Removal techniques depend on the type of sutures to be removed. The illustrations below show removal steps for four common suture types. Keep in mind that for all suture types, it's important to grasp and cut sutures in the correct place to avoid pulling the exposed (thus contaminated) suture material through subcutaneous tissue.
Plain interrupted sutures
Using sterile forceps, grasp the knot of the first suture and raise it off the skin. This will expose a small portion of the suture that was below skin level. Place the rounded tip of sterile curved-tip suture scissors against the skin, and cut through the exposed portion of the suture. Then, still holding the knot with the forceps, pull the cut suture up and out of the skin in a smooth continuous motion to avoid causing the patient pain. Discard the suture. Repeat the process for every other suture, initially; if the wound doesn't gape, you can then remove the remaining sutures as ordered.
Plain continuous sutures
Cut the first suture on the side opposite the knot. Next, cut the same side of the next suture in line. Then lift the first suture out in the direction of the knot. Proceed along the suture line, grasping each suture where you grasped the knot on the first one.
Mattress interrupted sutures
If possible, remove the small, visible portion of the suture opposite the knot by cutting it at each visible end and lifting the small piece away from the skin to prevent pulling it through and contaminating subcutaneous tissue. Then remove the rest of the suture by pulling it out in the direction of the knot. If the visible portion is too small to cut twice, cut it once and pull the entire suture out in the opposite direction. Repeat these steps for the remaining sutures, and monitor the incision carefully for infection.
Mattress continuous sutures
Follow the procedure for removing mattress interrupted sutures, first removing the small visible portion of the suture, if possible, to prevent pulling it through and contaminating subcutaneous tissue. Then extract the rest of the suture in the direction of the knot.
