When should subcutaneous prolene (polypropylene) sutures be removed after a caesarean section?

Subcutaneous Prolene Sutures Do Not Require Removal After Cesarean Section

If you used prolene (polypropylene) sutures in a subcutaneous (not subcuticular) layer, these are non-absorbable and should be removed at 7-10 days postoperatively. However, there appears to be confusion in your question—prolene is typically not used for skin closure in cesarean sections, and the term "subcutaneous" may be conflated with "subcuticular."

Critical Clarification: Suture Type and Location Matter

If You Used Absorbable Subcuticular Sutures (Standard Practice):

• Absorbable subcuticular sutures do not require removal at all—they are designed to dissolve on their own 1, 2
• The ERAS Society and ACOG recommend subcuticular suture closure as the preferred method for cesarean skin closure due to reduced wound separation compared to staples 3, 1
• Absorbable sutures retain approximately 50-75% of their original tensile strength after 1 week, providing extended wound support during the critical healing phase 1, 4

If You Actually Used Non-Absorbable Sutures (Less Common):

• Non-absorbable transcutaneous or subcuticular sutures should be removed at 7-9 days postoperatively 2, 4
• For abdominal and trunk wounds specifically, the 7-9 day window allows adequate collagen deposition and wound tensile strength development 2, 4

If You Used Staples Instead:

• Staples must be removed after at least 7-10 days, and preferably not before 10 days 1, 2
• The ERAS Society guidelines specifically note that removing staples before 4 days postoperatively significantly increases wound separation rates 3, 1
• Early staple removal (before 7 days) compromises wound tensile strength and increases risk of dehiscence 1, 2, 5

Pre-Removal Assessment Algorithm

Before removing any non-absorbable sutures or staples, systematically assess:

1. Wound healing adequacy 1, 2:

   • Wound edges well-approximated without tension
   • No gaping or separation of wound edges

2. Absence of infection signs 1, 2:

   • No significant erythema or warmth
   • No purulent drainage
   • No increasing pain
   • No systemic signs (fever)

3. Patient-specific risk factors requiring delayed removal 1, 2:

   • Diabetes or conditions affecting wound healing
   • Immunosuppression
   • High-tension wound locations
   • Obesity

Common Pitfall to Avoid

The most critical error is removing staples or non-absorbable sutures too early (before 7 days), which significantly increases wound dehiscence risk 1, 2, 6, 5. In a randomized controlled trial, staples removed at 3-4 days showed a 14.1-fold increased risk of wound disruption compared to absorbable sutures (7.1% vs 0.5%, p<0.001) 5.

Post-Removal Support

After removing non-absorbable sutures or staples 1, 2:

• Apply sterile adhesive strips (steri-strips) across the wound for additional support
• Keep the area clean and dry
• Avoid excessive strain on the wound site
• Monitor for delayed complications (infection, separation) in subsequent days