February 17, 2020

Q&A: Caring for stitches

by
Young woman applying moisturizer to her arm and caring for stitches after removal.

Don’t try removing your own sutures, and other good advice on caring for stitches.

A common reason people come to Vanderbilt’s My Health Walk-In Clinics is to have sutures (stitches) removed. Perhaps they don’t have primary care providers to do this, or they can’t return to the doctor or surgeon who put in the stitches. Bob Anderson, DNP, is part of our Walk-In Clinics’ medical staff, and he has removed a lot of stitches. Here, he answers questions about caring for stitches and what happens when it’s time for those stitches to come out.

Question: What typically prompts people to come into the clinics either to receive stitches or to have stitches removed?
Answer: People come to us with acute wounds, everything from scrapes to large lacerations, and we can handle those. If it’s above the level that we can provide, we will refer them to an emergency department.

Question: Stitches involve medical thread and a tiny needle, and you’re literally stitched up. But what is that stuff that looks like a cross between tape and glue?
Answer: Stitches are for actually sewing a wound shut. There are metal staples that can be used for certain wounds. There is also tissue glue, and Steri-strips (sterile medical tape).

They’re all methods of closing wounds, depending on where the wound is, how deep the wound is, whether it’s over an area that moves, over a joint, a finger joint or a knee or something like that. So they all can be used to close wounds and they all have a different role in that process.

Question: Do our Walk-In Clinic providers remove medical staples, or is that something a surgeon must do?
Answer:  We remove staples all the time. You need a special tool to remove staples. That’s why people are told to return and not to try to remove them at home.

Question: How long do stitches need to stay in?
Answer: It depends on where they are. It can range from, for the face, three to five days; other places, up to two weeks — 10 to 14 days — depending on where the wound is, how deep it is, whether it’s over an area that moves. Because tissue will not get back to its original tensile strength; it takes six to 12 months to do that. So depending on where the stitches are and what movement is in that area, the timing is different. Whoever stitched up your cut or incision will tell you when to return to get them removed.

There are occasions where we use absorbable sutures that do not have to come out. They will simply dissolve and fall out on their own. But that’s typically on the face.

Question: As a nurse practitioner, you check to be sure the incision is not infected. Beside that, is it just a matter of taking stitches out with tweezers?

Answer:  Yes. You cut the threads and basically pull them out. But there is a specific way to remove them, so you’re not pulling something that was on the outside of the skin (thus, not sterile) through the wound again. There’s a technique to removing sutures, and you want to make sure they’re removed intact. Doing them at home can lead to infection. And when it comes to wounds, infection leads to scarring.

Question: How can you tell if the cut is healing properly, versus becoming infected? What if your stitches are a little tender, or there’s any bleeding?

Answer: Infection hurts, so there’s going to be an increase in pain. There’s going to be increased redness, there may be swelling and there may be pus discharge. But sutures are a foreign body and it’s not unusual to see a little redness immediately after having them put in for the first 24, 48 hours or so. But it shouldn’t be increasing redness. There shouldn’t be increasing pain, and of course, the site should never produce pus. You may see some oozing of a clear fluid as your body’s trying to form a scab, but it should never be worsening.

Question: You would expect it to look better every day, not worse?
Answer: Right. Depending on the mechanism, there’s probably going to be some swelling, but it should never continue to worsen. It should start improving after a couple of days.

Question: Does removing the stitches hurt?
Answer: It shouldn’t be painful at all. You’re cutting a thread and pulling; it’s like undoing your shoelaces. Now, if the wound wasn’t taken care of, or you’re coming in weeks later — which I’ve seen, where the scar tissue is starting to form around the stitches — if the wound is never cleaned, there could be large scabs covering the sutures. That’s going to be uncomfortable. But a well-cared-for wound is not painful when removing the stitches.

Question: What about the notion that if a cut is itchy, that means it’s healing?
Answer: It is a good sign! But you do not want to scratch it. Your fingernails are dirty. You could make it infected by doing that. So if it really itches, the best thing to do is cover it with something, a bandage, so you don’t scratch at it. But itching is actually a normal healing.

Question: With stitches, is it OK to go swimming? Resume normal activities?
Answer: I would just adhere to taking care of the wound as you were told to take care of the wound.

There are specific things to do when you care for a wound. If we put stitches in, you should keep the area dry for 24 hours, and while the stitches or staples are in, it can’t be (submerged in) water. So there’s no swimming, there’s no bathing. You can wash it, you could shower, after 24 hours of them being in place.

A very thin layer of Vaseline — just plain Vaseline on the stitches to keep them moist — is something you need to do twice a day. Cover with a bandage if there’s a possibility of friction, rubbing against a pillow at night or something like that, where you could tear them out. If stitches get torn out, they can’t be put back in. It has to heal on its own, and then the wound has to be repaired at a later date.

Question: What about after the stitches are out but while the cut is still healing?
Answer: You shouldn’t use peroxide, and you shouldn’t use alcohol to clean it, because those can cause tissue damage. Just plain soap and water twice a day.

So you’ve taken excellent care of your wound, and you’ve come back to have the sutures or staples removed in the appropriate timeframe. There’s no infection, it looks fantastic. Now, when they’re first removed, it’s the same care. You can’t put the cut in water because all those little holes where you’ve pulled the stitches out are still open. You have to wait for those little wounds to scab up for 24 hours before you put it underwater or go swimming.

Then this tissue doesn’t return to its full tensile strength for six to 12 months.

The body heals by forming scars. By closing a wound we try to minimize that scarring. The scar does fade over time. People say, “Oh, you have to put vitamin E or you have to put something else on it, and that helps with scarring.” None of those things have been proven.

The only thing that you have to do is SPF 50 — sunblock it! Fresh scars and sunlight do not play well together. You have to use that sunblock for a year after having some injury.

Make sure that for at least a month afterwards you’re protecting that wound from injury. Avoid sports that could injure it. Then after a year, if it’s cosmetically unappealing, you could consider having a scar revised. But the tissue has to reach its full tensile strength first.

Vanderbilt Health operates a variety of walk-in clinics in Middle Tennessee, including some with Williamson Medical Center, to take care of everything from sprains and sport injuries to flu shots, fevers, coughs and rashes. Search locations and learn more about the conditions treated there.