Key Practice Points
Suture removal times vary from 4 to 14 days depending on the location of the laceration.
Sutures are removed from the face within 4 to 5 days to prevent the formation of epithelial plugs or “stitch” marks).
Most repaired lacerations are minimally painful. Discomfort can be managed with acetaminophen or nonsteroidal antiinflammatories.
Elevation of the wounded part can significantly reduce pain and swelling.
Sutured or stapled wounds can be bathed (without immersion) in a shower within 12 to 24 hours after repair.
Signs of wound infection include pain, swelling, redness, purulent discharge, and red streaks.
A laceration can take up to 1 year to reach its final appearance. In the first few weeks, it can be red and swollen but eventually lose its red color and flatten out. Informing the patient of these phases can be very helpful.
Wound aftercare includes return scheduling for suture removal, aftercare instructions to the patient, and information on what to expect as the wound heals. When carefully and fully informed, most patients take good care of their wounds and dressings. Written instructions are followed best when reinforced with unhurried verbal explanations. Because each wound and patient differs, information about dressing care, limitations of activity, bathing, and suture removal has to be individualized. Patients often expect that healing is complete when the sutures are removed. If educated about the changes that a wound undergoes over months, patients are more likely to understand and accept the wound’s appearance.
Suture and Staple Removal
Timing of Removal
The recommended intervals between wound repair and suture or staple removal are listed in Table 22-1 . In the face, where cosmetic appearance is paramount, sutures are removed as early as possible; this is done with the knowledge that a facial wound has barely begun to gain tensile strength at the time of suture removal. Minimal accidental force can cause disruption and can dehisce the laceration. The application of wound tapes for continued support over healing lacerations is recommended. A return visit for tape removal and wound adhesive closure is not necessary.
|Location||Days to Removal|
If wound tapes are the primary method of wound closure, they can be left in place for 10 days without causing complications. Adhesives flake off in 5 to 10 days. At minimum, these alternative closures should support the wound for the time recommended for sutures.
Suture punctures are small wounds. Epithelial cells invade these small wounds, leaving keratinized epithelial “plugs” caught in the healing suture wound. This phenomenon produces unsightly “railroad tracks” that can be avoided if sutures are removed in fewer than 7 to 8 days. Skin tapes and wound adhesives as wound closure methods are alternative techniques to avoid suture tracking. The subcuticular and pull-out dermal closures described in Chapter 11 are other closure options.
In other areas of the body, where cosmetic appearance is not as important and wound healing is not as rapid as in the highly vascular face, sutures are left in place for longer periods. Extensor surfaces of joints require longer times before removal because of the mechanical forces brought to bear on the healing wound. Because of the dependency of the lower extremities and their relatively slower rate of healing, sutures in those lower extremity sites are left in place longer as well.
Technique for Removal
The technique for suture removal is illustrated in Figure 22-1 . Staple removal is discussed in Chapter 14 . The suture is cut under the knot, close to the skin surface, so that when it is pulled from the wound, the previously exposed and contaminated portion of the suture does not travel back through the wound. Although standard scissors can be used for most suture removal tasks, iris scissors or a no. 11 scalpel blade is recommended to cut the fine sutures used on the face. Bandage or commercial suture removal scissors have tips that often are too blunt to cut small, closely spaced sutures easily. Before removal, all dried coagulum is removed gently from the suture line with cotton swabs and hydrogen peroxide. Cleaning away the coagulum makes locating small sutures and knots much easier. In addition, it prevents the unnecessary tugging and pulling that often accompany suture removal when sutures are excessively crusted.