Surgery, of course, poses a danger to the body, since it is an invasive (associated with a violation of the integrity of the skin) method of treatment. Complications after operations occur even among experienced surgeons. Wound healing after surgery occurs by primary or secondary intention.

In the first case, there is a tight contact between the smooth edges of a clean wound, which grow blood vessels. The process lasts 7–10 days, after which a small thin scar remains on the skin.

When the edges of the wound are uneven, they do not touch each other tightly and grow together poorly, which contributes to the development of bacterial infection and suppuration. This is a secondary intention, which often develops with local circulatory disorders and a decrease in the body's defenses. During the healing process, new tender tissue grows, from which a scar is subsequently formed. The process continues for several weeks or months.

Reasons for divergence of postoperative sutures

There are several reasons for the discrepancy:

• the stitches were removed prematurely, complete healing has not yet occurred;
• after heavy physical activity (weight lifting, running, jumping);
• due to bleeding, accumulation of blood clots in the wound;
• after a wound becomes infected;
• due to impaired blood circulation in tissues;
• due to a decrease in the body's defenses;
• after technically incorrect suturing.

The following factors contribute to the discrepancy:

• the patient has a pathology accompanied by impaired immunity, for example, diabetes mellitus;
• taking medications that reduce immunity, for example, glucocorticoid hormones (prednisolone, dexamethasone, etc.) or cytostatics (medicines used to treat oncological diseases); this also includes some treatment methods (radiation and chemotherapy);
• the patient has diseases that impair local blood circulation; this is obliterating endarteritis (inflammation of the walls of small arteries of the extremities), vascular atherosclerosis lower limbs, varicose veins veins;
• the patient has metabolic disorders due to nutritional defects, diseases, excess body weight or old age.

What are the dangers of seams coming apart?

This is most often not a serious complication; surgeons can easily cope with it. Complications include prolonged scar formation: after dehiscence, the wound will most likely heal by secondary intention, which increases the risk of bacterial complications and negatively affects the patient’s condition.

After healing, secondary intention often leaves rough retracted or, on the contrary, convex scars. On open areas the bodies they represent cosmetic defect, after healing they can be removed. For this purpose, cosmetic surgeries are performed.

Abdominal surgery ends with layer-by-layer suturing of tissue. When after surgery abdominal cavity all the seams come apart, there is a risk of developing a serious complication - prolapse of internal organs (eventration). This is a rare complication that usually occurs in patients diabetes mellitus with reduced immunity, circulatory, innervation or metabolic disorders.

Sometimes an operation on the abdominal organs ends successfully, but then the internal suture separates while the external one remains intact and heals normally. In this case, it is possible to develop a postoperative hernia - the release of internal organs under the skin.

Important! After the operation, you must strictly follow all the doctor’s recommendations.

Signs of seam dehiscence

The separation of the external suture is impossible not to notice: the edges of the wound move apart, deeper tissues and internal organs become visible. Discrepancy due to physical activity is not accompanied by a change in the appearance of the wound. Impaired local circulation is accompanied by darkening of the edges of the wound, infection by redness, swelling, and purulent discharge. Healing can only be secondary.

After operations on the abdominal organs, a protrusion sometimes appears in the place of a healed skin scar - a soft tumor, which indicates that the internal suture has split open and the internal organs have come out under the skin. Over time, the hernia formed after surgery reaches significant sizes, so it is better to operate it as early as possible.

Important to remember! If even a small painless protrusion appears in the suture area, you should immediately consult a doctor!

First aid for suture dehiscence

Divergence sometimes occurs suddenly for various reasons. This is very frightening for patients, but they should clearly know how to help themselves in this situation:

1. seam after the operation went bust, but the edges are pink, there is no discharge - you should apply a sterile bandage, and then consult a surgeon;
2. the wound is large, internal organs are visible through it - you should immediately call an ambulance; before her arrival you must be in a horizontal position; someone close to you should apply a sterile bandage to the wound;
3. after the divergence, the internal organs fell out - they cannot be put back on their own; you need to immediately call an ambulance, and before it arrives, cover the wound with a sterile napkin and take a horizontal position;
4. a hernia has suddenly formed - it also cannot be reduced independently; You should call an ambulance and remain in a horizontal position until it arrives.

