Nursing care
Suture and staple removal: alternate removal, adhesive strips and separating edges
Written and reviewed by Dana Whitfield, RN, MSN · 4 min read · Updated October 2026
Short answer
Before removing sutures or staples, confirm the order and assess that the wound edges are well joined. Remove alternate sutures or staples first, cutting each suture close to the skin on the side opposite the knot, and apply adhesive strips for support. If the edges begin to separate, stop, support the wound and notify the prescriber.
Assess healing before removing anything
Timing for removing non-absorbable sutures and staples depends on the site, tension and healing. Facial sutures may come out within a few days, the torso and arms usually after about a week or more, and the hands, knees and lower legs later still. The timing comes from the order, but the nurse confirms readiness by assessing the wound on the day.
Look for edges that are well approximated, a healing ridge, and no redness spreading beyond the margins, swelling, discharge or gaps. Signs of infection or poor healing are reported rather than removing closures on schedule. Increasing pain is also worth reporting, because it can be an early sign of infection. Explain the procedure, offer analgesia if needed and position the patient comfortably with good light.
Critical steps for interrupted sutures
Use aseptic technique and a sterile suture removal pack. Grasp the knot with forceps and lift it gently. Cut the suture close to the skin on the side opposite the knot, then pull the suture out toward the incision. This prevents the contaminated portion that sat on the skin from being dragged through the tissue.
Remove every second suture first. If the edges stay together, remove the rest. Count the sutures removed and check that each is complete, because a retained fragment can cause inflammation. Allow the patient short pauses and encourage slow breathing if the procedure is uncomfortable. Pulling away from the incision line, rather than toward it, places tension on the wound and can open the edges.
Staple removal and adhesive strips
Slide the lower jaw of the staple remover under the centre of the staple, keep the device level and squeeze the handle fully. The staple bends into an M shape and its legs lift out of the skin. Do not lift or twist the wrist while squeezing, because that tears the skin and causes pain.
As with sutures, remove alternate staples first and remove the rest only if the wound holds. Apply sterile adhesive strips across the incision to support the edges as healing continues, usually with skin dry so they adhere. Teach the patient to let the strips fall off naturally and to keep the area clean and dry as directed. Ask them to report redness, discharge, fever, increasing pain or any opening of the scar, and explain that the wound continues to gain strength for weeks after the closures are gone.
When the wound edges separate
If edges start to gape after early removals, stop removing further closures. Apply adhesive strips across the gap and notify the prescriber. Leaving remaining sutures or staples in place gives the wound support while the team decides on the next step. Document the length of separation and the wound's appearance.
A larger separation, especially of an abdominal wound, may be dehiscence and in rare cases evisceration, where organs protrude. Cover exposed tissue with sterile dressings moistened with sterile saline, position the patient to reduce tension, keep them nil by mouth if surgery may follow and call for urgent surgical review.
Apply the steps to a study scenario
In a hypothetical item, a nurse removes every second staple from an abdominal incision and notices the edges beginning to pull apart at one end. Options include removing the remaining staples to inspect the wound, continuing because the order states full removal, or stopping, applying adhesive strips and notifying the prescriber. Stopping is correct.
The order assumed adequate healing, and the finding shows otherwise; the remaining staples are still providing support. Document the number removed and left, the wound assessment, strips applied, the patient's tolerance, and who was informed. Assistive personnel may help with positioning, but wound assessment remains a nursing responsibility.
Sources and further reading
NHS Borders (Right Decisions): Suture and staple removal. Removal timing, alternate removal, cutting technique, staple remover use, adhesive strips, stopping when edges separate and documentation.
MSD Manual Professional: Lacerations. Suture and staple removal timing by body site and wound care and infection warning signs after closure.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our fundamentals practice questions are the closest set to what this page covers.
Common questions
Why are alternate sutures or staples removed first?
It tests whether the wound can hold its edges together while half the closures still provide support. If the edges stay closed, the rest can be removed.
Why is a suture cut on the side opposite the knot?
Cutting close to the skin opposite the knot means only the clean buried portion passes through tissue when the suture is pulled out.
What should the nurse do if a wound opens during staple removal?
Stop removing staples, apply adhesive strips across the gap and notify the prescriber. For a large opening, cover with saline-moistened sterile dressings and seek urgent review.
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