Sutures are a temporary measure, and their proper removal is the final step in the healing process. The procedure requires a precise, sterile approach to prevent infection and protect the newly formed tissue. The running suture, also known as a continuous suture, is frequently used to close surgical incisions. Its unique structure requires a specific removal method, which should ideally be performed by a healthcare professional in a sterile environment.
Defining the Running Suture
The running suture technique utilizes a single strand of material to place a series of stitches along the length of a wound, concluding with a final knot. This method differs significantly from simple interrupted sutures, where each stitch is individually placed and tied with its own knot. The primary advantage of a running closure is that it offers a faster way to approximate long wound edges in a single pass.
This continuous configuration allows for an even distribution of tension across the incision line, contributing to a better aesthetic result. Common variations include the simple running suture and the running locking suture, sometimes called a baseball stitch. The locking suture has loops that “lock” into the previous stitch for added wound edge eversion and hemostasis.
Pre-Removal Assessment and Supplies
Before removing any suture, the wound must be assessed to ensure it has reached sufficient tensile strength. Healing time varies widely based on anatomical location, ranging from 5 to 7 days for the face, 10 to 14 days for the trunk and upper extremities, and 14 to 21 days for the lower extremities. Removing sutures too soon risks wound separation, known as dehiscence.
The wound site must be inspected for signs of infection, including redness, swelling, discharge of pus, or increased warmth around the incision. If these symptoms are present, a clinician must evaluate the wound before removal is attempted. Necessary supplies should be sterile and include antiseptic solution (such as chlorhexidine or povidone-iodine), sterile gauze, and a specialized suture removal kit. This kit contains sterile forceps and suture removal scissors, which often have a small, hooked blade designed to safely slide under the suture without cutting the skin.
Step-by-Step Removal Procedure
The first step in the removal process is to thoroughly clean the entire area, including the suture material itself, using the antiseptic solution and sterile gauze. This minimizes the risk of introducing surface bacteria into the healing wound when the thread is pulled through. Proper lighting and a stable surface are also necessary to ensure clear visibility of the fine suture material and the wound edges.
Next, locate the starting or ending knot of the running suture and gently lift it away from the skin using the sterile forceps. The specialized suture scissors are then used to cut the suture material. It is important to cut the thread as close as possible to the skin surface where the suture emerges, specifically on the side that has not been exposed to the external environment.
Cutting in this location ensures that only the portion of the suture embedded within the sterile tissue is pulled through the wound line. Pulling the exposed, potentially contaminated portion of the thread through the incision is a common error that increases the risk of introducing bacteria. Once the thread is cut, the forceps are used to gently grasp the knot or the long end and pull it smoothly and continuously along the line of the incision.
The entire length of the running suture should come out in one complete piece with a steady, gentle motion. For very long incisions or running locking sutures, a method known as “converting to interrupted” may be used. This involves cutting the suture at several points along the line before pulling it out in smaller segments to prevent excessive drag or tension on the healing tissue. The entire wound is then wiped clean again with antiseptic solution immediately after the material is removed.
Immediate Post-Removal Care and Monitoring
Once the suture is fully removed, the incision site should be immediately inspected to confirm the wound edges are well approximated. If there is concern about the integrity of the closure or if the wound is subject to movement or tension, adhesive strips (such as Steri-Strips) should be applied across the incision line for supplemental support. These strips are left in place until they naturally peel off, usually taking 5 to 10 days, providing protection as the skin continues to gain strength.
The area should be kept clean and dry for at least 24 hours following removal; swimming or soaking the wound is discouraged until it is completely sealed. Monitoring the site for complications is necessary. Signs of a worsening infection, such as spreading redness or increasing pain, require prompt medical attention. A more serious complication is wound dehiscence, the separation of the wound edges, often indicated by a sudden widening of the incision.
In the longer term, the new scar tissue will be sensitive to ultraviolet light. Applying a broad-spectrum sunscreen (SPF 30 or higher) is necessary for several months to prevent hyperpigmentation. Gentle scar massage, often starting a few weeks after removal, may be recommended to help re-orient the collagen fibers and improve the final cosmetic appearance. Occasionally, a small bump may form along the incision line, which could indicate a non-dissolvable internal stitch, sometimes called a “spitting suture,” requiring examination by a healthcare provider.