Skip to main content
NCBI home page
Journal of Advanced Pharmaceutical Technology & Research logoLink to Journal of Advanced Pharmaceutical Technology & Research
. 2022 Dec 30;13(Suppl 2):S432–S436. doi: 10.4103/japtr.japtr_309_22

Awareness on the management strategy of stitch abscess among dental students

R Bharathi 1, Dhanraj Ganapathy 1, Nabeel Ahmed 1, Subhabrata Maiti 1,✉, Kiran Kumar Pandurangan 1
PMCID: PMC9926624  PMID: 36798554

Abstract

Stitch abscesses are abscesses that develop following surgical procedures as a result of suture infections. Because of nonabsorbable sutures, the material reacts with connective tissue, generating adhesions around the stitch. The use of this type of material increases the risk of infection. The aim of this study was to establish awareness on the management strategy of suture stitch abscess among dental students. An online survey consisting of ten questions about suture stitch abscess along with sociodemographic factors was circulated among equal numbers of 2nd years, 3rd years, final years, and compulsory rotatory residential internship (CRRI). The data obtained from the questionnaire were transferred to Microsoft Excel and imported to SPSS software for statistical analysis. Interns are more aware about the complications and management strategy of suture stitch abscesses compared to others. Awareness on the management strategy of suture stitch abscess is important, and it helps to reduce the side effects to improve the outcomes. Educating the risk factors, signs and symptoms, and management strategy is the best way to help raise awareness.

Keywords: Awareness, complication, dental students, innovation, management, suture stitch abscess

INTRODUCTION

Sutures are employed to repair open wounds, reduce infection, and accordingly minimize the formation of scars. Stitch abscesses, or abscesses caused by suture infections, are a common complication following surgical treatments. It has been difficult to tell the difference between lymph nodes that metastasize and stitch abscess or recurrence at the local site of the main tumor after surgery for malignant malignancies.[1] Stitch abscesses might be diagnosed with precision using ultrasonography.[2,3]

Silk sutures react with connective tissue generating adhesions surrounding the suture which increases the risk of infections.[4] According to past studies comparing silk suture material and polyglycolic acid, the silk suture material used in operational procedures is declining to avoid complications causing suture abscess in the wounds due to trauma, the damage of Achilles tendon, the incisions of abdomen, and liver resection surgery.[5] The degree of inflammatory reaction in human gingival tissues varies depending on the suture material utilized. Because of bacterial adherence, silk suture generates an increased severe inflammatory response than sutures that are absorbable. As a result, employing silk sutures should raise the risk of oral mucosa suture abscesses.[6]

A stitch abscess is caused by an infectious reaction and pathological effects of the infectious and immunologic responses to sutures.[7] When it comes to allergy reactions, younger people are more sensitive to allergens than older people. As a result, as foreign substances, sutures may elicit a higher allergic response in younger people.[8] There was a strong link between the patients with allergy history and the sutural stitch abscesses. Furthermore, liver failure was linked to the development of stitch abscesses.[9]

To minimize stitch abscesses, silk suture materials should not be employed in surgical process which includes patients with very young age, past allergic responses, or problems in the liver.[10,11] Our team has extensive knowledge and research experience that has translated into high-quality publications.[12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38] The aim of this current study is to evaluate the awareness on the management strategy of suture stitch abscess among dental students.

MATERIALS AND METHODS

Survey design

The survey was performed among 123 undergraduate dental students studying in a private dental college and hospital in Chennai. All the students in this study gave their voluntary consent to participate in this study. The questionnaire was given to the students. This survey was approved by the university ethical clearance committee (number IHEC/SDC/PROSTHO/21/045).

Data collection

A structured questionnaire was generated. The questionnaire consisted of eight close ends evaluating the student's awareness regarding the suture stitch abscess. It also included sociodemographic information such as name, gender, and year of study.

Questions and variables

The first part of the questionnaire included three questions about the student's sociodemographic details. The second part consisted of eight questions evaluating the student's attitude and awareness about suture stitch abscesses. The participants were given instructions to select the most appropriate answer.

Data analysis

The results were recorded and analyzed using the software SPSS by IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. Analysis of this study is expressed in terms of association of knowledge and attitude and percentage toward suture stitch abscess using the Chi-square test.