Important to know! You cannot reset prolapsed organs or hernia yourself - this often leads to serious complications!

Useful video: Postoperative sutures - healing time

Medical care for postoperative suture dehiscence

The provision of medical care depends on the cause of the discrepancy and the patient’s condition:

• discrepancy due to the patient’s physical stress; for a small clean wound with smooth pink edges, an operation is performed to excision the edges, after which the suture is reapplied; sometimes the doctor prescribes conservative treatment: regular dressing changes, local or general antibacterial therapy;
• a large infected wound first requires conservative treatment (local and general antibacterial therapy), and then the issue of further treatment is decided; it can be conservative (longer) or operative: the edges of the wound are excised and a suture is applied. this promotes rapid healing;
• eventration (non-infected wound): prolapsed organs are washed with an aseptic solution and set back, the wound is sutured tightly in layers;
• eventration (suspicion of a bacterial complication): after repositioning the internal organs, conservative treatment is carried out, followed by suturing;
• dehiscence of internal sutures and postoperative hernia: the hernia is carefully reduced and the question of when the planned operation will be performed is decided.

Important to remember! Suture dehiscence after surgery is most often not a serious complication, but requires immediate medical attention.

Any surgical intervention is a forced measure associated with varying degrees of trauma to body tissues. The recovery time of the body after surgery and the speed of healing of the sutures determine how quickly the patient can return to active life. Therefore, questions about how quickly the sutures will heal and how to avoid postoperative complications are so important. The speed of wound healing, the risk of complications and appearance scar after surgery. We'll talk more about seams today in our article.

Types of suture materials and suturing methods in modern medicine

An ideal suture material should have the following characteristics:

Be smooth and glide without causing additional damage. Be elastic, stretchable, without causing compression and tissue necrosis. Be durable and withstand loads. Tie securely in knots. Be biocompatible with body tissues, inert (do not cause tissue irritation), and have low allergenicity. The material should not swell from moisture. The period of destruction (biodegradation) of absorbable materials must coincide with the time of wound healing.

Different suture materials have different qualities. Some of them are advantages, others are disadvantages of the material. For example, smooth threads will be difficult to tighten into a strong knot, and the use natural materials, so valued in other areas, is often associated with an increased risk of developing infections or allergies. Therefore the search ideal material are ongoing, and so far there are at least 30 thread options, the choice of which depends on specific needs.

Suture materials are divided into synthetic and natural, absorbable and non-absorbable. In addition, materials are manufactured consisting of one thread or several: monofilament or multifilament, twisted, braided, various coatings.

Non-absorbable materials:

Natural - silk, cotton. Silk is a relatively durable material, thanks to its plasticity it ensures the reliability of knots. Silk is a conditionally non-absorbable material: over time its strength decreases, and after about a year the material is absorbed. In addition, silk threads cause a pronounced immune response and can serve as a reservoir of infection in the wound. Cotton has low strength and is also capable of causing intense inflammatory reactions. Stainless steel threads are durable and produce minimal inflammatory reactions. Used in abdominal surgeries, suturing the sternum and tendons. The best characteristics have synthetic non-absorbable materials. They are more durable and their use causes minimal inflammation. Such threads are used for matching soft tissues, in cardiac and neurosurgery, and ophthalmology.

Absorbable materials:

Natural catgut. The disadvantages of the material include a pronounced tissue reaction, the risk of infection, insufficient strength, inconvenience in use, and the inability to predict the timing of resorption. Therefore, the material is currently practically not used. Synthetic absorbable materials. Made from degradable biopolymers. They are divided into mono and polyfilament. Much more reliable compared to catgut. They have certain periods of resorption, which differ from one another to another. different materials, quite durable, do not cause significant tissue reactions, and do not slip in the hands. Not used in neuro and cardiac surgery, ophthalmology, in situations where constant strength of sutures is required (for suturing tendons, coronary vessels).

Suture methods:

Ligature sutures - they are used to ligate vessels to ensure hemostasis. Primary sutures - allow you to compare the edges of the wound for healing by primary intention. Sutures can be continuous or interrupted. According to indications, immersed, purse-string and subcutaneous sutures can be applied. Secondary sutures - this method is used to strengthen primary sutures, to re-close a wound with a large number of granulations, in order to strengthen a wound that heals by secondary intention. Such sutures are called retention sutures and are used to unload the wound and reduce tissue tension. If the primary suture was applied in a continuous manner, interrupted sutures are used for the secondary suture, and vice versa.

