Suture Removal

Suture removal is not complicated. The vast majority of sutures (aka stitches) placed in the ER are done with a technique called simple interrupted. What that means is that each stitch has a single knot: it goes into the wound on one side, comes out on the other, and is tied with a knot.

Doctors learn to suture midway through medical school. In my experience, nothing has changed about this in the last 25 years. The standard advice is to tell patients to return for suture removal in the clinic or the ER. For things on the face, it’s usually recommended to have those out in 5 days. If they stay in longer, you tend to get scarring where the actual suture was—so besides the laceration scar, you may have little dots on either side of the scar from where the suture was. Things on other parts of the body are often removed at 7 to 10 days. Sometimes with a laceration over a joint or somewhere that is very mobile, the sutures should stay in 10 to 14 days. But this is not an exact science.

Removing them is not difficult. It requires some small tools to hang on to the end of the suture and either a fingernail clipper, small scissors, or a scalpel to cut the suture.

I’ve had this conversation with patients many times—almost every shift, in fact. It seems to me that we tell patients to come back so that they don’t leave the sutures in permanently, so that they get removed appropriately (which I will explain), and to make sure that someone looks at the wound to ensure it’s not infected. However, most skin infections will happen within a couple of days of suture placement. If you’ve made it to 5 days or more without an infection, it’s unlikely that the wound is going to get infected. There are no guarantees, but that’s usually the case.

So if you don’t want to return to the doctor to have your sutures removed, it’s perfectly reasonable to do it yourself. There are videos on YouTube about how to do this. But very simply: pull on one end of the knot and cut one side of the loop (close to the skin, on the opposite side of the knot). You should then be left with a suture that looks like a circle with two “rabbit ears.” If you pull up on the knot and cut underneath the knot—and cut both sides of the loop—you will end up with a pair of rabbit ears, but the rest of the suture remains in the skin. This is what can become problematic.

In the three pictures below, the one on the left shows when the suture is placed. The one in the middle shows the correct way to cut the suture to remove it. The one on the right is incorrect.