Sutures Under Heavy Tension Should Remain in Place Longer
Sutures under heavy tension should be left in place longer than usual to prevent wound dehiscence and ensure proper healing. 1
Rationale for Extended Suture Duration
- Sutures under tension provide critical support to the wound during the healing process, and premature removal can lead to wound dehiscence 1
- In corneal transplantation, surgeons commonly leave sutures in place long-term when selective suture removal has achieved low astigmatism and good vision 1
- Extended suture duration allows for complete wound healing and prevents complications in high-tension areas 1
Optimal Timing for Suture Removal in High-Tension Areas
- Standard suture removal timing (7-9 days) is generally considered suitable for wounds under normal tension 1
- For high-tension wounds, sutures should remain in place for extended periods:
- Corneal transplant sutures may remain in place indefinitely when good outcomes are achieved 1
- Abdominal wounds under tension may benefit from sutures remaining in place for 2-3 weeks 1
- Femtosecond laser-assisted keratoplasty allows for earlier suture removal due to greater mechanical stability and wound healing 1
Mechanical Considerations
- Continuous sutures distribute tension more evenly across the wound and may reduce the risk of dehiscence compared to interrupted sutures 1, 2
- Absorbable sutures retain approximately 50-75% of their original tensile strength after 1 week, providing extended support for wounds under tension 1
- The pulling force required varies by technique: pulley sutures (3.46N) require less force than single (5.69N), vertical mattress (7.25N), or horizontal mattress (8.11N) sutures 3
Complications of Premature Suture Removal in High-Tension Wounds
- Wound dehiscence is the primary risk of removing sutures too early in high-tension areas 1
- A Cochrane meta-analysis found lower rates of superficial wound dehiscence in continuous suture groups compared to interrupted suture groups (RR 0.08; 95% CI 0.02 to 0.35) 1
- Late suture breakage, irritation, infection, and rejection are potential complications of leaving sutures in place too long 1
Special Techniques for High-Tension Wounds
- Double butterfly sutures can withstand greater tension due to their "pulley" effect and broad base in the corium 4
- Purse-string sutures can be effective for closing difficult wounds under tension and may remain in place for 4-8 weeks (mean 5.7 weeks) 5
- For large defects, partial closures may decrease unwanted tension against free margins 6
Practical Recommendations
- For high-tension wounds, consider using larger suture sizes (more than 0-1) and leaving them in place longer (more than 6 weeks) to minimize scar widening 5
- When using absorbable sutures in high-tension areas, select materials with longer absorption profiles to provide extended wound support 1
- Monitor high-tension wounds closely for signs of suture cutting through tissue, which may indicate need for reinforcement or alternative closure techniques 5