Granulation Tissue Removal During Suture Removal
Thorough debridement of granulation tissue is strongly recommended before attempting suture removal to ensure all sutures are visualized and completely removed. 1
Why Granulation Tissue Should Be Removed
Granulation tissue can present several challenges during suture removal:
- It can completely obscure sutures, making visualization difficult
- It is vascular and bleeds easily when manipulated
- It may be painful when touched or manipulated
- It can harbor bacteria and potentially lead to infection
The American Academy of Periodontology recommends using a degranulation bur to thoroughly remove all granulation tissue before suture removal 1. This ensures complete visualization of the wound bed and all suture material.
Technique for Granulation Tissue Removal and Suture Removal
- Assessment: Evaluate the wound for excessive granulation tissue
- Debridement:
- Use appropriate tools (degranulation bur or sterile scissors) to carefully remove granulation tissue
- Ensure all sutures are visible before attempting removal
- Suture Removal:
- Once identified, grasp the suture with forceps
- Gently lift the suture
- Cut the suture at skin level on one side
- Pull the entire suture out in one piece using forceps
- Ensure the entire suture is removed, not just visible portions 1
Special Considerations
For Extensive Granulation Tissue
If granulation tissue is extensive and visualization remains poor despite initial debridement, consider using Negative Pressure Wound Therapy (NPWT) to manage the wound and promote better visualization 2, 1. When using NPWT:
- Place a wound contact layer (non-adherent silicon layer) between NPWT wound filler and wound bed
- This prevents damage to the granulation tissue during dressing changes 2, 1
Common Causes of Excessive Granulation
Excessive granulation tissue formation may be caused by:
- Excess moisture
- Excess friction or movement
- Critical colonization
- Infection 2
Post-Removal Monitoring
After suture removal, monitor the wound for:
- Resolution of granulation tissue
- Signs of infection
- Complete healing
- Recurrence of granulation tissue (which may indicate remaining suture material) 1
Caution
When removing granulation tissue, be careful not to damage underlying healthy tissue. Granulation tissue is vascular, so some bleeding is expected during removal. Apply gentle pressure if bleeding occurs.