What is the recommended suture removal time for a patient with a wound on the palm of their hand, particularly those with underlying conditions such as diabetes or smokers?

Suture Removal Timing for Palm of Hand Wounds

For standard palm wounds, remove sutures at 10-14 days; however, in patients with diabetes or who smoke, extend this to approximately 21 days and verify complete wound healing before removal. 1, 2

Standard Timing for Palm Wounds

• The palm of the hand requires 10-14 days for suture removal in uncomplicated cases, as this high-movement and high-tension area needs adequate time for wound healing 1
• This standard timeframe applies to healthy patients without complicating factors that impair healing 1

Modified Timing for High-Risk Patients

Diabetic Patients

• Diabetic patients require extended suture retention of approximately 21 days due to impaired wound healing mechanisms 2
• Before removing sutures in diabetic patients, the wound must be carefully assessed for adequate healing, as their compromised perfusion and metabolic state significantly delays the healing process 1
• Diabetic patients with ankle-brachial index (ABI) < 0.50 have severe ischemia that further impairs wound healing and requires particularly cautious assessment 1

Smokers

• Tobacco use significantly lengthens the time to suture removal, with studies showing smokers requiring approximately 21 days rather than the standard 10-14 days 2
• The mechanism involves impaired microvascular perfusion and delayed epithelialization of the suture tract 2

Critical Pre-Removal Assessment

Before removing sutures from any palm wound, especially in high-risk patients, verify:

• Complete epithelialization of the suture path is the clinical indication for the ideal day of removal 2
• The wound edges are well-approximated without tension 1
• No signs of infection (erythema, purulent drainage, or systemic signs) are present 3
• Adequate blood supply to wound edges, evidenced by pink, viable tissue 3

Additional Risk Factors Requiring Extended Timing

• Manual workers: Patients who perform manual labor may require suture retention beyond 21 days due to increased mechanical stress on the wound 2
• Suture location in palmar fold areas: Wounds in the palmar creases require longer retention times due to high-tension forces during hand movement 2
• Age over 40 years: Patients aged 41-50 years and especially those over 50 years require significantly longer suture retention, often beyond 21 days 2
• History of skin-lightening product use: 85% of patients with incomplete wound closure at suture removal had used these products, suggesting they may impair healing 2

Risks of Improper Timing

Premature Removal (Before Adequate Healing)

• Wound dehiscence is the primary risk, with separation occurring along the suture line 1, 4
• Widened scars and increased cosmetic defects in this visible, functional area 1
• Dehisced palm wounds can require prolonged treatment (>1 month) and cause significant functional impairment and inability to work 4

Delayed Removal (After 14 Days in Standard Patients, After 21+ Days in High-Risk Patients)

• Increased risk of infection from retained foreign material 1
• Permanent suture marks (track marks) in the skin 1
• Tissue reaction to prolonged suture presence 1
• Epithelialization over the sutures, making removal more difficult 1

Post-Removal Care

• Keep the area clean and dry immediately after suture removal 1
• Apply steri-strips for additional support, as the palm is a high-movement area requiring reinforcement 1
• Monitor closely for wound separation in the first 24-48 hours after removal 1
• In the 90% of cases with complete closure at removal, healing proceeds uneventfully; the 9% with partial closure require continued wound care 2

Common Pitfalls to Avoid

• Never remove sutures based solely on the calendar date—always assess the wound for complete epithelialization first, especially in diabetic patients and smokers 1, 2
• Do not underestimate the impact of tobacco use on healing; smokers consistently require extended suture retention 2
• Avoid early removal in manual workers who will immediately return to work, as mechanical stress will cause dehiscence 2
• Do not remove sutures if there is any sign of infection, inadequate perfusion, or incomplete epithelialization 1, 3