How long do stitches take to heal?

Every surgeon strives to achieve wound healing by primary intention. In this case, tissue restoration takes place in as soon as possible, swelling is minimal, there is no suppuration, the amount of discharge from the wound is insignificant. Scarring with this type of healing is minimal. The process goes through 3 phases:

Inflammatory reaction (first 5 days), when leukocytes and macrophages migrate to the wound area, destroying microbes, foreign particles, and destroyed cells. During this period, the connection of the tissues has not reached sufficient strength, and they are held together by seams. The phase of migration and proliferation (up to the 14th day), when fibroblasts produce collagen and fibrin in the wound. Thanks to this, granulation tissue is formed from the 5th day, and the strength of fixation of the wound edges increases. Phase of maturation and restructuring (from the 14th day until complete healing). During this phase, collagen synthesis and connective tissue formation continue. Gradually, a scar forms at the site of the wound.

How long does it take for stitches to be removed?

When the wound has healed to the point that it no longer requires the support of non-absorbable sutures, they are removed. The procedure is carried out under sterile conditions. At the first stage, the wound is treated with an antiseptic, and hydrogen peroxide is used to remove crusts. Grasping the thread with surgical tweezers, cross it at the point where it enters the skin. Gently pull the thread from the opposite side.

Suture removal time depending on their location:

Sutures on the skin of the torso and limbs should be left in place for 7 to 10 days. Stitches on the face and neck are removed after 2-5 days. Retention sutures are left in place for 2-6 weeks.

Factors influencing the healing process

The speed of healing of sutures depends on many factors, which can be divided into several groups:

Features and nature of the wound. Definitely, wound healing after minor surgery will be faster than after laparotomy. The process of tissue restoration is lengthened in the case of suturing a wound after an injury, when there has been contamination, penetration of foreign bodies, and crushing of tissue. Location of the wound. Healing occurs best in areas with good blood supply and a thin layer of subcutaneous fat. Factors determined by the nature and quality of the services provided surgical care. In this case, the features of the incision, the quality of intraoperative hemostasis (stopping bleeding), the type of suture materials used, the choice of suturing method, compliance with aseptic rules, and much more are important. Factors related to the patient’s age, weight, and health status. Tissue repair is faster in at a young age and in people with normal weight bodies. Chronic diseases, in particular diabetes mellitus and other endocrine disorders, oncopathology, prolong the healing process and can provoke the development of complications. vascular diseases. At risk are patients with foci of chronic infection, with reduced immunity, smokers, and HIV-infected people. Reasons related to caring for the postoperative wound and sutures, compliance with diet and drinking habits, physical activity of the patient in the postoperative period, following the surgeon’s recommendations, and taking medications.

How to properly care for seams

If the patient is in the hospital, a doctor or nurse will care for the sutures. At home, the patient should follow the doctor's recommendations for wound care. It is necessary to keep the wound clean, treat it daily with an antiseptic: a solution of iodine, potassium permanganate, brilliant green. If a bandage is applied, consult your doctor before removing it. Can speed up healing special drugs. One of these products is contractubex gel, containing onion extract, allantoin, and heparin. It can be applied after epithelization of the wound.

For the speedy healing of postpartum sutures, strict adherence is required hygiene rules:

• washing hands thoroughly before using the toilet;
• frequent change of gaskets;
• daily change of linen and towels;
• within a month, taking a bath should be replaced with a hygienic shower.

If there are external stitches on the perineum, in addition to careful hygiene, you need to take care of the dryness of the wound; for the first 2 weeks you should not sit on a hard surface, constipation should be avoided. It is recommended to lie on your side, sit on a circle or pillow. The doctor may recommend special exercises to improve blood supply to tissues and wound healing.

Healing of sutures after cesarean section

You will need to wear a postoperative bandage and maintain hygiene; after discharge, it is recommended to take a shower and wash the skin in the suture area twice a day with soap. At the end of the second week, you can use special ointments to restore the skin.