RESULTS

In this survey out of 123 students (n = 123), 47.15% (58) were male and 52.85% (65) were female. In this study, 24.39% were 2nd-year BDS, 25.20% were 3rd-year BDS, 25.20% were 4th-year BDS, and 25.20% were intern BDS [Figure 1]. The graph shows awareness of various questions about stitch abscess among dental students for question 1 [Figure 2], question 2 [Figure 3], question 3 [Figure 4], and question 4 [Figure 5].

Figure 1.

Figure 1

Open in a new tab

Bar graph shows the distribution of students with their year of study. There is not much difference in the distribution of this survey regarding the year of study

Figure 2.

Figure 2

Open in a new tab

Bar chart shows the correlation of study year and awareness toward suture stitch abscess. Second-year BDS students have a poor awareness about suture stitch abscesses (Chi-square test [26.278a] - P < 0.05, significant)

Figure 3.

Figure 3

Open in a new tab

Bar graph shows the correlation of study year and awareness toward the organism causing suture stitch abscess. Interns have a good awareness about organisms causing the suture stitch abscess (Chi-square test [19.775a] - P < 0.05, significant)

Figure 4.

Figure 4

Open in a new tab

Bar graph shows the correlation of study year and awareness toward the complications of suture stitch abscess. Interns have a good awareness about complications causing the suture stitch abscess compared to others (Chi-square test [22.010a] - P > 0.05, not significant)

Figure 5.

Figure 5

Open in a new tab

Bar graph shows the correlation of study year and awareness toward the management of suture stitch abscess. Interns have a good awareness about treatment options of suture stitch abscesses (Chi-square test [14.765a] - P > 0.05, not significant)

DISCUSSION

Heat, redness, swelling, and discomfort are all signs of inflammation, making superficial abscesses easy to spot. Abscesses in other parts of the body may simply create broad symptoms such as fever and discomfort.[39,40] On physical examination, pain and soreness are common findings. A deep abscess may consume a little tube (sinus) leading to the surface and begin oozing pus.[41]

Without treatment, an infection in your stitches can spread to other parts of your skin or body, resulting in abscess formation, cellulitis, or even sepsis.[42] Sample discharge from infected stitches can be collected and used to help identify the bacteria causing the infection.[43] Once a bacterial infection is confirmed, antibiotic susceptibility testing can be done to determine which antibiotics will be most effective for treating the infection.[44] Other tests and culturing methods can be used if a fungal infection is suspected. If the infection is small or localized, an antibiotic cream can be prescribed to apply to the site. If the infection is more serious or affects a larger area, an oral antibiotic can be prescribed. The results from antibiotic susceptibility testing can be used to determine which antibiotic is best to treat the infection. A very severe infection may require intravenous antibiotics or surgical removal of any dead or dying tissue.[45,46,47]

To avoid problems such as stitch abscesses, all oral and maxillofacial surgeons should reconsider using silk sutures for blood vessels in case of high ligation in surgeries of oral SCC right away.[48] Simultaneously, current knowledge regarding the risks of silk sutures must be extensively communicated through reporting on the stitch abscess recurrence following surgery of oral cancer, including dental surgical procedures. There were no studies that assessed the awareness of management strategies among dental students.[49]

CONCLUSION

Interns are more aware about the complications and management strategy of suture stitch abscesses compared to others. Awareness on the management strategy of suture stitch abscess is important, and it helps to reduce the side effects to improve the outcomes. Educating the risk factors, signs and symptoms, and management strategy to dental students irrespective of their study year is the best way to help raise awareness.

Financial support and sponsorship

The present study is funded by the:

  • Saveetha Institute of Medical and Technical Sciences

  • Saveetha Dental College and Hospitals

  • Saveetha University

  • Sri Balaji Transport and Suppliers PVT Ltd., Chennai.

Conflicts of interest

There are no conflicts of interest.

Acknowledgment

The authors acknowledge Saveetha University for all the help and support.

