Purse string sutures are removed by locating the knot, cutting the suture thread close to the skin on one side of the knot, and then gently pulling the entire thread out through the wound. The process is straightforward but requires precision to avoid dragging contaminated portions of the thread through the tissue or disrupting the healing wound. Removal typically happens 7 to 10 days after placement for smaller wounds, though some purse string closures stay in place for 3 to 4 weeks depending on the size and location of the defect.
What Purse String Sutures Are Used For
A purse string suture is a continuous stitch that runs in a circle around a wound opening, similar to a drawstring on a bag. When tightened, it cinches the skin edges inward, reducing a round or oval defect to a much smaller opening. This technique is commonly used after excision of skin tumors on the head and neck, for closing circular wounds from trauma, and in various surgical contexts including breast procedures, umbilical reconstruction, and securing drainage tubes at stoma sites.
Because the suture is one continuous thread rather than a series of individual stitches, the removal process differs slightly from standard interrupted sutures. You’re pulling out a single looped thread rather than cutting and removing each stitch individually.
Equipment You’ll Need
A standard suture removal kit contains everything required for the procedure:
- Fine-tipped forceps for grasping the knot and thread
- Small, sharp scissors (often called suture scissors or iris scissors) for cutting the thread close to the skin
- Sterile gauze pads (both 2×2 and 4×4 sizes) for cleaning the area and applying gentle pressure afterward
You’ll also want an antiseptic solution to clean the surrounding skin before starting, and fresh dressing materials for afterward.
Step-by-Step Removal Process
Before touching the suture, clean the skin around the wound with antiseptic and pat it dry with sterile gauze. This reduces the risk of pushing surface bacteria into the suture tract during removal.
Start by identifying the knot. In a purse string suture, there is typically one knot where the thread was tied off after cinching the wound closed. Use the forceps to gently grasp the knot and lift it slightly away from the skin surface. This creates enough space to slide one blade of the scissors underneath.
Cut the suture thread as close to the skin as possible on one side of the knot. The goal is to ensure that when you pull the thread out, you never drag a portion that was exposed on the skin surface back through the tissue underneath. Cutting right at the skin entry point minimizes this risk.
Once the thread is cut, use the forceps to grip the knot and pull the suture slowly and steadily in the direction of the wound. Because this is a continuous suture, the entire loop of thread should slide out in one piece. Pull gently and evenly. If you feel significant resistance, stop and reassess rather than forcing the thread through, as this could tear delicate new tissue.
After the suture is fully removed, inspect the thread to confirm you have the complete length. A retained fragment left under the skin can cause a foreign body reaction or infection. Count the entry and exit points along the wound to make sure no segment of thread remains embedded.
When Removal Should Happen
Timing depends on wound size, location, and tension. For smaller skin defects, polypropylene purse string sutures are generally removed around 7 to 10 days after the procedure. Larger or higher-tension closures often stay in for 3 to 4 weeks to allow more complete healing before the mechanical support is removed.
Facial sutures tend to come out on the earlier end of that range because the face has excellent blood supply and heals quickly, and leaving sutures in too long increases the risk of visible track marks. Wounds on the trunk, extremities, or areas that move a lot during daily activity may need the full 3 to 4 weeks.
Some purse string sutures are placed with absorbable material, which dissolves on its own over weeks to months and doesn’t require removal at all. If your surgeon used an absorbable suture for the deeper layers and a non-absorbable one on the surface, only the surface thread needs to be taken out.
Signs That Removal Should Be Delayed
The wound needs to be assessed before removal begins. If the edges are not holding together well, or the skin gaps open when you gently test it, removing the suture too early risks the wound reopening. This is called dehiscence, and it’s more likely in areas under tension or in patients with slower healing.
Active signs of infection also change the approach. Redness spreading beyond the wound edges, thick cloudy discharge, warmth at the site, or a bad odor from the incision all warrant evaluation before proceeding with removal. In some cases, the suture itself is contributing to the problem (foreign body reactions and chronic irritation can cause suture exposure and granulation tissue), but that determination needs to be made on a case-by-case basis.
What to Expect During Removal
Most people feel a tugging sensation as the thread slides through the skin, but the process is not typically painful. The cutting itself is painless since the scissors only contact the thread. The brief pulling sensation comes as the suture passes through the tissue tracts, which may be slightly tender if there’s any surrounding inflammation.
For purse string sutures that have been in place for several weeks, the tissue may have grown snugly around the thread. This can make the pulling sensation slightly stronger, but it should still be tolerable. If the area is particularly sensitive, a topical numbing agent can be applied beforehand.
Caring for the Wound Afterward
Once the suture is out, the wound still needs protection while the deeper layers finish healing. Cover the site with a sterile gauze pad taped on all four sides to keep it clean and dry. If your surgeon prescribed a topical ointment, apply a thin layer directly over the closure line before placing the gauze.
Change the dressing daily or every few days based on how much the wound is still draining. Each time you change it, inspect the site for signs of trouble. Normal healing looks like a thin pink line with mild tenderness that decreases over time. Concerning signs include:
- Spreading redness or color changes beyond the edges of the wound
- Thick, cloudy, or foul-smelling discharge
- The wound opening up or becoming deeper, longer, or wider
- Warmth around the site that wasn’t there before
- Fever above 101°F (38.4°C), chills, or sweating
After the dressing is no longer needed, the scar will continue to mature and flatten over the following months. Purse string closures generally produce minimal scarring because they convert a large open defect into a much smaller gathered closure, reducing the final scar length significantly compared to a straight-line closure.
Purse String Sutures Around Tubes and Stomas
Purse string sutures used to secure gastrostomy tubes or drainage sites follow a slightly different removal logic. These sutures are designed so that once the tube is removed, tightening the purse string cinches the opening shut to prevent leakage. Removal of the suture itself typically happens after the stoma tract has closed sufficiently, and the timing depends on how quickly the site seals.
In these cases, the suture may be under more tension than a simple skin closure, and the surrounding tissue can be more fragile due to prolonged tube contact. The same basic technique applies: identify the knot, cut close to the skin on one side, and pull the thread out gently. But the threshold for stopping and seeking help if something doesn’t feel right is lower, given the proximity to internal organs and the risk of reopening a tract that hasn’t fully healed.