Healing of sutures after laparoscopy

Complications after laparoscopy are rare. To protect yourself, you should follow bed rest days after the intervention. At first, it is recommended to stick to a diet and give up alcohol. For body hygiene, a shower is used, and the suture area is treated with an antiseptic. The first 3 weeks limit physical activity.

Possible complications

The main complications during wound healing are pain, suppuration and insufficient sutures (dehiscence). Suppuration can develop due to the penetration of bacteria, fungi or viruses into the wound. Most often, infection is caused by bacteria. Therefore, after surgery, the surgeon often prescribes a course of antibiotics with for preventive purposes. Postoperative suppuration requires identification of the pathogen and determination of its sensitivity to antibacterial agents. In addition to prescribing antibiotics, the wound may need to be opened and drained.

What to do if the seam comes apart?

Suture insufficiency is more often observed in elderly and debilitated patients. The most likely timing of complications is from 5 to 12 days after surgery. In such a situation, you should immediately seek medical help. The doctor will decide on further management of the wound: leave it open or re-suture the wound. In case of evisceration - penetration of an intestinal loop through a wound, emergency surgical intervention is required. This complication may occur due to bloating, severe coughing or vomiting.

What to do if the stitch hurts after surgery?

Pain in the suture area for a week after surgery can be considered normal. During the first few days, the surgeon may recommend taking a painkiller. Following your doctor’s recommendations will help reduce pain: limitation physical activity, wound care, wound hygiene. If the pain is intense or persists for a long time, you should consult a doctor, since pain may be a symptom of complications: inflammation, infection, formation of adhesions, hernia.

You can speed up wound healing by using folk remedies. For this purpose, herbal mixtures are used internally in the form of infusions, extracts, decoctions and local applications, herbal ointments, rubbing. Here are some of the folk remedies used:

Pain and itching in the suture area can be relieved with the help of herbal decoctions: chamomile, calendula, sage. Treatment of the wound vegetable oils- sea buckthorn, tea tree, olive. The frequency of treatment is twice a day. Lubricating the scar with a cream containing calendula extract. Applying a cabbage leaf to the wound. The procedure has an anti-inflammatory and healing effect. The cabbage leaf must be clean; it must be doused with boiling water.

Before using herbal remedies, you should definitely consult a surgeon. He will help you choose individual treatment and give the necessary recommendations.

This feels like a painful lump that runs almost from the commissure of the labia, often to the side and back, rarely exceeding 2-3 cm in length. In the first days they rub a lot, causing a lot of suffering, after removing them you will feel relief. Sometimes a cosmetic intradermal suture is applied; it is not felt and is easier to tolerate.

Why do my stitches hurt after childbirth?

Because this is a sutured wound that appears as a result of a rupture or incision in the perineum. In a week it will be much easier for you, but you will fully recover in about 8 weeks, or even six months...

Let's figure out what types of suturings there are, how they are applied and how the woman is subsequently treated.

Internal - applied to tears in the cervix and vagina, they usually do not hurt and do not require any special care. They are applied from absorbable materials, there is no need to remove them, there is no need to process them in any way, there is no need to smear or douche, you just need to ensure complete sexual rest for at least 2 months, because here they are in far from ideal conditions.

In order for the wound to heal well, it needs rest and asepsis. Neither one nor the other can be fully provided; the mother will still have to get up to the child, she will have to walk. It is impossible to apply any bandage in this area, and postpartum discharge creates nutrient medium for microbes, which is why the situation quite often occurs that the sewn areas diverge.

You can sew up the perineum using different techniques and materials, but these are almost always removable options (they will need to be removed within 5-7 days). Most often, if everything goes well, they are removed in the maternity hospital, before discharge.

The treatment of stitched areas in the maternity hospital is carried out by a midwife. This can be done both on the examination chair and directly in the ward. Usually treated with brilliant green 2 times a day. In the first two weeks, the pain is very pronounced, it is difficult to walk, and sitting is prohibited; mothers feed while lying down, eat either standing or lying down.

After removal surgical threads and after being discharged from the maternity hospital, the woman will not be able to sit normally for almost another month. At first, you can only sit sideways on something hard, and even from the maternity hospital you will have to return reclining, in the back seat of the car.

How long does it take for stitches to heal after childbirth?

You will feel discomfort in the area where the perineum was torn for at least 6 weeks. Yes, and care at first will have to be very thorough.

