When to remove sutures?

From the Guidelines

Sutures used to secure a tracheostomy tube should be removed within 7-10 days, and preferably before discharge, unless required to secure the airway during prone ventilation. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of timely suture removal to minimize complications and promote optimal healing 1.

Key Considerations for Suture Removal

• The timing of suture removal depends on various factors, including the location of the wound, the type of surgery, and the patient's overall health status.
• For tracheostomy tubes, sutures should be removed within 7-10 days to reduce the risk of skin breakdown and other complications.
• In general, sutures on the face can be removed after 3-5 days, while those on the scalp, trunk, and upper extremities can be removed after 7-10 days.
• Lower extremity sutures and joint sutures may require longer periods, typically 10-14 days, due to higher tension and slower healing.

Evidence-Based Recommendations

• A study published in 2021 in the journal Otolaryngology--head and neck surgery provides guidance on tracheostomy securement, stoma care, and patient transport, emphasizing the importance of timely suture removal 1.
• Another study published in 2024 in the journal Ophthalmology discusses the management of corneal ectasia, including the removal of sutures after keratoplasty, which typically begins after 3 to 6 months to ensure corneal wound stability 1.
• A 2020 position paper on intraoperative surgical site infection control and prevention published in the World Journal of Emergency Surgery highlights the role of skin closure methods in preventing surgical site infections, including the use of continuous versus interrupted sutures 1.

Clinical Implications

• Clinicians should prioritize timely suture removal to minimize complications and promote optimal healing.
• The removal technique involves gently lifting the knot with forceps and cutting the suture below the knot, then pulling it out in the direction of the wound to minimize contamination.
• After removal, applying adhesive strips (Steri-Strips) can provide additional support during the final healing phase.

From the Research

Suture Removal Guidelines

• The removal of non-absorbable sutures is crucial to avoid complications and ensure optimal cosmetic results 2
• Before suture removal, the wound must be checked for signs of infection and indications of dehiscence 2
• Removing sutures at the recommended time assists in preventing new skin growth from covering the sutures and in reducing scarring 2
• Aseptic non-touch technique (ANTT) is recommended for suture removal, but local policy should always be followed 2

Timing of Suture Removal

• The optimal timing of suture removal depends on the anatomical location of the wound 3
• Influencing factors associated with the timing of suture removal include the location of the wound, co-morbidity, and signs of early wound complications 3
• Recommendations for timing of suture removal vary in the interval 3-14 days 3

Suture-Associated Complications

• Suture-associated surgical site infection (SSI) may develop when bacterial contaminants colonize the suture surface and establish biofilms that are highly resistant to antibiotic treatment 4
• Antimicrobial sutures coated with antiseptics such as triclosan and chlorhexidine have been used to minimize the occurrence of SSI 4
• The efficacy of antiseptic-based sutures may be affected due to the emergence of resistant strains, and new approaches for the development of alternative antimicrobial sutures are necessary 4

Comparison of Sutures and Staples

• Sutures resulted in slightly fewer overall wound infections compared to staples, but the evidence was insufficient to state a difference in terms of severe wound infection 5
• Staples may increase the risk of adverse events, readmission rate, and postoperative pain, while sutures may improve grade of satisfaction with the cosmetic outcome 5