Suture Removal

For the assessment, anaesthesia and closure that precede this, see Wound Assessment & Laceration Repair.

Timing of suture or staple removal by wound location

Wound location	Timing of removal (days)
Face	3–5
Scalp	7–10
Torso and upper limbs	7–10
Hands and fingers	10–12
Extensor surface of elbow or knee	10–12
Anywhere below the knee	10–12
Palms or soles	14–21

Closure material other than tissue adhesive comes out at different intervals depending on location. Facial sutures are removed at 3–5 days to prevent cross-hatching and visible needle entrance marks. Some clinicians apply adhesive strips afterwards to bolster the wound for a few more days.

Faster removal on the face is possible because of its excellent blood supply, and is driven by the cosmetic priority. Slower-healing, higher-tension areas need longer to avoid dehiscence.

Site-specific healing risk

The lower limbs carry the greatest risk of infection and poor healing because of impaired circulation. The scalp and face carry the lowest.

Aftercare between closure and removal

• Keep the wound clean and dry, under a non-adherent dressing impermeable to bacteria.
• Apply topical antibiotic ointment daily until the closure device is removed — but not over tissue adhesive or adhesive strips.
• Immobilise the wound; splint anything near a joint, and elevate above heart level for the first 48 hours.
• After 12 hours, a well-healing wound can be gently cleansed of residue.

Watch for infection before removal day

Steadily increasing pain 12 or more hours after closure is often the first sign. Early signs are erythema extending more than about 0.5 cm from the wound edge, plus swelling, tenderness and warmth. Later come fever, purulent discharge and ascending lymphangitis.

Treat with a systemic antibiotic active against skin flora. Infection starting more than 5 to 7 days after the injury suggests a retained foreign body.

Practical notes

• Staples should not be used on the face because of the potential for increased scar formation.
• Tissue adhesive needs no removal appointment at all, which is a real advantage in children and in patients unlikely to return.
• Adhesive strips are useful for a laceration on a limb about to be casted, where suture removal would otherwise be blocked.
• Scars stay erythematous and prominent for about 8 weeks before collagen remodelling thins them and the redness fades.