A suture is a medical device, typically a thread or wire, used to hold body tissues together and close a wound or surgical incision. Sutures act as a temporary scaffold, bringing the edges of the skin together to allow the body’s natural healing process to occur. Proper care of the wound and timely removal of non-absorbable materials are important steps to support healing and minimize scarring. This process requires a clear understanding of the different closure methods and careful monitoring for complications.
Types of Wound Closure Materials
Medical professionals use several materials and techniques for wound closure, which vary depending on the wound’s location, depth, and tension. Absorbable sutures are designed to be broken down and dissolved naturally by the body’s tissues over a period of time. These are primarily used for closing deeper layers of tissue beneath the skin and do not require manual removal.
In contrast, non-absorbable sutures are made from materials like nylon or polypropylene that resist degradation and must be physically removed once the wound has healed sufficiently. They are most commonly used on the skin’s surface, particularly in areas where a strong, prolonged hold is needed.
Alternative methods of skin closure are also commonly used:
- Medical staples provide rapid closure for long incisions, often along the torso or scalp, and must be removed with a specialized device.
- Tissue adhesives, or surgical glues, are liquid materials that polymerize to form a strong bond across the wound edges, and they naturally flake off as the skin heals.
- Sterile adhesive strips, such as Steri-Strips, are sometimes applied to provide additional support to a closed incision or after external sutures have been removed.
The Process of Suture Removal
The timing for removing non-absorbable sutures is highly dependent on the anatomical location of the wound and the rate of tissue healing. Wounds on the face, which have an excellent blood supply and heal quickly, typically require removal within three to five days. Areas under greater tension or with slower healing, such as the extremities or joints, often need the sutures to remain in place for ten to fourteen days or longer to ensure adequate wound strength.
Suture removal requires sterile instruments, typically including fine-tipped scissors and forceps or tweezers. The goal is to minimize the risk of pulling any part of the suture that was outside the skin through the healing incision, which could introduce bacteria.
The forceps are used to gently lift the knot of the stitch, and the scissors are then used to cut the suture thread close to the skin surface on the side opposite the knot. Once the thread is cut, the forceps gently pull the knot and the attached thread segment out. If the wound edges gape open, show signs of active bleeding, or if the wound is red, swollen, or draining pus, the wound is not ready for removal. In these instances, removal should be stopped immediately, and a healthcare professional must be consulted for a formal assessment and guidance.
Monitoring and Caring for the Closed Wound
Initial care for a closed wound focuses on keeping the site clean and dry for the first twenty-four to forty-eight hours to promote initial healing. While showering is generally allowed soon after, it is important to pat the area dry gently afterward and avoid soaking the wound in a bath or swimming pool until the closure materials are removed. If a dressing is applied, it should be changed as directed, ensuring the surrounding skin is kept clean and avoiding the use of harsh cleansers like alcohol or hydrogen peroxide on the incision line.
A wound requires immediate medical attention if signs of infection develop, which include increased redness spreading outward from the incision, excessive swelling, or new or worsening pain. Other concerning indicators are the presence of pus or foul-smelling discharge, red streaks emanating from the wound, or a fever.
After non-absorbable sutures or staples have been removed, or after adhesive strips have fallen off, the newly healed skin remains fragile. The wound has only regained a small fraction of its original tensile strength at this point, so it must be protected from trauma or excessive stretching for several weeks. Once the wound is fully closed and dry, protecting the forming scar from direct sun exposure with clothing or a broad-spectrum sunscreen is recommended to help minimize its final appearance.