10. Suture Aftercare
After suturing, your patient should be given instructions for taking care of the sutures and wound. This module covers patient advice, and the recommended timings and procedure for removal of sutures.
In this module
10.01 Advice Prior To Removal Video 1
After suturing, you should advise your patient to keep the wound clean and dry for the first 24 hours.
Bathing is allowed after 48 hours. Patients should gently clean the area with soap and water and pat dry to avoid stress on the wound margins and possible dehiscence (where the wound breaks open along the line of suture).
Any bandage can safely be removed after 48 hours, unless the wound continues to bleed or has a discharge. If a bandage is kept in place but gets wet, it should be replaced with a clean, dry one.
10.02 Advice Prior To Removal Video 2
If a suture becomes loosened or breaks, it is important that the patient notifies their doctor or hospital.
You should explain the symptoms and signs of infection (including redness and streaking, heat, the discharge of pus, swelling, and increasing pain).
You should advise a time for removal of the sutures, depending on the part of the body that has been treated and the healing potential of the individual. For most areas this is usually after 7 to 10 days. Go to the Removing sutures topic for more detailed information.
10.03 Suture Removal
Remove sutures as soon as soon as is safe. Timing will depend on the site of the wound and the healing potential of the individual.
Factors that may delay healing include:
- Poor nutrition/malnutrition
- Poor circulation
- Medication such as anti-inflammatories, steroids and anticoagulants.
- Immunodeficiency, for example as a result of chemotherapy and irradiation
- Age
- Obesity
- Co-morbidities such as diabetes, vascular disease and renal failure
In patients where none of these factors are considered an issue, for most areas sutures should be removed after 7 to 10 days. Facial sutures should be removed after 5 days, and those on the back or legs after 10 to 12 days.
Many patients are very apprehensive about suture removal, so the first step is to reassure the patient that the procedure is not painful.
10.03.01 Principles
Sutures should be removed gently in a good light using a sterile, single use stitch cutter. A stitch cutter is a steel blade with no handle, and various sizes are available.
If a stitch cutter is not available, Mayo scissors with semi-blunt tips are recommended to minimise the risk of the scissor tips inadvertently cutting other structures. However, when removing very fine sutures, Mayo scissors may not be able to get under the suture and sharp pointed scissors will be necessary.
The area should be cleaned thoroughly with an aqueous antiseptic to remove encrusted blood and loosened scar tissue.
To reduce the potential for contamination and post infection, the suture material should be cut as close as possible to where it enters the skin. The suture should then be pulled out gently across the wound ensuring that the section which has been exposed to the outside world is not drawn through the wound.
When removing interrupted sutures it is prudent to remove every other one, and gently assess the wound strength by drawing the edges apart. This allows you to observe signs of dehiscence.
If necessary, apply adhesive strips over the wound to allow it to continue strengthening.
10.03.02 Practise Removing Sutures With Scissors
Grasp the knot with dissecting forceps and then cut the suture precisely with scissors flush with the tissue surface so that the exposed length of suture, which may be contaminated, does not have to pass through the tissues.
Remove the suture by pulling back towards the wound, so that the wound edges are not drawn apart by a distracting force.
10.04 Advice After Removal
Wound care after sutures have been removed is just as important as it was prior to removal, to encourage healing and minimise the risk of scarring.
Advise patients to keep any adhesive strips on the wound for about 5 days. They should then soak them to remove, and not peel them off.
Stress the importance of continuing to keep the wound clean and dry.
Skin regains tensile strength slowly. Therefore, the wound should be protected from injury during the next month.
Injured tissue requires additional protection from the sun's damaging ultraviolet rays for the next several months. Advise your patient to use sunscreen if the wound is to be exposed.