1. Nursing Instruction
  2. Overview
  3. Emergency and Critical
【Major Points】
  1. I will be able to know what to prepare for care of the suture wounds.
  2. I will be able to know the steps to care of the suture wounds.
  3. I will be able to know when to seek immediate medical attention.
 
The purpose of wound suturing:
To help wound healing, prevent the entry of contamination or foreign objects, and reduce the likelihood of wound infection.

Supplies:
May purchase from the pharmacy or medical supply store (Figure 1)
  1. 0.9% saline water (2-3 small bottles)
  2. Sterile cotton swabs
  3. Povidone-iodine (Aqua beta-iodine)
  4. Antibiotic ointment (not necessary, used in medical prescriptions)
  5. Sterile gauze pads with suitable sizes
  6. Surgical paper tape
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Figure 1 Supplies for suture wound care
 
Care Steps:
  1. Remove the old dressing:
    1. Wash your hands
    2. Gently remove tapes. Secure the skin with your fingers, separate the skin downwards from the tape, then remove the old gauze.
    3. If the gauze is adhesive to the wound site, rinse it with 0.9% saline water from the side of it, then gently remove the gauze. 
  2. Observe the wound:
    1. Check the symptom of the wound (changes of size; amount , color or smell of wound discharge).
    2. Put on the gloves to palpate the surrounding to check if there are any signs of infection, including redness, swelling, heat or pain.
  3. Clean the wound:
    1. First, soak a cotton swab with 0.9% saline water to clean the wound.
    2. Clean the wound from the center toward the outer area in a circular motion.
    3. Clean toward 2-3cm of the outer edge (Note: Ensure each cotton swab is used only once.)
  4. Dry the wound: After the wound is cleaned, dry the area with a dry cotton swab inside out.
  5. Sterile the wound:
    1. After the wound is dried, apply beta-iodine and wait for at least 30 seconds to sterilize the site.
    2. After sterilizing the site, repeat step 3  to remove beta-iodine.
  6. Dress the wound:
    1. Apply antibiotic ointment according to the prescription from doctor (some ointment might spill out after opening, be sure to clean the outlet before using it) and avoid using any medication of unknown origin.
    2. Cover with gauze sized over 1cm of the outer edge of the wound.
    3. Secure the dressing the tape (avoid humid, oily, sweaty skin that affects the adhesion of tape).
 
Care Principles:
  1. Wash your hands with soap.
  2. Keep the sutured wound dry and clean. Dressing should be changed immediately if it was soiled or wet.
  3. The sutured wound may have mild swelling and pain within 12 to 24 hours after the procedure. If the wound is located on your limbs, you may try to elevate the limb or apply ice packing to ease the discomfort. 
  4. If the stitches are located on the joints e.g. wrist, elbow or knee, minimize/limit your movement to avoid stretching the stitches.
  5. Consume more protein (e.g. meat, eggs, milk, fish, etc.) and vitamin C (e.g. kiwi, citrus, apples, etc.) to promote wound healing.
  6. Take medications as prescribed and follow up at out patient department.
    1. Take your medicine regularly as prescribed.
    2. Register for return visit: Emergency Trauma Clinic , every Monday and Wednesday, from 13:30 to 17:00.
 
When to remove the stitches?
It depends on the location of the suture wound, the doctor will make an assessment removing the stitches.
  1. Average wound requires approx. 7 to 10 days.
  2. Facial wound approx. 5 to 7 days.
  3. Wound over joints requires approx. 10 to 14 days.
  4. Within 3 months after the stitches are removed, you may cover the wound with sterile surgical tapes STERISTERIP(R) (also known as wound closure strips or microporous surgical tape) to maintain the tension and reduce scar formation.
 
Seek medical attention immediately if you have the following conditions :
  1.  Wound reopen or continous oozing/bleeding.
  2. The wound appears redness, swelling, heat, pain, or pus-like drainage.
  3. Associated with other symptoms e.g. fever with chills, or shivering.
The above conditions indicate poor healing of the wound, and you should visit your doctor immediately.
 
Reference
  1. Huang, S. J., Wu, L. H., Chen, Y. H., Lau, Y. J., Chuang, Y. C., Hsueh, P. R. & Lu, M. C. (2018).Prevention of surgical site infections: local challenges and strategies of implementation.Infection Control Journal, 28(1), 17-26. http://doi.org/10.6526/ICJ.2018.103
  2. Lin, T. R., Hu, M. F., Liu, J. H., Liu, C. C., Yang, C. I., Lin, J. Y., Huang, M. J. & Shie, P.S. (2021). Reducing the incidence of medical adhesive-related skin injuries in surgical intensive care unit. Hu Li Za Zhi, 68(1), 74-81.https://doi.org/10.6224/JN.202102_68(1).10
  3. Kelly-O'Flynn, S., Mohamud, L. & Copson, D. (2020). Medical adhesive-related skin injury. British Journal of Nursing, 29(6), S20-S26. https://doi.org/10.12968/bjon.2020.29.6.S20
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    Taipei Veterans General Hospital 
    No.201, Sec. 2, Shipai Rd., Beitou District,  3e72dadb9904d06fa0fb3744e4ed2612.png
    Taipei, Taiwan 11217, R.O.C.
    Tel: +886-2-2871-2121 #04
    • Smoking and chewing betel nut significantly induce oral cancer. Obesity will potentially increase the risk of breast cancer and colorectal cancer. Please control body weight and keep away from tobacco and betel nut.
    • Information provided above can’t overcome physician's treatment and replace physician patient relationship.
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