of the wound.
4. The fourth degree is called evisceration or true eventration, in which the internal organs slightly fall out of the wound. As a result, suppuration may appear inside, intestinal strangulation, or partial obstruction.

Diagnosing eventration is quite simple. At the initial stage, a dry or serous discharge will be imprinted on a dry gauze napkin applied to the injury. This means that the deep layer of the wound has already split apart, everything is held together only thanks to the glued skin. Sometimes emphysema may be observed near the wound - in this case the edges are swollen, and during palpation a clear crunching sound is heard, as if from dry snow or simple starch.

What to do if the stitch breaks after a mastectomy?

Dehiscence of the sutured skin can occur due to infections, injuries and bruises, the use of tight or weak sutures, as well as physical exertion and pressure on the scar. Most often, doctors prescribe repeated suturing, which avoids previous mistakes and speeds up the recovery process.

You can prevent possible risks by contacting an experienced surgeon. The success of plastic surgery is confirmed by thousands of patients. You can schedule a free consultation with a doctor by calling us at the number on the website.

Complications after osteoplasty and sinus lifting

The main postoperative complications include the appearance of pain, swelling at the surgical site and surrounding tissues, bleeding, numbness and paresthesia

Suture dehiscence after sinus lifting and bone grafting is not as common as pain and swelling, but is also a rather unpleasant condition. Typically, suture dehiscence occurs due to mechanical damage or trauma at the surgical site when the doctor’s recommendations are not followed. The cause may also be a manufacturing defect in the thread or incorrectly chosen tactics in using knots. But this happens extremely rarely, only among insufficiently experienced specialists. Violation of the regime in the postoperative period:

• Using a straw when taking food and water;
• Puffing out cheeks, whistling, singing and screaming;

• Constant tugging at the surgical site and nodes with the tongue;
• Excessive rinsing with antiseptics and other solutions, which can cause unnecessary pressure in the mouth;
• Intensive use of a toothbrush to clean the tongue, cheeks and teeth;
• Rough food that is difficult to chew, which can cause injury to the suture;

As a result, the wound will open and, most likely, infection will occur at the osteoplasty site and in the surrounding tissues. This will naturally cause local inflammation, pain, fever and astheno-vegetative syndrome. All this is one side of the coin, the other side is that after the infectious agent enters the wound, an inflammatory reaction will occur and the stitches will separate. What can cause an inflammatory reaction:

• Non-compliance with the regimen after surgery;
• Refusal of antibiotics and anti-inflammatory drugs, which will reduce pain and protect against the development of infection;
• Poor or lack of oral hygiene;

• Visiting sports sections, saunas, baths, swimming pools;
• Smoking and drinking alcoholic beverages.

If this situation occurs, you should immediately seek medical help, as all this can lead to the loss of the implant. And then there is a long period of rehabilitation of the bone and soft tissues, repeated osteoplasty, a period of healing and recovery. Therefore, you should only contact qualified specialists who, in addition to a first-class operation, will also be able to correctly explain the importance of the recovery phase after surgery in order to eliminate all possible complications.

Prevention of joint contractures

Joint contracture is a decrease in passive joint movements due to scar-type skin deformation, as well as similar deformation of tendons, muscles and joints. Mostly, a flexion type contracture appears (the limb becomes impossible to straighten) in the joints of the knees and elbows. This pathology becomes an obstacle to the installation of a prosthesis and lengthens the rehabilitation period.

Preventive methods:

1. Correct placement of an arm or leg for immobilization. The position of the stump is required so that it is straightened for the maximum time. It is unacceptable to hold it bent for a long time, since the muscles in this case shorten, which leads to a decrease in the mobility of the stump.
2. Eliminate pain and swelling in a timely manner. It is advisable to use a wheelchair with a special footrest if we are talking about a leg stump. This chair will prevent curvature of the spine. Periodic repositioning of the stump is required, otherwise the joints may become immobile. Combining correct body positioning with movement is the main requirement when treating pain and swelling.
3. Gymnastics for therapeutic purposes. When performing exercises, you need to avoid movements that lead to pain. Initially, gymnastics is carried out under medical supervision (it is carried out by a physical therapy doctor). It includes breathing exercises, stretching exercises, strengthening the spinal muscles and muscles of the healthy limb, and improving coordination.