REFERENCES

  • 1.Hong JS, Yoo SJ, Shin HK. A new technique of suturing using adhesive skin closure for uncooperative patients. Int Wound J. 2022:1–8. doi: 10.1111/iwj.13787. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Kronborg O. Polyglycolic acid (Dexon) versus silk for fascial closure of abdominal incisions. Acta Chir Scand. 1976;142:9–12. [PubMed] [Google Scholar]
  • 3.Sheriff KA, Chandana CS, Ganapathy D. Knowledge and Awareness towards Herbals Substitutes for Root Canal Disinfectants among Dental Students. JPRI. 2020;32:160–70. Article no. JPRI59807. [Google Scholar]
  • 4.Nagar H. Stitch granulomas following inguinal herniotomy: A 10-year review. J Pediatr Surg. 1993;28:1505–7. doi: 10.1016/0022-3468(93)90442-n. [DOI] [PubMed] [Google Scholar]
  • 5.Calkins CM, St Peter SD, Balcom A, Murphy PJ. Late abscess formation following indirect hernia repair utilizing silk suture. Pediatr Surg Int. 2007;23:349–52. doi: 10.1007/s00383-007-1894-x. [DOI] [PubMed] [Google Scholar]
  • 6.Togo S, Kubota T, Takahashi T, Yoshida K, Matsuo K, Morioka D, et al. Usefulness of absorbable sutures in preventing surgical site infection in hepatectomy. J Gastrointest Surg. 2008;12:1041–6. doi: 10.1007/s11605-007-0297-6. [DOI] [PubMed] [Google Scholar]
  • 7.Carmont MR, Silbernagel KG, Edge A, Mei-Dan O, Karlsson J, Maffulli N. Functional outcome of percutaneous Achilles repair: improvements in Achilles tendon total rupture score during the first year. Orthopaedic Journal of Sports Medicine. 2013;1:2325967113494584. doi: 10.1177/2325967113494584. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Imamoğlu M, Cay A, Sarihan H, Ahmetoğlu A. Paravesical suture granuloma simulating a local recurrence of the immature sacrococcygeal teratoma. J Pediatr Surg. 2005;40:584–5. doi: 10.1016/j.jpedsurg.2004.11.018. [DOI] [PubMed] [Google Scholar]
  • 9.Imamoglu M, Cay A, Sarihan H, Ahmetoglu A, Ozdemir O. Paravesical abscess as an unusual late complication of inguinal hernia repair in children. J Urol. 2004;171:1268–70. doi: 10.1097/01.ju.0000113037.59758.6b. [DOI] [PubMed] [Google Scholar]
  • 10.Khan MW, Aziz MM. Experience in laparoscopic cholecystectomy. Mymensingh Med J. 2010;19:77–84. [PubMed] [Google Scholar]
  • 11.Hsu TC, Wang CL, Wang TG, Shieh FJ. Sonographic detection of a stitch abscess. J Clin Ultrasound. 1998;26:225–7. doi: 10.1002/(sici)1097-0096(199805)26:4<225::aid-jcu11>3.0.co;2-i. [DOI] [PubMed] [Google Scholar]
  • 12.Avinash K, Malaippan S, Dooraiswamy JN. Methods of isolation and characterization of stem cells from different regions of oral cavity using markers: A systematic review. Int J Stem Cells. 2017;10:12–20. doi: 10.15283/ijsc17010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Pratha AA, Thenmozhi MS. A study of occurrence and morphometric analysis on meningo orbital foramen. Res J Pharm Technol. 2016;9:880–2. [Google Scholar]
  • 14.Nair M, Jeevanandan G, Vignesh R, Subramanian EM. Comparative evaluation of post-operative pain after pulpectomy with k-files, kedo-s files and mtwo files in deciduous molars-a randomized clinical trial. Brazilian dental science. 2018;21:411–7. [Google Scholar]
  • 15.Kannan R, Thenmozhi MS. Morphometric study of styloid process and its clinical importance on Eagle's syndrome. Res J Pharm Technol. 2016;9:1137–9. [Google Scholar]
  • 16.Samuel AR, Thenmozhi MS. Study of impaired vision due to Amblyopia. Research Journal of Pharmacy and Technology. 2015;8:912–4. [Google Scholar]
  • 17.Viswanath A, Ramamurthy J, Dinesh SP, Srinivas A. Obstructive sleep apnea: Awakening the hidden truth. Niger J Clin Pract. 2015;18:1–7. doi: 10.4103/1119-3077.146964. [DOI] [PubMed] [Google Scholar]
