Best Suture Care and Removal of Stitches

Stitches bleeding through gauze, gauze can also serve as a bandage to cover and protect wounds from infection.

• Sutures, or stitches, are the most commonly used method to repair a cut or wound. Other methods used to treat wounds are skin adhesives or glue, Steri-Strips or butterfly bandages, staples or even leaving skin wounds open (unsutured) to heal without closure in some cases (this is termed “healing by secondary intention”).
• Sometimes, a very contaminated or dirty wound is left alone for a few days with a plan to repair it with loose stitches later to prevent capturing contaminating pathogens in and underneath the sutures.
• These delayed methods of closing a wound are performed only after thorough irrigation, or washing, of the laceration and exploration and removal of any foreign debris or dirt.
• When applicable, sutures are used to close the wound. Suture material is classified as absorbable or nonabsorbable. Absorbable sutures dissolve over time. Nonabsorbable sutures need to be removed within a time specified by the doctor (usually 5 to10 days, depending on the location and type of wound).

Nonabsorbable suture care is similar, regardless of the type of suture; absorbable types require time to be absorbed but otherwise share similar care.

• First, keep the wound clean and as dry as possible. Do not immerse or soak the wound in water. This means no swimming, washing dishes (unless thick rubber gloves are used), baths, or hot tubs until the stitches are removed or after about two weeks if absorbable suture material was used.
• Leave original bandages on the wound for the first 24 hours. After this time, showering or rinsing is recommended, rather than bathing.
• After the first day, remove old bandages and gently cleanse the wound with soap and water. Cleansing twice a day prevents buildup of debris and will result in easier suture removal.

If a wound is deep, more than about ¼ inch long, does not stop oozing blood, is in a sensitive or cosmetically important area (eye region, lips, or genitals for example), call the doctor or consider going to an emergency or urgent care facility. All wounds and sutured areas may scar. If you have serious cosmetic concerns, you may need to consult a plastic surgeon for special suturing methods to reduce scarring.

After sutures are placed, examine the wound with the suture daily during bandage changes. Look for signs or symptoms of infection:

• Increased pain
• Swelling
• Redness
• Fever
• Drainage of pus or pus-like material
• Red streaking from the wound
• Separation of the wound

If you develop any of these symptoms, you should contact your doctor immediately for further evaluation. Your doctor will likely start you on antibiotics and may ask you to make an office visit.

• You should also see your doctor for continued bleeding, removal of sutures, and if the doctor who placed the sutures recommends that your wound be checked (usually two days after placement of sutures).
• Call your doctor if your sutures fall out before your scheduled time for suture removal because your wound may open up, potentially causing a larger scar.

If you develop any of the signs or symptoms of infection or have any of the other reasons to visit your doctor and your doctor cannot see you promptly (meaning that same day), you should go to the hospital's emergency department for examination and further treatment. Any deep long wound is likely to need suturing and additional care. Do not try to treat such wounds at home.

If the wound with the suture develops signs or symptoms of an infection (pus develops, red streaks, becomes warm red and swells), the doctor may make one of several diagnoses.

• Cellulitis: Local infection of the skin
• Abscess: Deeper infection of the wound with a collection of pus-like material
• Dehiscence: Separation of the wound edges, primarily due to infection
• Foreign body: An infection from debris or dirt remaining in the wound and not removed earlier

• If the doctor diagnoses cellulitis, you will be treated with antibiotics.
• If you have an abscess, then the collection of pus will need to be drained. This may involve stitch removal or an incision to make a track so that pus can flow out or drain to the surface. You likely will also need antibiotics. Further home care will include soaking the infected area with clean warm towels three to four times a day to assist the healing process.
• If your wound's edges separate, the wound may need to be left open to heal on its own. Your treatment will likely also include antibiotics.
• When there is something in the wound (termed a foreign body that may be a piece of dirt, or splinter, or a broken needle or metal barb) that is causing the infection. This material will need to be removed by a physician.

All lacerations will usually heal, even if left alone and no sutured. Suturing simply allows a cut to heal more quickly and with a better cosmetic result; it may also reduce the chance of post-wound infections.

• All wounds leave a scar when they heal. Many factors determine how noticeable a scar will appear. Some of these factors are how the cut is situated along lines of tension, if an infection occurs, or if the sutures are not removed in the amount of time specified by your doctor. Some patients tend to form keloids (reddish, raised formation of fibrous scar tissue caused by excessive tissue repair in response to a wound or surgical incision).
• Exposure to sunlight within the first 6 months can cause permanent discoloration of the wound. This can be prevented by using sunscreen (SPF 15 or greater) on the area during this time.
• For people who have not completed a primary series of tetanus shots, any recommendations for additional tetanus immunization should be followed. Wound contamination is still the most common source for the development of tetanus, which can cause death.
• People with other medical problems (diabetes, for example) may take longer than average to heal.
• Newer suture materials are under development; some may contain antimicrobials and others may contain wound healing compounds.