When to remove facial sutures?

From the Guidelines

Facial sutures should be removed within 5 to 7 days after placement to minimize scarring and prevent superficial wound dehiscence, as supported by the most recent evidence 1. The timing of suture removal depends on various factors, including:

• Wound location: areas with high tension or thicker skin like the forehead or scalp may require sutures to remain for 5-7 days, while delicate areas like eyelids or lips usually require removal after 3-5 days 1.
• Wound size: larger wounds may require longer suture retention to ensure adequate healing.
• Individual healing factors: patients with compromised wound healing, such as those with diabetes or smoking history, may require longer suture retention. Before removal, it is essential to ensure the wound edges appear well-approximated with minimal redness. The removal process should be performed using sterile technique with clean forceps and fine scissors to minimize discomfort and additional trauma. After suture removal, applying adhesive strips (Steri-Strips) can provide continued support during the healing process, and advising patients to protect the area from sun exposure for several months can help prevent hyperpigmentation of the scar. Early suture removal on the face is preferred because facial tissue has excellent blood supply promoting rapid healing, and prolonged suture presence can create permanent track marks (suture marks) that remain visible after healing is complete. Additionally, a study published in 2021 1 suggests that sutures should be removed within 7-10 days, preferably before discharge, unless required to secure the airway during prone ventilation, which further supports the recommendation for early suture removal.

From the Research

Timing of Suture Removal

• The optimal timing of suture removal depends on the anatomical location of the wound 2.
• Recommendations for the timing of suture removal vary between 3-14 days, and are influenced by factors such as the location of the wound, co-morbidity, and signs of early wound complications 2.

Factors Affecting Suture Removal

• The location of the wound is a key factor in determining the timing of suture removal, with different areas of the body requiring different removal times 2.
• Co-morbidity and signs of early wound complications can also impact the timing of suture removal, and may require adjustments to the standard removal schedule 2.

Suture-Related Infections

• Suture-associated surgical site infection (SSI) can develop when bacterial contaminants colonize the suture surface and establish biofilms that are highly resistant to antibiotic treatment 3.
• Antimicrobial sutures coated with antiseptics such as triclosan and chlorhexidine have been used to minimize the occurrence of SSI, but the emergence of resistant strains may affect their efficacy 3.

Prevention of SSI

• The use of antimicrobial sutures, particularly in surgical procedures with high SSI rates, such as colorectal and hepatobiliary surgery, or when a SSI can be life-threatening, such as in cardiac surgery, may help reduce the incidence of SSI 4.
• The use of triclosan-coated polyglactin 910 suture materials with antibacterial activity (Vicryl plus) has been shown to reduce the number of wound infections after midline laparotomy compared to traditional suture materials 5.