  • 18.Dinesh SP, Arun AV, Sundari KK, Samantha C, Ambika K. An indigenously designed apparatus for measuring orthodontic force. J Clin Diagn Res. 2013;7:2623–6. doi: 10.7860/JCDR/2013/7143.3631. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Varghese SS, Thomas H, Jayakumar ND, Sankari M, Lakshmanan R. Estimation of salivary tumor necrosis factor-alpha in chronic and aggressive periodontitis patients. Contemp Clin Dent. 2015;6:S152–6. doi: 10.4103/0976-237X.166816. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Priyanka S, Kaarthikeyan G, Nadathur JD, Mohanraj A, Kavarthapu A. Detection of cytomegalovirus, Epstein-Barr virus, and torque teno virus in subgingival and atheromatous plaques of cardiac patients with chronic periodontitis. J Indian Soc Periodontol. 2017;21:456–60. doi: 10.4103/jisp.jisp_205_17. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Panda S, Jayakumar ND, Sankari M, Varghese SS, Kumar DS. Platelet rich fibrin and xenograft in treatment of intrabony defect. Contemp Clin Dent. 2014;5:550–4. doi: 10.4103/0976-237X.142830. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Kasabwala H, Maiti S, Ashok V, Sashank K. Data on dental bite materials with stability and displacement under load. Bioinformation. 2020;16:1145–51. doi: 10.6026/973206300161145. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Agarwal S, Maiti S, Ashok V. Correlation of soft tissue biotype with pink aesthetic score in single full veneer crown. Bioinformation. 2020;16:1139–44. doi: 10.6026/973206300161139. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Sharmila R, Subhabrata Maiti, Jessy P. Comparative Analysis Of Abrasion Resistance In Relation To Different Temporary Acrylic Crown Material Using Toothbrush Simulator- An In vitro Study. Int J Dentistry Oral Sci. 2021;08:2153–7. [Google Scholar]
  • 25.Ponnanna AA, Maiti S, Rai N, Jessy P. Three-dimensional-printed malo bridge: Digital fixed prosthesis for the partially edentulous maxilla. Contemp Clin Dent. 2021;12:451–3. doi: 10.4103/ccd.ccd_456_20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Agarwal S, Ashok V, Maiti S. Open- or closed-tray impression technique in implant prosthesis: A dentist's perspective. J Long Term Eff Med Implants. 2020;30:193–8. doi: 10.1615/JLongTermEffMedImplants.2020035933. [DOI] [PubMed] [Google Scholar]
  • 27.Aparna J, Maiti S, Jessy P. Polyether ether ketone – As an alternative biomaterial for metal richmond crown-3-dimensional finite element analysis. J Conserv Dent. 2021;24:553–7. doi: 10.4103/jcd.jcd_638_20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Merchant A, Ganapathy DM, Maiti S. Effectiveness of local and topical anesthesia during gingival retraction. Braz Dent Sci. 2022;25:e2591. [Google Scholar]
  • 29.Muthukrishnan S, Krishnaswamy H, Thanikodi S, Sundaresan D, Venkatraman V. Support vector machine for modelling and simulation of Heat exchangers. Therm Sci. 2020;24(1 Part B):499–503. [Google Scholar]
  • 30.Nandhini NT, Rajeshkumar S, Mythili S. The possible mechanism of eco-friendly synthesized nanoparticles on hazardous dyes degradation. Biocatal Agric Biotechnol. 2019;19:101138. [Google Scholar]
  • 31.Ezhilarasan D. Oxidative stress is bane in chronic liver diseases: Clinical and experimental perspective. Arab J Gastroenterol. 2018;19:56–64. doi: 10.1016/j.ajg.2018.03.002. [DOI] [PubMed] [Google Scholar]
  • 32.Rajagopal R, Padmanabhan S, Gnanamani J. A comparison of shear bond strength and debonding characteristics of conventional, moisture-insensitive, and self-etching primers in vitro . Angle Orthod. 2004;74:264–8. doi: 10.1043/0003-3219(2004)074<0264:ACOSBS>2.0.CO;2. [DOI] [PubMed] [Google Scholar]
  • 33.Neelakantan P, Sharma S, Shemesh H, Wesselink PR. Influence of irrigation sequence on the adhesion of root canal sealers to dentin: A fourier transform infrared spectroscopy and push-out bond strength analysis. J Endod. 2015;41:1108–11. doi: 10.1016/j.joen.2015.02.001. [DOI] [PubMed] [Google Scholar]
