Tendon Suture Rejection: Symptoms and Management

Post-suture rejection reaction of finger tendon repair?

Last October, I injured my left hand and after an emergency visit, I was transferred to orthopedics where I learned that the tendon on the left side of my ring finger was ruptured (I believe it was the flexor tendon).
After surgery, I underwent rehabilitation; although I cannot fully extend it like before, it does not affect functionality.
However, in March of this year, the scar area suddenly began to protrude gradually, and there were small black dots that appeared translucent in the middle.
Upon returning for a check-up, I was informed that this was a suture extrusion reaction and was advised not to undergo surgery unless there was pain (as they were concerned that the tissue might not heal properly and the repaired tendon could rupture again).
Currently, the protruding area has turned a pinkish-purple color (deeper than the surrounding skin), it itches and hurts when lightly touched, has a dull sensation (the fingertip has sensation, but the left side still feels numb), and there seems to be reduced blood circulation (sometimes the ring finger feels cooler in that area compared to the rest).
I would like to know if this situation is normal, whether the extrusion reaction will resolve on its own, and if there are any suggestions for improvement (to reduce the extrusion reaction, etc.).

Dou Dou, 20~29 year old female. Ask Date: 2020/12/11

Dr. You Dianqi reply Orthopedics

Hello, if there is a reaction to the ends of non-absorbable sutures used for tendon repair, it may persist for some time due to their non-absorbable nature.
I recommend soaking in warm water to promote peripheral circulation.
Wishing you a speedy recovery.
Thank you.

Reply Date: 2020/12/11

More Info

Tendon suture rejection, also known as suture granuloma or foreign body reaction, can occur after tendon repair surgery. This condition arises when the body reacts to the suture material used to hold the tendon together. In your case, it seems that you are experiencing a localized reaction at the site of the tendon repair, characterized by a raised, translucent area with a black dot, which may indicate the presence of suture material that is being extruded from the body.

Symptoms of Tendon Suture Rejection
The symptoms you are describing are consistent with a foreign body reaction. These may include:
1. Localized Swelling: The area around the suture site may become raised and swollen, as you have observed.

2. Color Changes: The skin may change color, becoming red, purple, or darker than the surrounding area, indicating inflammation or irritation.

3. Pain and Itching: Light touch causing pain or itching is common, as the body is reacting to the foreign material.

4. Altered Sensation: You mentioned that the sensation in the affected area is dull or delayed, which can occur due to nerve irritation or damage during the initial injury or surgery.

5. Temperature Changes: The affected finger may feel cooler than the surrounding areas, which could indicate reduced blood flow or circulation issues.

Management and Recommendations
1. Observation: If there is no significant pain or functional impairment, your doctor may recommend a watchful waiting approach. Many cases of suture rejection resolve on their own as the body gradually expels the foreign material.

2. Avoiding Surgery: As your doctor advised, surgical removal of the suture may not be necessary unless you experience severe symptoms or functional limitations. Surgery carries risks, including the potential for re-injury to the tendon.

3. Topical Treatments: Over-the-counter topical corticosteroids may help reduce inflammation and itching. However, consult your healthcare provider before starting any new treatment.

4. Physical Therapy: Continuing with physical therapy can help maintain mobility and function in your finger. A therapist can provide exercises to improve circulation and reduce stiffness.

5. Monitoring Symptoms: Keep an eye on the area for any changes. If you notice increased pain, swelling, or signs of infection (such as warmth, redness, or discharge), contact your healthcare provider promptly.

6. Consultation with a Specialist: If symptoms persist or worsen, consider seeking a second opinion from a hand specialist or orthopedic surgeon who can provide further evaluation and management options.

Conclusion
While the symptoms you are experiencing can be concerning, they are not uncommon following tendon repair surgery. Many patients experience some degree of foreign body reaction, and with appropriate management, the situation often improves over time. It's essential to maintain open communication with your healthcare provider and follow their recommendations closely. If you have any further questions or concerns, do not hesitate to reach out for more personalized advice.

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