Definition & Overview
Patients who have had non-absorbable sutures placed following a surgical procedure are scheduled for a routine suture removal once the wound has healed to some extent.
Sutures are commonly used in cases wherein the skin is not expected to come together without being stitched back, primarily due to the size of the wound. In some cases, absorbable sutures are used, which means the body will absorb the suture material within 60 days. However, there are some cases or injuries wherein absorbable sutures are not suitable, such as when the suture has to maintain its strength for longer than 60 days. In such cases, non-absorbable sutures are used, which are removed once the wound has fully healed.
Suturing or stitching the skin back together remains one of the most commonly used techniques in closing wounds despite the rise of other wound closure methods, such as surgical staples, skin glue, and skin tapes.
Who Should Undergo and Expected Results
The procedure is for patients who underwent surgery wherein an incision was made and sutures were used to close up the wound. It is also performed on patients who had sutures placed as part of their treatment following a traumatic skin injury that caused a deep or large tear on the skin.
Suture removal is performed only when the wound has healed up to a certain extent or when the skin has regained around 10% of its full tensile strength. At this point, the skin is strong enough to keep the wound closed, but is also still flexible enough to make suture removal easy. If sutures are left in place for far too long, it is possible that the skin will heal around them, in which case they will be harder and more painful to remove.
However, the removal procedure is sometimes delayed if wound healing is not achieved in time usually due to:
- Existing diseases
- Disorders or syndromes
- Previous surgery using the same suture location
- The use of certain drugs, such as steroids, anti-inflammatories, or cytotoxic medications
- Poor nutrition
- The condition of the wound, such as if it receives sufficient blood supply or became infected
- Location of the wound
- Humidity or dehydration of the wound
- The patient’s age
Due to the rise of dissolvable sutures and minimally invasive procedures, suture removal is no longer always required in all surgical cases. Nevertheless, it is still a major part of post-surgical care and follow-up in many surgical cases. Surgeons typically inform their patients on when to come back to have the sutures removed. Until then, the patients are instructed on how to properly care for the wound to ensure its prompt healing.
The approximate time during which sutures need to be removed is usually influenced by the location of the wound. Sutures used on facial wounds can be removed after 3 to 5 days, while those on the scalp or trunk need at least 7 to 10 days before they can be removed. Sutures on the arms, legs, and joints are usually left in place for at least 10 days to 2 weeks before they can be safely removed.
How is the Procedure Performed?
A suture removal is an outpatient procedure that may cause slight discomfort, which has been described as a pulling or stinging sensation. Sutures are typically taken out completely in a single visit, but in some cases, especially if the wound so requires, the sutures may need to be removed gradually over a series of visits.
Prior to removing the sutures, the surgeon first cleans the wound with an antiseptic to make sure that no scar tissue or encrusted blood is left. He then picks up the knot of the sutures using sterile forceps, then cuts the suture with a pair of surgical scissors. This effectively loosens the suture, allowing the surgeon to pull the thread gradually away from the skin.
Once the suture is removed, the surgeon cleanses the wound and places an adhesive strip over it to protect it as the healed skin continues to regain its full tensile strength.
Patients are then given instructions on how to take care of the wound, which still needs to be protected from further injury for at least a month after the suture removal procedure.
Possible Risks and Complications
The procedure is associated with a number of possible post-removal complications, which include:
- Wound reopening, which may occur if the sutures were removed prematurely
- Severe scarring
- Keloid formation, or when a large and firm mass of scar tissue forms over or near the site of the wound
Silloway KA., Morgan RF., Kenney JG., Edlich RF. “Innovations in skin suture removal.” The American Journal of Surgery. 1985 June; 149(6): 799-801. http://www.americanjournalofsurgery.com/article/S0002-9610(85)80190-2/abstract
Parirokh M., Asgary S., Eghbal MJ. “The effect of different suture removal time intervals on surgical wound healing.” Iran Endod J. 2006 Fall; 1(3): 81-86. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3895885/
Barber G. “Removal of sutures.” Br Med J. 1952 Nov 15; 2(4793): 1103. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2022054/