  • 34.Sahu D, Kannan GM, Vijayaraghavan R. Carbon black particle exhibits size dependent toxicity in human monocytes. Int J Inflam 2014. 2014:827019. doi: 10.1155/2014/827019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Jose J, Subbaiyan H. Different treatment modalities followed by dental practitioners for Ellis class 2 fracture–A questionnaire-based survey. The open dentistry journal. 2020:14. [Google Scholar]
  • 36.Wu F, Zhu J, Li G, Wang J, Veeraraghavan VP, Mohan SK, et al. Biologically synthesized green gold nanoparticles from Siberian ginseng induce growth-inhibitory effect on melanoma cells (B16) Artif Cells, Nanomed Biotechnol. 2019;47:3297–305. doi: 10.1080/21691401.2019.1647224. [DOI] [PubMed] [Google Scholar]
  • 37.Dua K, Wadhwa R, Singhvi G, Rapalli V, Shukla SD, Shastri MD, et al. The potential of siRNA based drug delivery in respiratory disorders: Recent advances and progress. Drug Dev Res. 2019;80:714–30. doi: 10.1002/ddr.21571. [DOI] [PubMed] [Google Scholar]
  • 38.Patil SB, Durairaj D, Suresh Kumar G, Karthikeyan D, Pradeep D. Comparison of extended nasolabial flap versus buccal fat pad graft in the surgical management of oral submucous fibrosis: A prospective pilot study. J Maxillofac Oral Surg. 2017;16:312–21. doi: 10.1007/s12663-016-0975-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Javed F, Al-Askar M, Almas K, Romanos GE, Al-Hezaimi K. Tissue reactions to various suture materials used in oral surgical interventions. ISRN Dent 2012. 2012:762095. doi: 10.5402/2012/762095. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Bosilkovska M, Walder B, Besson M, Daali Y, Desmeules J. Analgesics in patients with hepatic impairment: Pharmacology and clinical implications. Drugs. 2012;72:1645–69. doi: 10.2165/11635500-000000000-00000. [DOI] [PubMed] [Google Scholar]
  • 41.Banche G, Roana J, Mandras N, Amasio M, Gallesio C, Allizond V, et al. Microbial adherence on various intraoral suture materials in patients undergoing dental surgery. J Oral Maxillofac Surg. 2007;65:1503–7. doi: 10.1016/j.joms.2006.10.066. [DOI] [PubMed] [Google Scholar]
  • 42.Leknes KN, Røynstrand IT, Selvig KA. Human gingival tissue reactions to silk and expanded polytetrafluoroethylene sutures. J Periodontol. 2005;76:34–42. doi: 10.1902/jop.2005.76.1.34. [DOI] [PubMed] [Google Scholar]
  • 43.Moran SL, Cooney WP, editors. Soft tissue surgery. Philadelphia: Lippincott Williams & Wilkins; 2009. [Google Scholar]
  • 44.Benson EA, Goodman MA. An evaluation of the use of stilboestrol and antibiotics in the early management of acute puerperal breast abscess. Br J Surg. 1970;57:255–8. doi: 10.1002/bjs.1800570404. [DOI] [PubMed] [Google Scholar]
  • 45.Cartmill BT, Parham DM, Strike PW, Griffiths L, Parkin B. How do absorbable sutures absorb.A prospective double-blind randomized clinical study of tissue reaction to polyglactin 910 sutures in human skin? Orbit. 2014;33:437–43. doi: 10.3109/01676830.2014.950285. [DOI] [PubMed] [Google Scholar]
  • 46.Leaper DJ, Page RE, Rosenberg IL, Wilson DH, Goligher JC. A controlled study comparing the conventional treatment of idiopathic anorectal abcess with that of incision, curettage and primary suture under systemic antibiotic cover. Dis Colon Rectum. 1976;19:46–50. doi: 10.1007/BF02590851. [DOI] [PubMed] [Google Scholar]
  • 47.Selvan SR, Ganapathy D. Efficacy of fifth generation cephalosporins against methicillin-resistant Staphylococcus aureus – A review. Res J Pharm Technol. 2016;9:1815–8. [Google Scholar]
  • 48.Gupta R, Sheikh A, Strachan DP, Anderson HR. Burden of allergic disease in the UK: Secondary analyses of national databases. Clin Exp Allergy. 2004;34:520–6. doi: 10.1111/j.1365-2222.2004.1935.x. [DOI] [PubMed] [Google Scholar]
  • 49.Benson EA, Goodman MA. Incision with primary suture in the treatment of acute puerperal breast abscess. Br J Surg. 1970;57:55–8. doi: 10.1002/bjs.1800570113. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Advanced Pharmaceutical Technology & Research are provided here courtesy of Wolters Kluwer -- Medknow Publications

RESOURCES