How are staples and sutures (surgical closures) removed from the abdominal area after surgery?

Removal of Staples and Sutures from Abdominal Wounds

Timing for Removal

Non-absorbable sutures and staples should be removed 7 to 9 days after abdominal surgery, which is the standard timeframe that balances adequate wound healing with prevention of complications. 1, 2

• Removing closure materials before 7 days causes wound dehiscence due to inadequate tensile strength development 2, 3
• Leaving non-absorbable sutures beyond 9 days increases the risk of surgical site infection, suture abscesses, and "spitting sutures" where the body attempts to extrude the foreign material 3
• High-tension areas on the trunk may require the full 10-14 days before removal 2

Technique for Staple Removal

Use a sterile staple remover device by sliding the lower jaw under the staple center, squeezing the handles to bend the staple into an "M" shape, and lifting it away from the skin. 4, 5

• Clean the wound area with antiseptic solution before beginning removal 2
• Remove every other staple first, then assess wound integrity before removing the remainder 6
• If any separation occurs during removal, stop and leave remaining staples in place for additional days 2

Technique for Suture Removal

For interrupted transcutaneous sutures, cut the suture close to the skin on one side and pull the knot through from the opposite side to avoid dragging contaminated material through the tissue. 1

• Use sterile scissors or a blade to cut the suture 1
• Grasp the knot with forceps and pull in the direction that minimizes tissue trauma 1
• Remove alternate sutures first to assess wound stability, similar to staple removal 2

Absorbable Subcuticular Sutures

Continuous subcuticular absorbable sutures (4-0 poliglecaprone or polyglactin) do not require removal, as they retain 50-75% of tensile strength after 1 week and are designed to dissolve over time. 1, 2

• These sutures dramatically reduce superficial wound dehiscence by 92% (RR 0.08; 95% CI 0.02-0.35) compared to interrupted sutures that require removal 1, 2
• No intervention is needed unless signs of infection develop 2

Post-Removal Monitoring

Inspect the wound immediately after removal for any signs of separation, and monitor daily for 3-5 days for delayed dehiscence or infection. 2, 7

• Check for increasing pain, redness, swelling, warmth, purulent discharge, or foul odor 7
• Pain that increases after the first 2-3 days post-removal suggests complications requiring medical evaluation 7
• Systemic signs like fever, chills, or red streaks extending from the wound require immediate medical attention 7

Management of Complications After Removal

If wound dehiscence occurs after staple or suture removal, re-closure with sutures is the definitive approach for clean, non-infected separation. 7

• Sutures are significantly superior to tissue adhesives or steri-strips for preventing wound breakdown (RR 3.35; 95% CI 1.53-7.33) 2, 7
• Use subcuticular continuous sutures when possible, as this technique provides superior outcomes 7
• Do not re-apply steri-strips as sole management, as they provide insufficient mechanical support 7

Critical Pitfalls to Avoid

• Never remove all staples or sutures simultaneously without first testing wound integrity by removing alternating ones 2, 6
• Do not leave any retained suture material, particularly superficial or exposed pieces, as this significantly increases infection risk 3
• Avoid attempting to manage infected retained sutures conservatively; removal and drainage are required 3
• Never delay seeking medical attention if infection signs develop after removal, as early intervention prevents systemic complications 7, 3