# Suture/staple Removal

## Overview

This module describes when and how to remove sutures or staples.

## Indications

Time to removal

Time to removal

The interval between application and removal of the staple is the same as that for standard suture placement and removal, although healing is more rapid with the staple.

of sutures depends on wound location. Leaving wound closure materials too long can increase the risk of scarring.

- Scalp: 8-10 days
- Face: 5 days
- Chest/abdomen, limbs and hands: 8-10 days
- Back: 2 weeks
- Feet: 2-4 weeks

Wounds with suspected infection require consultation with a senior and possibly earlier removal.

## Contraindications

1. Do not remove sutures or staples too early

## Patient information & consent

Always verify your patient’s identity and obtain informed consent before proceeding.

### How do I explain this procedure?

“I’m going to remove the stitches/staples used to close your wound. For stitches, I’ll use a small blade to cut the thread used and then pull them out. For staples, I'll use a special staple remover.”

### What can my patient expect?

“This may be slightly painful if there is crusting around the stitches. Removing staples can feel like I am pinching your skin.”

### What is my patient’s role?

“Please stay still and tell me if there is too much pain and you need a break.”

## Preparation

### Documentation

1. Patient notes

### Equipment

1. Alcohol-based hand rub

2. Sharps container
   Sharps container

   If a sharps container is not within arm's length, use a kidney dish or other hard container to temporarily hold used sharps and to carry them to the sharps container for disposal.

3. Stitch cutter
   Stitch cutter

   Any sharp scissors or a scalpel blade may be used instead.

   or skin staple remover

4. Sterile non-toothed forceps

5. Non-sterile gloves

6. Normal saline and gauze for cleaning

## Site & Positioning

Ask the patient to sit or lie down with the wound exposed and within easy reach.

## Procedure

### Suture removal

Follow medical asepsis with non-sterile gloves.

1. Perform hand hygiene. Don gloves.

2. Clean the wound with normal saline.

3. Pull gently with forceps on one of the cut ends of the suture to lift the suture away from the wound.

4. Use the stitch cutter blade to cut the suture close to the skin. The suture should pull out.

5. Repeat until all sutures are removed.

6. Dispose of medical waste safely.

### Skin staple removal

Follow medical asepsis with non-sterile gloves.

1. Perform hand hygiene. Don gloves.

2. Clean the wound with normal saline.

3. Position both prongs of the staple remover under the staple.

4. Depress the handle of the staple remover so that the staple is bent outward in the midline,

   easing the staple
   easing the staple

   out of the skin.

## Troubleshooting

The suture knots are trapped and crusted over.

Gently brush away crusted secretions with a swab. If there is plenty of crust, soak it with a damp swab before removing it. If the suture still does not come free, call a senior to help you remove the buried suture.

It’s time to remove the stitches, but a section of the wound is still gaping.

Remove alternate sutures and assess the wound again after 2-3 days.

I do not have a staple remover.

Position blunt forceps under the staple. Insert a needle holder or artery forceps into the centre of the staple and gently push the staple outwards (medial or lateral depending on which side you start with) and upwards working the staple free of the skin, first on one side then the other.

I am unable to work the staple loose without a staple remover.

Use a scissor to cut through the staple, then carefully work the staple edges loose, first the one side then the other.

## Risks

1. Sharps injury to healthcare personnel

2. Cutting the patient with the stitch cutter

## References

1. Newell KA. Wound Closure. In: Dehn R, Asprey D, eds. Essential Clinical Procedures. 3rd ed. Philadelphia: Elsevier; 2013.

2. Olivier N, Suture removal. In: Mulder M, Joubert A, Olivier N, eds. Practical Guide for General Nursing Sciences. 2nd ed. Pearson; 2020.