After 2 weeks from the day of surgery, it is advisable to visit a rehabilitation doctor.

Medical examination

If the suture comes apart after surgery, what should I do? You should go to the hospital right away. When you visit a specialist, he will examine the general condition of the wound, as well as the surrounding tissue. If necessary, the surgeon will prescribe other studies:

• to determine infection - bacterial culture of samples from the injury;
• blood analysis;
• X-ray of the postoperative wound to determine the degree of eventration;
• computed tomography or ultrasound to determine the place where purulent contents or sanguineous discharge have accumulated.

Technique for applying surgical sutures

A surgical suture is the simplest and highest quality way to connect tissues for healing. Any doctor will tell you that the main task is to carry out the procedure carefully. It is important to keep the edges of the wound smooth and firmly unite the layers of organs.

The types of techniques depend on the materials and tools with which you have to work. For example, hand stitching is done by simply stitching fabrics together using a needle and holder. The surgeon does not hold the needle in his hands. He takes it with tweezers or a special needle holder. Biological and synthetic threads and wire are used.

But a mechanical seam is a connection of tissues using a device with metal staples. The procedure takes less time, but is not suitable for all injuries.

Additionally, we can distinguish types of sutures, taking into account the complexity of the wound and its depth:

• continuous intradermal suture and simple interrupted suture (simple wounds with smooth edges, do not leave scars);
• horizontal mattress U-shaped suture (deep wounds, inside of which blood or pus can accumulate);
• suture according to Donatti (deep wounds, when it is necessary to connect several layers of tissue at once, eventration).

High-quality work is characterized by rapid wound healing and the ability to remove the threads within 4-12 days (depending on location and complexity).

Interesting fact! According to records, around 1000 BC. e. Instead of thread, large ants were used during operations. They were brought to the wound so that they would bite the skin. Then they were killed, the body was cut off, and the jaws were left behind.

Treatment options

You can see what the wound looks like if the suture has come apart after surgery in the photo above in the text. But how to fix the problem?

The most popular cause of eventration is considered to be an infection that has entered the wound, especially if the discharge of purulent contents is clearly observed. In this case, the doctor will recommend an antibiotic.

After surgery, the patient may suffer from a decrease in immunity and weakening of the body, so a general strengthening multivitamin is usually prescribed.

Healing time for external sutures on the perineum

It's no secret that all mothers who have just given birth are interested in the question of how long postpartum sutures last. The healing process is directly related to the size of the wound surface, the correctness of care during the recovery period, the general condition of the woman’s body, and the techniques and materials used when suturing. If self-absorbable threads (natural or synthetic) were used during suturing, healing will take about two weeks, and scar formation when using metal staples or non-absorbable threads takes longer - 15-30 days; in the latter case, the sutures are removed in the maternity hospital before discharge, approximately on the seventh day after birth.

Rules for caring for postpartum sutures on the perineum

While the woman is in the maternity hospital, the sites of ruptures or incisions are treated by a procedural nurse - care consists of washing the sutures with hydrogen peroxide and then applying brilliant green or iodine to them.

Patients with stitches on the external genitalia upon discharge from a medical institution are required to receive recommendations on how to care for the intimate area.

Postpartum instructions include the following important points:

— Choose underwear of the appropriate size to wear. Panties that are too small or insufficiently wide can put pressure on injured areas and prevent stitches from healing. The material from which the underwear is made is also important; give preference to natural materials, preferably cotton - synthetic fabrics often cause skin irritation and various types of inflammation.

— Observe the rules of intimate hygiene: during this period, it is necessary to wash the external genitalia twice a day with simple soap without aggressive components and synthetic fragrances (scented gels should be avoided, but baby soap is ideal), and additionally wash your face every two hours and change your panty liner ; in addition, it is required to treat the genitals with warm water after each visit to the toilet. It is important to wash the seam on the crotch not only carefully, but also thoroughly; you can direct the shower stream at it.

- Douching is strictly prohibited!

— After hygienic manipulations, carefully blot your genitals with a towel; friction can damage already vulnerable tissues.

- Provide air flow to the genitals from time to time - periodically it is recommended to lie on a bed or sofa, take off your panties, spread your legs apart and bend them at the knees.

