What Is a Suture Granuloma?
A suture granuloma is a small mass of clustered immune cells that may develop around the site of a surgical procedure. It is a potential complication of surgery that can be an increased risk in certain cases, as some types of sutures appear to promote granuloma formation. In a patient with a history of surgeries, small masses must be evaluated with care to differentiate between benign and malignant growths, and it may be necessary to perform a biopsy to determine what kinds of cells are involved.
In the case of a suture granuloma, the immune cells cluster to create a wall between the rest of the body and a foreign object. The immune system may determine that sutures, staples, fixators, and other surgical devices are dangerous, and can use scarification and clumps of immune cells to isolate these materials. This can create the appearance of a lump at the suture site that may protrude from the skin and can appear red and irritated in some cases.
Sometimes, a granuloma develops shortly after surgery, while in other cases, it may develop in the long term in response to the irritation caused by staples and permanent sutures. The patient may be concerned by the appearance of the lump and may report it to a medical professional. An evaluation can include a quick palpation, a discussion of the patient's history, and a needle aspiration biopsy to find out what kinds of cells are involved.
If the growth is a simple suture granuloma, the medical professional may not recommend any treatment. In cases where the growth impedes movement or causes a cosmetic problem, it can be removed. After removal, the surgeon can recontour the skin to remove any lumps or dips, and may recommend the use of compression bandages and other tools to limit the development of another lump. Sometimes, however, the granuloma may become recurrent, and it could create a lifelong problem for the patient.
Patients should monitor their surgical sites carefully for issues like heat, swelling, changes in skin color or texture, and strange growths. Surgeons prefer to err on the side of caution and can examine a patient with concerns about anything occurring at the site of an incision. Since this type of granuloma can mimic a more invasive growth, and vice versa, it is important to accurately diagnose the growth with the assistance of a biopsy to determine whether it is a risk.
Are Suture Granulomas Rare?
Due to advances in surgery and the sutures used today, suture granulomas do not occur often. Silk sutures that the body can’t absorb may result in surgical granulomas in up to 7 percent of surgeries. With reduced use of non-absorbable silk sutures, which can result in higher rates of suture granulomas, the rate of these growths dropped.
Suture granulomas occur more often in surgeries close to the skin, such as Mohs surgery for skin cancer. Since suture granulomas can occur years after surgery, patients may not think surgical sutures are the cause. Suture granulomas may seem like unexplained growths at first glance.
Is a Suture Granuloma the Same as a Keloid?
Keloid scars are raised spots that can develop after a skin injury, usually on the shoulders, earlobes, cheeks, or chest. Suture granulomas are an inflammatory reaction by the body to the stitches or staples used to close surgical wounds. Keloids are reactions to an injury, while granulomas react to the sutures.
Neither of these skin conditions is harmful unless infected, but they might be painful or unsightly enough to prompt their removal. Talk to a doctor or a dermatologist if you would like to get your keloid scar or suture granuloma treated.
Is a Suture Granuloma the Same as a Post-Surgical Seroma?
A post-surgical seroma is a sterile buildup of fluid underneath the skin, typically at the site of an incision. Seromas can look swollen, and may feel tender or sore. Like suture granulomas, post-surgical seromas will usually go away on their own, but if one is large or causing pain, your doctor may decide to drain it.
To tell the difference between a suture granuloma and a post-surgical seroma, examine the area of the growth. If it is around a suture and does not cause pain, it is probably a granuloma. If it looks like a raised lump underneath the skin near the incision site and is slightly painful, it is probably a seroma.
Is a Suture Granuloma the Same as a Scar?
No. Suture granulomas are a buildup of immune cells, while scars are a buildup of tissue. While suture granulomas will disappear with time or treatment, scars are often permanent, depending on the severity of the wound.
There are also a few different types of scars, including keloid, hypertrophic, pitted, and contracted scars. Each type depends on the type of injury you have sustained. You can treat scars through massage, pressure dressings, silicone gels, or professional help, but a scar will likely remain with you for the rest of your life.
