Suture Removal in a Collapsed Society

Most of the sutures used today are the non-absorbable variety for closing flesh wounds and surgical incisions.  When the patient leaves the doctor, he is given instructions on caring for the sutured area. The site is to be kept clean and generally covered with a dressing to prevent contamination.  There are usually instructions that indicate showering and rinsing is acceptable, but bathing is not—the risk of introducing bacteria is too high.  If the dressing becomes wet or soiled, it must be changed.  The caregiver also advises the patient to watch for signs of infection and return for evaluation immediately if infection is suspected.  And finally, the patient is instructed when to return to the office for suture removal.

I always hated that part.  I hate making an extra trip to the doctor’s office and being reminded of whatever stupidity or misfortune occurred to warrant getting stitches.  And besides, suture removal doesn’t look like rocket science and you aren’t going to get any anesthetic when they remove the stitches anyway. It just seems like something that could easily be done by the patient.

So why do physicians always want a patient to return for suture removal?  There are a couple of reasons.  The first one is obvious—the caregiver needs to be sure that the wound is healing properly and that there are no signs of infection whatsoever.  That’s kind of a no-brainer.  The second reason is less obvious—it’s important to remove the sutures properly so that infection isn’t introduced under the skin and so that the recently fused skin isn’t pulled apart.

But what if something happens and you can’t return to the doctor for suture removal?  Or what if society has collapsed so much that you couldn’t even see the doctor to have stitches placed when the injury occurred?  In off-grid medicine classes, everyone always wants to know how to suture.  No one ever asks how to remove the sutures correctly. 

First off, let’s review suture removal times.  The average time is 7-10 days.  That varies based on the location of the sutures.

• Face/oral mucosa—3-5 days
• Neck—5-7 days
• Scalp—7-12 days
• Hands/back/over joints—10 days
• Upper extremities/trunk—10-14 days
• Lower extremities—14-28 days

Areas with better perfusion (blood circulation)—like the face, mouth, and neck—heal faster.  Areas farther away from the heart heal slower.  Younger people generally heal faster than older people, and people in good health heal faster than those in poor health.

Actually removing the suture isn’t difficult, but it does need to be done correctly to reduce the risk of re-injury or introducing infection.  Having the right tools is helpful.

Suture Removal

Using forceps (tweezers), grasp the knot and lift

• Cut the suture under the knot and close to the skin with iris scissors or a #11 blade
• Never cut the suture far from the skin.  This will pull the contaminated suture through the skin and risk introducing bacteria.
• Pull the knot straight up or slightly toward the suture line
• Do not remove the suture by pulling it away from the suture line.  Some sutures have a tendency to stick a bit and pulling away risks pulling open the newly healed wound. 

Links to related posts:

All aboutSutures

Duct TapeSuture

Wound ClosingOptions

 25 october 2023