Caring for stitches after childbirth

- Self-absorbing options in the vagina and cervix area do not require special care.

External threads require careful care. Their application is most often done in layers, using removable material.

After applying them, you will have to wash yourself after each visit to the toilet. clean water with the addition of potassium permanganate, and thoroughly dry the perineum with a clean towel.

The pads will need to be changed very often as the wound needs to be dry. While you are in the maternity hospital, the midwife will perform the treatment.

Removing the threads is a low-painful procedure that significantly relieves discomfort.

In the first days, it will be necessary to delay the first bowel movement as much as possible, especially with grade 3 ruptures; in the future, it will be induced using suppositories.

It will be necessary to abstain for some time from cereals and bread, vegetables and other stool-stimulating foods. This usually does not cause big problems since before childbirth a cleansing enema is performed, which in itself can delay stool.

Dehiscence of suturings most often occurs in the first days or immediately after their removal, rarely later. The cause may be early sitting down, sudden movements, as well as complications such as suppuration. This is not a common complication, which occurs with serious ruptures of the perineum, 2-3 degrees.

If there is inflammation, redness, sharp pain in the perineum, premature removal of the material restraining the perineal rupture before the wound has completely healed is not good, because this will form a rough scar. Your gynecologist will tell you how to treat the wound.

If the early period went well, healing proceeds without complications, after discharge from the hospital only hygienic measures will be required. Bepanten or another softening and healing ointment may be recommended.

When do sutures heal completely after childbirth?

On average, discomfort disappears after 2 weeks, but sex will be unpleasant for at least 2 months after the birth of the child. As it heals, a scar forms, which somewhat narrows the entrance to the vagina, making sex painful.

Choosing the most painless position, which is different for each couple, and using ointments against scars, for example, contractubex, will most likely help you cope with this.

Strange sensations in the vaginal area can bother you for quite a long time, up to six months. However, later they completely resolve.

When you need to suspect that something is going wrong:

- If you have already been discharged home, and the stitched area is bleeding. Sometimes bleeding occurs as a result of wound dehiscence. You won’t be able to fully examine yourself on your own, so hurry back to the doctor.

If internal stitched wounds hurt. Normally, after suturing vaginal tears, there may be slight pain for 1-2 days, but it quickly passes. A feeling of heaviness, fullness, or pain in the perineum may indicate the accumulation of hematoma (blood) in the area of ​​injury. This usually happens in the first three days after birth, you will still be in the maternity hospital, tell your doctor about this feeling.

Sometimes suturings fester after discharge from the hospital. In this case, a painful swelling is felt in the wound area, the skin here is hot, and a high temperature may rise.

In all these cases, you should not think on your own what to apply to the wound; you should urgently consult a gynecologist.

Operation caesarean section- difficult, but doable. Similar operations are performed today without complications, but during the rehabilitation period cases of pathological disorders are recorded. Due to the presented fact, doctors explain to a woman in advance what to do if suture came apart after caesarean section, as well as methods for preventing the most common complication. The problem with scars is common and dangerous to a woman’s health, and sometimes even to her life. It is also noted that suture dehiscence can occur both during the rehabilitation period and during a new pregnancy with the growth of the fetus in the uterine cavity.

Often, even a long break between pregnancies does not “save” from problems with the integrity of the uterine sutures. All this can be avoided if you carefully adhere to the rules of the rehabilitation period of cesarean section, which young mothers cannot stand when immersed in caring for the baby. The article will describe in detail the main problems after a cesarean section, as well as methods for preventing discrepancy.

A caesarean section is a delivery surgical method. As a result, the woman develops two sutures - an internal one on the uterus and an external one, which should be carefully looked after in the postoperative period according to the doctor’s recommendations. Due to the cut and rupture of blood vessels, the wound, both external and internal, will take a long time to heal. An internal wound requires a refusal to carry weights and other basics for a speedy recovery. At the same time, the external wound must constantly be subjected to antiseptic treatment.

With proper and timely care, the external scar is formed within a week - the doctor immediately removes the threads. The internal wound heals on its own and does not require repeated medical intervention.

This is important: Seam separation can occur both externally and internally. Moreover, the outer seam may remain intact, while a discrepancy will be diagnosed inside. Since the external scar immediately signals the development of problems, the internal one will only produce severe pain, which women usually endure for some time - this leads to serious internal bleeding and repeated surgery.

