Can Emergency Department Patients Remove Their Own Non-absorbable Sutures at Home?
Date First Published:
April 19, 2020
Last Updated:
April 22, 2020
Report by:
Zachary Hamersma, Brian Lewis, EM Senior Residents (Spectrum Health/Michigan State University Emergency Medicine Residency Program)
Search checked by:
Jeffrey S. Jones, MD, Spectrum Health/Michigan State University Emergency Medicine Residency Program
Three-Part Question:
What proportion of [adult patients with lacerations repaired in the emergency department] are [capable of successfully removing their non-absorbable sutures] at [home if provided suitable instructions and equipment] versus [the standard follow-up care]?
Clinical Scenario:
25-year-old presents to the emergency department after sustaining a laceration to his ankle after cutting his leg on a piece of metal. The wound is hemostatic on presentation. There does not appear to be any gross contamination and a simple closure is adequate with nonabsorbable sutures. After closure the patient is given routine discharge instructions when he questions you about removing his sutures at home.
Search Strategy:
Medline 1966-04/20 using PubMed, Cochrane Library (2020), and Embase
Search Details:
[(exp suture removal) OR (exp suture removal kit) OR (exp self-removal)]. Limit to English Language and clinical trials
[(exp sutures) AND (exp self care or exp self-removal)]. Limit to English Language and clinical trials
[(exp sutures) AND (exp self care or exp self-removal)]. Limit to English Language and clinical trials
Outcome:
134 clinical trials were identified; one addressed the clinical question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Are patients willing to remove, and capable of removing, their own nonabsorbable sutures? Macdonald P, Primiani N, Lund A. Jul-12 Canada | 183 adults who presented to the ED with a laceration sutured using non-absorbable sutures. The study group was provided with wound care instructions, a suture removal kit, and instructions regarding suture self-removal. |
RCT | Proportion of patients successfully removing their own sutures | 91.5% of intervention group vs 62.8% control group removed own sutures | Single blinded, pseudo-randomization, and no formal cost-benefit evaluation was conducted. Did not have the power to truly show if there are negative outcomes associated with self- suture removal and there was no verification of wound infection and dehiscence. |
| Visits to follow-up physician for wound care | Patients visited their physician less often in the intervention group (9.8% vs 34.6%) | ||||
| Complication rates | No significant differences |
Author Commentary:
There is very little in the literature that assesses the willingness to, or rate at which patients remove their own sutures. Suture removal for uncomplicated or simple lacerations is relatively safe and easy. Clinicians should consider discharging patients with appropriate suture removal kits and instructions. These kits generally contain a sterile pair of scissors, forceps and a gauze sponge and are generally quite inexpensive. Patients should also be directed to look for signs of infection and instructed to see a physician or return to the ED should the experience any problems with their wound, or complications when removing sutures.
Bottom Line:
The majority of ED patients with uncomplicated lacerations prefer to remove their own sutures. Clinicians should consider discharging patients with appropriate suture removal kits and instructions.
References:
- Macdonald P, Primiani N, Lund A.. Are patients willing to remove, and capable of removing, their own nonabsorbable sutures?