2021 Volume 33 Issue 3 Pages 107-112
Stitch abscesses may occur following surgery for head and neck cancer. The clinical symptoms and image findings cannot always differentiate them from local recurrence or lymph node metastasis.
We report a case of multiple stitch abscesses which occurred in the surgical site following a neck dissection for squamous cell carcinoma of the oral floor.
A 71-year-old female underwent bilateral supra-omohyoid neck dissection, tumor resection of the oral floor, and reconstruction using a vascularized free forearm flap of the right side of the oral floor. About four months after the surgery, subcutaneous abscesses were found in the bilateral submandibular region, and suture threads were found in these abscesses. Consequently, a diagnosis of stitch abscesses was made. Thereafter, multiple subcutaneous mass lesions were found from the submandibular to the middle region of the neck. Although CT, MR, and FDG-PET indicated cervical recurrence, ultrasonography revealed foreign bodies suspected to be stitches. We biopsied a subcutaneous tumor in the submandibular region and silk thread used for ligation was found in the abscess. Histopathological examination indicated local inflammatory cellular infiltration surrounding the stitches with granulation tissue due to angiogenesis. Consequently, a diagnosis of stitch abscesses was made. Similar findings were indicated under the skin in the donor forearm site. The removed specimens revealed a stitch abscess.
The change to absorbable sutures for vascular ligation still has many problems in Japan. Effective use of energy devices under appropriate conditions may be one method to reduce the risk of stitch abscess formation.