— Empty your bladder in a timely manner, otherwise the filled organ will put pressure on the uterus and prevent its contraction.

Lifestyle with sutures on the cervix, vagina and perineum

Cervical ruptures during labor and subsequent suturing of the ruptures do not impose additional restrictions on a woman’s activity, unlike perineal injuries.

If there are tears and seams in the perineal area, the young mother is instructed to strictly follow the following recommendations:

- During the first three weeks after childbirth, sitting positions should be avoided; this period is necessary for the complete fusion of the muscles of the perineum and pelvic floor. It is necessary to perform all usual activities (eating, performing hygiene procedures, personal care), as well as taking care of the newborn while standing or lying down. This also applies to traveling in a car - the back seat must be cleared so that a woman can sit there comfortably and safely. There are special positions to avoid stress on the perineum, “half-sided”, “leg to leg”, the doctor should explain this in detail. An excellent option for active mothers is an orthopedic circle; you can even sit on it while driving.

— Visit the toilet to have timely bowel movements and avoid constipation. The patient is allowed to sit on the toilet on the first day after birth. To facilitate the process of defecation, mother can use suppositories (rectal suppositories) with glycerin and other herbal remedies. These effective and at the same time safe drugs help intestinal function and smooth bowel movements. If necessary, the doctor may prescribe other medications, but it must be remembered that when breastfeeding, the baby also receives these substances.

- Do not lift heavy objects. It is highly not recommended to deal with objects and things weighing more than three kilograms, so if the child is large (4 kg or more), you should ask for help from family and friends until the mother’s condition is completely normalized.

What to process?

During the acute phase, it is necessary to carefully care for the resulting damage - treat it with antiseptic solutions, as well as powders. This removes the inflammatory process well. Please note that you cannot peel off a dried napkin. It must first be moistened in a 3% solution of hydrogen peroxide. Then it will move away from the skin. The bandage should be pulled from the periphery of the wound to its center. Next, the wound is treated with the same solution. Pour a little of it onto the wound and wait until the hydrogen peroxide “fizzes.” Then blot the wound with a clean bandage and repeat the procedure until the area is clean. After this procedure, the wound should be kept open for 15 minutes. Ideally, 3-5 minutes of irradiation of the wound with an ultraviolet lamp. It clears up the infection and also speeds up healing.

The doctor may also recommend treatment with a solution of brilliant green, Fukortsin, Iodinol, or Iodopyron.

After the procedure, you need to apply a bandage with dimexide, which is diluted with saline in a ratio of 1:3. As an addition, a 1% solution of dioxidine is poured onto the compress. If there is suppuration in the wound, the specialist installs drainage or removes all skin sutures from this area. In the future it will be tightened by secondary tension. When the inflammation subsides, the edges of the injury can be tightened with a bandage.

Levomekol, ointments with panthenol and sea buckthorn oil are considered excellent wound healing agents. Milk thistle oil fights inflammation well, improves complete healing and resolves existing scars.

At the scarring stage, after two months, Contractubex or Mederma is used.

For more severe concomitant diseases that interfere with wound healing, a permanent or temporary mesh is applied. This prevents the damage from expanding.

Features of caring for internal sutures (in the vagina and cervix)

Sutures on the internal genital organs made with absorbable threads (such suture material is called catgut, in modern institutions, vicryl or safil) do not require complex manipulations. They do not need to be removed or washed with any solutions; it is enough for the young mother to ensure complete rest and strictly adhere to the rules of personal intimate hygiene so that the infection does not enter the organs of the reproductive system, since discharge in the postpartum period (especially the first twenty days) is a favorable environment for reproduction pathogenic microbes.

Perform any intimate procedures after washing your hands first - this applies to washing your genitals, visiting the toilet, changing sanitary pads, etc. After each visit to the toilet, remove the used pad and wash yourself, so that the direction of movement goes from the vulva to the rectum with warm water and soap.

Remember - the intestinal microflora should under no circumstances get on the genitals, which is why it is so important to follow this sequence of actions. After treating the perineum with water, gently pat it dry with a clean or disposable towel, collecting all the moisture. If you use linen products, change them at least once a day, and more often as they become dirty. Empty your bladder every three to four hours, even if you don't feel the urge to urinate. You will have to avoid taking a bath in the first month after giving birth.