Immortal plain gut sutures: A case report
Hannah Anderson1, Kathryn Lynn2, Raziyeh Mahmoudzadeh2
1Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
Purpose:
We report the case of a 79-year-old male who presented with irritation and foreign body sensation due to the subconjunctival plain gut sutures that did not dissolve three years after undergoing pars plana vitrectomy (PPV) for macular hole repair.
Observation:
A 79-year-old male presented with foreign body sensation and irritation in his left eye. On slit lamp examination, the source of the foreign body sensation was two apparently intact plain gut sutures were visible under the conjunctiva, nasal and temporal to the cornea. These plain gut sutures were placed at the conclusion of PPV surgery three years prior to presentation. After discussion, the patient elected suture removal, and two thin, translucent suture fragments were removed. Histopathologic evaluation revealed eosinophilic dense collagenous material with frayed edges, compatible with gut suture, associated with rare macrophages and scant fibrous tissue.
Conclusion And Importance:
The sclerotomies created for PPV occasionally need to be sutured at the conclusion of surgery to ensure wound closure, to retain tamponade, or to reduce endophthalmitis risk. Plain gut sutures have been shown to cause less scleral inflammation and to improve patient comfort compared to Vicryl sutures. However, in this case the plain gut sutures had not dissolved three years after PPV and had caused discomfort for patient and needed to be removed.
Insights
Non-dissolving plain gut sutures caused persistent irritation years after pars plana vitrectomy (PPV). Surgical removal was necessary to alleviate the patient's foreign body sensation and discomfort.
Area of Science:
- Ophthalmology
- Surgical Innovation
- Biomaterials Science
Background:
- Pars plana vitrectomy (PPV) is a common surgical procedure for various retinal conditions.
- Sclerotomies created during PPV may require suturing for wound closure and complication prevention.
- Plain gut sutures are sometimes used for their perceived lower inflammatory profile.
Observation:
- A 79-year-old male experienced chronic foreign body sensation and irritation in his left eye.
- Examination revealed non-dissolved plain gut sutures in the subconjunctiva, three years post-PPV.
- Histopathology confirmed the sutures as dense collagenous material consistent with gut.
Findings:
- Plain gut sutures, intended for absorption, failed to dissolve three years after PPV.
- The persistent sutures caused significant patient discomfort and foreign body sensation.
- Suture fragments were successfully removed, providing symptomatic relief.
Implications:
- This case highlights the potential for delayed or absent absorption of plain gut sutures.
- It underscores the importance of long-term monitoring for suture-related complications after PPV.
- Consideration of alternative suture materials or techniques may be warranted to ensure predictable absorption and patient comfort.