You should also be aware of the symptoms of internal and external seam separation. The external seam is covered with ichor - this indicates poor vascular restoration or divergence of the formed wound. An internal suture is a wound closed with self-absorbable materials. There is no need to remove such threads - they dissolve on their own within 80-90 days.

During the period of resorption of the threads, the wound provokes pain, which in the first days after a cesarean section is relieved by taking painkillers. Gradually, the intensity of the pain should decrease - if this does not happen, it means that complications have begun, for which you should immediately consult a doctor.

The table below identifies three types of scar integrity violations:

Violation	Description
Threatened uterine rupture	Such a complication often does not manifest itself clinically and can only be detected by performing an ultrasound scan of the scar.
Starting rupture of the old seam	It is usually characterized by severe pain in the surgical area; signs of painful shock in a woman are possible: drop in blood pressure, tachycardia, cold sticky sweat. On the part of the child’s body, such a pathology may be accompanied by a decrease in heart rate.
Completed uterine rupture	In addition to the symptoms already listed, it is characterized by sharp pain in the abdomen in the interval between contractions, a change in the movement of the child’s torso in the birth canal, and the development of bleeding from the vagina.

Often, suture dehiscence after surgery occurs in the first 3 months, so during this time a woman should take care of herself and follow all the doctor’s recommendations. In some cases, women in labor after surgery are prohibited from even picking up their baby - the ban is imposed for the first weeks postoperative period.

What a suture looks like after a caesarean section can be seen in this photo:

About problems in the postoperative period

Suture dehiscence after cesarean section is not the only complication in women. All possible problems conditionally divided into 2 groups – early and late. Early complications are problems that developed during the postoperative period. Late - formed a month after surgery.

In addition to seam divergence, early problems include the following:

• Light bleeding - if the bandage on the external seam becomes wet and bloody, you should treat it with hydrogen peroxide and consult a doctor.
• Hematomas - compactions with symptoms in the form of increased body temperature, as well as severe pain, can provoke inflammation.
• Inflammation - this often happens due to stress, infection in the wound and other problems.
• Suppuration - if the suture has rotted, the doctor installs drainage for the timely drainage of purulent masses. Rotting of the seam is possible due to infection in the absence of proper wound care.
• Seam dehiscence occurs in most cases in the first 2 weeks after removing the threads. There can be many reasons for this - stress, poor vascular recovery process and other prerequisites.

Late problems include the formation of fistulas - cavity canals formed as a result of rejection of the threads with which the wound was sutured. A woman with diabetes mellitus should monitor the condition of the suture especially carefully. People with this disease are at risk of developing complications in the postoperative period due to constant changes in blood glucose levels, which reduces the connective function of cells.

Preventing discrepancies

Since the wound will usually heal within the first few weeks after surgery, women in labor should follow these doctor's instructions to prevent problems. Namely:

• In the first few days after surgery, a woman is contraindicated from picking up a newborn baby. The period of the ban may be increased by the doctor due to the examination and the presence of problems in the wound healing process.
• For several months after delivery, the woman in labor is prohibited from lifting weights - muscle overstrain provokes an increase in intrauterine pressure, and this can lead to rupture of the internal suture.
• To reduce stress on the new wound, women should wear a bandage after childbirth.
• After surgery, a woman takes antibacterial drugs for a certain time. You should also treat the cut using iodine, brilliant green or another special solution. Now in the maternity hospital, immediately after surgery, a special plaster is glued to the woman in labor, which is not removed for a week - until the threads are removed.

Most women, after complete recovery, resort to plastic resection of the scar. Here you can use laser resurfacing or microdermabrasion, the results of which can be seen in the before and after format in the photo. These operations are minimally invasive and do not lead to pathological consequences.

If the suture heals slowly, which may be due to individual characteristics body, the woman’s performance and the surgeon’s professionalism, it is recommended to treat the affected area sea ​​buckthorn oil or milk thistle, Levomekol or panthenol ointments.

It is only important to listen to the advice of a doctor who will tell you about contraindications for their implementation. The formation of a scar after a cesarean section is a long process and largely depends on the human factor. This can only be explained by the occurrence of complications in recovery due to violation of care and rules of the postoperative period - the doctor did not consult the woman on treatment issues and was careless during surgery. Often the mother herself is to blame for the discrepancy - even one awkward movement can provoke serious complications with a new surgical intervention.

