A Suture Removal

In practice

A patient returns ten days after a laceration repair on his forearm, and the provider has ordered removal of his interrupted sutures. The medical assistant confirms his identity and the order. She explains that he may feel some pulling but should not feel pain. She removes the dressing with gloved hands, discards it, and changes gloves. Then she inspects the incision: the edges look even, with no drainage, redness or swelling. She cleans the suture line first, with a fresh moistened gauze for each stroke. Then she begins removing sutures. For each one, she lifts the knot with forceps, cuts beneath it on one side only, close to the skin, and draws the suture out by the knot, so that nothing from the outside passes through the tissue. She takes out every second suture first, checking the wound after each. After the third suture, she sees the edges at one end begin to gape slightly. She stops. She leaves the remaining sutures in place, covers the wound, and tells the provider what she saw. The provider examines the incision and decides to leave the rest for a few more days. The provider then asks her to apply adhesive closure strips across the area that had begun to open. She documents the sutures removed, the appearance of the wound and the provider's decision.