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Dissolvable Stitches: Things To Know

Updated: Feb 1

Unlike regular sutures, dissolvable stitches can be absorbed by the body and eventually fall out on their own. That provides an unparalleled level of convenience because it eliminates the suture removal follow up appointment.


dissolvable purple and gold stitches side by side
Purple & Yellow dissolving stitches

Table of Contents:


Absorbable sutures vs regular stitches

The major difference between dissolving stitches and regular ones is that the former will fall out on their own while the latter requires removal.


Below is a table comparing the two.

Attributes

Absorbable Sutures

Non-absorbable Sutures

Dissolvability

Yes

Yes

Removal required

No

Yes

Color

Yellow, purple, green, white

Black, blue, green, metal, white

Uses

Mostly internal wounds (subcutaneous, oral)

Mostly external wounds

Type of material

Natural and synthetic

Natural and synthetic

Hopefully that gives you a good general overview of the various differences between the two.


What they look like

The self-dissolving stitches look very similar to sewing knots. They can be colored or undyed but it literally looks like a sewing thread. Here is a photo of various colored sutures.


dissolvable vs non-dissolvable stitches
dissolvable vs non-dissolvable stitches

Note: They can potentially change colors as they dissolve when the dyed layer breaks down.


 

How to tell if they're dissolvable

The two ways you can tell if your stitches can dissolve is by asking your doctor or by identifying their color. The answer from your doctor is definitive while the color method is more of a guess.


Color

You can try to figure out whether your sutures can fall out on their own by the color of the thread. Healthcare vendors typically will dye different suture materials to be a specific color.

  • Absorbable stitches color can be yellow, purple, green or white.

  • Non-absorbable stitches color can be black, blue, green, metal or white.


The color can usually give you the correct answer but you do have to be cautious with the white stitches. As you may have noticed, the color white is listed for both types of sutures. The reason is because all of them are originally UNDYED but they become DYED for ease of recognition. Medical supply companies will sell both dyed and undyed versions.


safco ordering - dyed and undyed sutures
Dental supply company offering DYED and UNDYED sutures

Therefore, if you've white threads coming out of your surgical site, your guess would be equivalent to a 50/50 coin flip.


Label

You won't have access to the label of the sutures that were used on your surgical site but your doctor does. The packaging will literally tell you if they'll fall out on their own or not. This is why we say asking your doctor who did your procedure is the most accurate way to tell.


wego silk sutures - black non absorbable

 

When dissolvable sutures dissolve

When these stitches dissolve would depend on the type of material that they're made of. Different materials will dissolve at different rates.


Below is a table of the various suture materials and when they dissolve. The dissolution times are based on manufacturer estimations.


Absorbable Sutures

Dissolving Time

Fast Gut

Plain Gut

Chromic Gut

Polyglycolic acid (PGA)

Polydioxanone (PDS)

Polytrimethylene carbonate (Maxon)

Polyglactin 910 (Vicryl rapide)

Glycomer 631

Polyglytone 6211

Poliglecaprone (Monocryl)


How long do they last

Despite the long dissolving times listed in the table for these sutures, they often don't last that long in practice. The reason is because the estimated dissolution time is when the sutures become completely absorbed by the body.


However, there are many instances where complete absorption is NOT REQUIRED for the stitches to fall out. Once the threads have dissolved enough, it can be weakened to the point where they can simply "fall out".


A common example would be wisdom teeth stitches, which often use chromic gut or vicryl sutures. The expected time for them to fall out is actually 10-14 days despite the 90 days for chromic gut and 42 days for the vicryl as listed in the table.


What we're trying to say is that they don't need to be completely dissolved before they fall out. They'll fall out well before they get completely broken down!


How to dissolve faster

The natural dissolvable stitches are broken down by proteolytic enzymes and our theory is to drink extra pineapple juice to see if you can dissolve dissolvable stitches faster.


In a study by the American Journal of Surgery, catgut was found to be prone to rapid proteolytic digestion while in the gastrointestinal tract. Guess what has a lot of proteolytic enzymes... as you guessed, pineapple juice!


Pineapples are known to contain bromelain, which consists of a group of proteolytic enzymes. It is essentially a complex combination of multiple endopeptidases of thiol and other compounds derived from the pineapple fruit, stem, or root.


Before you go drinking gallons of pineapple juice... just know that there haven't been any studies which have tested this in practice. It is merely our theory which we came up with by putting two and two together.


What if they don't dissolve?

It is near impossible for them to not dissolve since they either get degraded via hydrolysis or proteolytic enzymes. Both of which are bodily functions that are commonly used. Essentially they are all made of materials that permit this.


The only exception would be the non-dissolvable sutures because those are made of materials that aren't meant to dissolve.


 

What they're made of

Dissolvable stitches can be naturally made of intestinal linings of ruminant animals or synthetically made of polymers and copolymers.


Suture

How its made

Material Type

Fast Gut

Natural

Animal intestines

Plain Gut

Natural

Animal intestines

Chromic Gut

Natural

Animal intestines

Polyglycolic Acid

Synthetic

Polymers

Polydioxanone

Synthetic

Polymers

Polytrimethylene carbonate

Synthetic

Copolymers

Polyglactin 910

Synthetic

Copolymers

Glycomer 631

Synthetic

Copolymers

Polyglytone 6211

Synthetic

Copolymers

Poliglecaprone

Synthetic

Copolymers


We can broadly categorize them into three groups:

  • Group 1 - All natural

  • Group 2 - Synthetic polymers

  • Group 3 - Synthetic copolymers (multiple types of polymers)


Natural

The natural absorbable sutures would be the family of gut sutures. They are made of collagen that is derived from the small intestine of ruminant animals (cows, goats, & sheep). Despite their similarity to food products, they're not edible.


fast absorbing plain gut sutures

Synthetic polymers vs copolymers

The synthetic polymer stitches are made of long chains of repeating monomers. The copolymer stitches are made of long chains of different polymers that are stitched together.