A characteristic action for any surgery is a dissection of the body's skin or mucous membranes. In most cases, stitches cannot be avoided.

In relatively healthy people, the healing time of sutures is less than ten days from the date of surgery. A longer period is already a pathology or is associated with suture dehiscence. There are a number of reasons for this condition.

Causes of seam divergence

In particular, some surgeons remove sutures too early. Perhaps they are in a hurry to leave the patient as soon as possible, or perhaps they do not take into account that certain wounds take longer to heal. This takes away all the brilliance of a skillfully performed operation.

In some cases, a suture is placed in areas of poor blood circulation, which may be caused by a disease, for example, diabetes mellitus or atherosclerosis of the vessels of the lower extremities. The same result is possible when the edges of the wound are tensioned, in which small capillaries are compressed. The reason may also be that the suturing technique is not soft enough, and then the edges of the wound are compressed too much by the suture material.

The quality of the seam is greatly influenced by the state of immunity, which can be reduced due to illness, the use of a number of medications, or be congenital.

However, the most common cause suture dehiscence is the presence of infection in the wound.

How to recognize seam divergence?

The divergence of the seam can be determined visually, and almost always. In the area where the thin wound strip is located, a noticeable depression appears, and the edges of the wound diverge to the sides. The wound can be examined inside, where the naked eye reveals tissues that are deeper, such as subcutaneous fat and muscles, and in some cases, internal organs. This condition is called a “gaping wound.”

The edges of the wound may look different, which is determined by the reason that caused the sutures to separate. If sutures are removed hastily or the immune system is weak, the edges of the wound are usually pink, smooth, and healthy-looking. With infection and suppuration, the edges of the wound become inflamed and swollen, and a certain amount pus between the stitches and in the depths of the wound. If the wound dehiscence occurs due to poor blood circulation, the edges of the wound become pale or black. Necrotic areas can be both dry and wet, and the wound itself is filled with cloudy liquid.

The wound usually diverges at the time the sutures are removed or shortly thereafter, and the provoking factors here are mainly inadequate physical activity, although other reasons are possible. Ingoda, the edges of the wound diverge even when the sutures are not removed, which is observed with excessive tension of the edges of the wound and in the presence of suppuration. Soft fabrics here they find themselves cut by the seams themselves, which is why the condition is called “cutting through” the seams.

The separation of the seams is not always noticeable; this primarily applies to internal seams that hold the deep layers of the wound. The skin on the wound looks perfectly healed. More often this happens after longitudinal incisions along the midline of the abdomen. This condition is fraught with postoperative complications, which are treated with repeated operations. In this case, the reasons are basically the same - infection and technical errors during layer-by-layer suturing of the wound.

Consequences of seams coming apart

Despite all the discomfort, wound dehiscence in the overwhelming majority rarely poses a serious danger to the health or life of the patient, if only because the dehiscence of the sutures is limited to the wound of the subcutaneous fat and skin. Gaping wounds with prolapse of organs are very rare.

Dehiscence of sutures is fraught with an increase in the healing period and, instead of a maximum of ten days, this period can, depending on many factors, last for several months. In addition, when the sutures diverge, there is a risk of infection and purulent complications. Scars always look rougher if there has been a dehiscence of the seams. In addition, such a condition, after penetration through the anterior abdominal wall, often leads to the development of hernias.

What to do if the seams come apart?

If the seam breaks, doctors have two ways to solve this problem. Conservative involves performing special permanent dressings until the wound heals completely on its own. When the issue is resolved promptly, the cause of the suture dehiscence is eliminated during a repeat operation, followed by subsequent re-suturing of the wound.

AND close location edges, both conservative and surgical treatment, which is used primarily for cosmetic purposes.

Repeated surgery is performed if the wound is large, but the operation makes sense only if it is possible to establish the cause of the suture dehiscence. A wound that has opened after suppuration will heal after the purulent process is eliminated, but for example, a wound on the foot or leg or atherosclerotic vascular lesions will continue to be provoked by a lack of blood circulation. Repeated suturing of such wounds may not be successful.