Are Suture Granulomas Painful?
Most suture granulomas are not painful. Painful suture granulomas should be examined by a physician, as the pain could be a sign of infection.
A dermatologist may surgically remove painful suture granulomas that don’t respond to anti-inflammatory treatments, oral steroids, or antibiotics.
How Can I Prevent Suture Granulomas?
You can’t necessarily prevent suture granulomas, but there are plenty of things you can do to take care of your wound while it heals. Take painkillers to relieve pain and swelling. Keep the wound moist to prevent and lift any scabbing, and to promote skin cell regeneration. Treat the area with care, as the skin will be delicate, even after your doctor removes the stitches.
Is Infection Common After Surgery?
If you have an unusual growth or scarring after surgery, you may be worried that your wound has become infected. Luckily, there is only a 1-3% chance that you will develop a surgical site infection (SSI). The infection could be at the surface level, within the incision, or in the organs.
Signs of an infection include redness, delayed healing, warmth around the wound site, tenderness, fever, pain, and swelling. Sometimes, wounds may discharge pus. If you believe that you have an SSI, contact your doctor immediately. Antibiotics treat infections, but it’s important to catch them early on.
The Bottom Line
Suture granulomas may be alarming to see weeks, or even months or years, after surgery. Many people, especially cancer patients, may think they have a tumor if a suture granuloma is particularly large.
Suture granulomas may look like a skin cancer recurrence, but these growths are benign. Most suture granulomas don’t require treatment and will go away on their own. Infection, pain, or unsightliness may prompt a visit to the doctor or dermatologist to ensure there is no infection.
As with any skin growth, a consultation with your primary care physician or dermatologist could be vital. Once a doctor diagnoses a suture granuloma, patients and their health care team can decide whether treatment or removal is needed.
I have one on my foot after major foot surgery. Bad enough to be completely non weight bearing for 8 weeks, then this happened. It became infected and was drained, then surgically removed and now it appears to be infected again. I hope this isn't a life long problem for me. I keep seeing the foot surgeon. Maybe I should see a dermatologist.
I have had two of these. The first one I had after oral surgery to remove a very small nodule on the inside of the lip on my mouth. Then I had that one removed by a plastic surgeon because I refused to go back to the oral surgeon. Now I have the same thing again! They sent both of them to the lab and they are benign - which is great. But how can I get rid of this lump on my lip? It hurts and interferes with my eating too.
Is incision granuloma cancerous?
What would the ICD-9 code be for this?
I have my second granuloma at the site of a drainage tube used to drain fluid from a seroma resulting from extensive hernia repair surgery. It is ugly, and it hurts. I had surgery to remove the first one, and it seemed to heal fine. Yet at the 3.5 month point, it reappeared, at least as bad as before. Any ideas/comments? Is there any need for a second opinion beyond the surgeon involved?
I have a granuloma on my shoulder after rotator cuff surgery. It was there when the bandage was removed and became sore and painful. The surgeon aspirated it and the report came back negative but he said he was concerned and wants to surgically remove it and that means another procedure in the hospital. I however do not want to go to surgery again. Does anyone know the risk of leaving it alone.
Granuloma of sutures can be extremely painful.
@strawCake - I think it's nice you were all so concerned about your sister. Everyone should have family to take care of them during medical procedures.
As the article said, suture granuloma is looks much scarier than it actually is. One of my friends had it after she had surgery and her doctor didn't even want to remove it. However, my friend is a bit vain and she insisted-she just didn't like the way it looked!
Wow suture granuloma really adds insult to injury, pardon the pun! Having surgery is stressful enough without finding a strange lump or bump at the incision site.
My sister broke her elbow a few years ago and had to have two surgeries: one to put pins in, and one to take them out. Maybe my family is a little dramatic, but we were all nervous wrecks when she has her surgeries.
We were also extremely overbearing about making sure the incision healed up properly too! I can imagine we would have all lost our minds if she had developed any lumps while she was healing.
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