Copolymer vs polymer vs monomer:

  • Monomer - single molecule, often organic meaning it has carbon atoms.

  • Polymer - multiple monomers that are stringed together into a long chain.

  • Copolymer - multiple polymers that are stringed together into a long chain.


Monomer vs polymer vs copolymer
Monomer vs polymer vs copolymer

That is essentially what the synthetic threads are made of.


 

How dissolvable stitches work

Dissolvable stitches are able to dissolve because they're made of materials that the body can readily breakdown and absorb. Depending on the suture material, they will either be dissolved via proteolytic enzymes or via hydrolysis.


Suture

Material Type

How it dissolves

Fast Gut

Animal intestines

Proteolytic enzymes

Plain Gut

Animal intestines

Proteolytic enzymes

Chromic Gut

Animal intestines

Proteolytic enzymes

Polyglycolic acid

Polymers

Hydrolysis

Polydioxanone

Polymers

Hydrolysis

Polytrimethylene carbonate

Copolymers

Hydrolysis

Polyglactin 910

Copolymers

Hydrolysis

Glycomer 631

Copolymers

Hydrolysis

Polyglytone 6211

Copolymers

Hydrolysis

Poliglecaprone

Copolymers

Hydrolysis


Proteolytic enzymatic degradation

The natural suture materials are literally made out of collagen from intestinal linings. Essentially the material is similar to food, the way they breakdown will be via proteolytic enzymatic degradation. Our body digests food all the time and absorb them.


Hydrolysis

All of the synthetic materials breakdown via hydrolysis which cleaves the polymers into monomers using water.


sharpoint-polysyn-absorbable-surgical-suture

As an example, we'll use the breakdown mechanism of polyglycolic acid (PGA) sutures.


Specifications of PGA:

  • Monomer = glycolic acid

  • Polymer = polyglycolic acid

  • Essentially it is a string of glycolic acids


When PGA comes into contact with water, it undergoes hydrolysis and breaks down into glycolic acid.


polyglycolic acid hydrolysis mechanism


 

Complications

Just because these sutures can be absorbed by the body, it doesn't mean there are no complications. Here are a couple of potential complications which you may experience with them while you're healing.


Potential complications:

  • Infection. These are foreign objects to your body which means they can get infected. If that happens, it may swell up, turn red, or even ooze out pus.

  • Rejection. The body can reject the stitches and try to push them out by migrating it towards the surface of your skin as it heals. This condition is known as a spitting suture.

  • Irritation. The threads can get irritated and turn red around the surgical site. Alternatively, if the ends are too long it can be a source of irritation which are common with wisdom teeth stitches.

  • Accidentally pulling them out. You don't get stitches every day and some people may get curious and play with them. Unfortunately, there are situations where people pull them out accidentally!

  • Falling out too soon. If the suture knots weren't tied tight enough, they can potentially come undone while you're eating. That means they would've come out earlier than expected.


dissolvable stitch over extraction socket
dissolvable stitch over extraction socket

If you experience any of the above complications you should contact your doctor. Further treatment may be required or new ones may need to be placed.


 

What if they don't dissolve?

These types of stitches are made in such a way that they will self-dissolve without any intervention from you. The materials will naturally get broken down by the pre-existing bodily mechanisms. What we're trying to say is that it is impossible for them to not dissolve.


Our bodies readily produce proteolytic enzymes that will break down the natural ones. If you have synthetic ones, they will get broken down with hydrolysis which uses just water.


However, as we discussed above there can be complications with the dissolution process. Your body can reject the sutures instead of dissolving them. In this case, the threads will get pushed out of your body in lieu of dissolving them.


Treatment

If they're not dissolving, your doctor may need to remove the stitches instead of waiting for them to fall out on their own. Complete removal may not be possible at times.

  • Complete removal. No local anesthesia is required for removal since its painless. Your doctor can grab the suture with forceps, college pliers, or hemostat and pull it out.

  • Partial removal. If complete removal is not possible, it is recommended to trim the suture down to skin level as close as possible to the surface.


That's everything that our dentists in Long Island City have to say about dissolvable stitches. Most dental procedures do not require them but when you're most likely to need them would be after wisdom teeth removal or getting an abscess drained.



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About the author: Dr David Chen, DDS

Hello, I'm Dr Chen and I'm an actively practicing dentist in Long Island City, NY. I graduated from Columbia University College of Dental Medicine in 2016 but prior to going to dental school I was already working in the dental field. It's been more than a decade since I first got to know dentistry and let me tell you, time flies by quickly. Since then I've developed a fondness for writing, which is how this all got started!

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Medical Disclaimer:

This blog is purely meant for information purposes and should not be used as medical advice. Each situation in your mouth is unique and complex. It is not possible to give advice nor diagnose any oral conditions based on text nor virtual consultations. The best thing to do is to go in person to see your dentist for an examination and consultation so that you can receive the best care possible.

The purpose of all of this oral health information is to encourage you to see your dentist and to inform you of what you may expect during your visit. Due to the unfortunate nature of dentistry, there isn't really any true home remedies that will get rid of dental problems. Roughly 99.99% of them require in-person intervention by a healthcare professional.

Hint: That is the reason why you can't eliminate seeing dentists in your life!

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