Surgical Sutures in Pediatric Care
Introduction
Surgical sutures, commonly known as stitches, are medical devices used to hold body tissues together after an injury or surgical procedure. They are essential tools in wound management, playing a critical role in helping cuts, lacerations, and surgical incisions heal properly. Sutures work by bringing wound edges together, preventing bleeding, reducing infection risk, and supporting tissue healing until the body can naturally repair itself.
In pediatric care, sutures are used for various purposes, from closing accidental cuts and lacerations to closing surgical incisions after operations. The choice of suture type, size, and technique depends on multiple factors including the child's age, wound location, depth, and healing requirements.
Key Point:
The word "suture" refers to the medical thread or material itself, while "stitches" describes the technique of placing these sutures to close a wound. Both terms are commonly used interchangeably in everyday conversation.
Purpose and Uses of Surgical Sutures
Surgical sutures serve multiple important functions in pediatric wound care:
- Wound Closure: Bringing separated tissue edges together to facilitate proper healing
- Bleeding Control: Helping to stop or reduce bleeding by compressing blood vessels
- Infection Prevention: Closing wounds to protect internal tissues from external contamination
- Tissue Support: Providing mechanical support during the healing process
- Scar Minimization: Proper wound edge alignment helps reduce visible scarring
- Deep Layer Closure: Securing internal tissue layers during surgical procedures
Common Situations Requiring Sutures in Children
- Cuts longer than half inch (12 mm) on the body
- Facial cuts longer than quarter inch (6 mm)
- Deep wounds that penetrate beyond the skin surface
- Wounds with separated or gaping edges
- Cuts over joints or areas with movement
- Surgical incisions from planned procedures
- Wounds in areas where scarring should be minimized
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Important:
Any wound that may need sutures should be evaluated by a healthcare professional within 6 hours of injury to prevent infection and ensure optimal healing.
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Types of Surgical Sutures
Sutures are classified based on several characteristics. Understanding these types helps in recognizing what has been used for your child's wound closure.
1. Based on Absorption
| Type | Description | Common Uses |
|---|---|---|
| Absorbable Sutures | Dissolve naturally in the body over time. Body enzymes break them down. | Internal layers, pediatric skin closure, areas where removal is difficult |
| Non-Absorbable Sutures | Remain permanently or require manual removal by healthcare provider. | High-tension areas, joints, skin closure requiring strong support |
2. Based on Material Source
| Category | Examples | Properties |
|---|---|---|
| Natural Sutures | Catgut (from animal collagen), Silk | Traditional materials, higher tissue reaction |
| Synthetic Sutures | Vicryl, PDS, Monocryl, Nylon, Prolene | More predictable, lower tissue reaction, widely used |
3. Based on Structure
| Structure | Characteristics | Advantages | Disadvantages |
|---|---|---|---|
| Monofilament | Single strand | Lower infection risk, smooth passage through tissue | Poor knot security, requires more knots |
| Multifilament | Multiple strands braided or twisted | Better handling, good knot security | Can harbor bacteria, higher tissue drag |
Common Suture Materials Used in Pediatrics
| Material | Type | Absorption Time | Pediatric Uses |
|---|---|---|---|
| Fast-Absorbing Gut | Absorbable, Natural | 7 days | Facial lacerations, areas healing quickly |
| Vicryl (Polyglactin) | Absorbable, Synthetic | 8-10 weeks | General soft tissue, muscle closure |
| Vicryl Rapide | Absorbable, Synthetic | 6-7 weeks | Skin closure on extremities and trunk in children |
| Monocryl | Absorbable, Synthetic | 100 days | Subcuticular closure, facial wounds, cosmetic procedures |
| PDS (Polydioxanone) | Absorbable, Synthetic | 6 months | Pediatric cardiac procedures, fascia closure |
| Nylon (Ethilon) | Non-Absorbable, Synthetic | Does not absorb | Skin closure requiring removal, high-tension areas |
| Polypropylene (Prolene) | Non-Absorbable, Synthetic | Does not absorb | Vascular procedures, areas needing permanent support |
Trend in Pediatric Care:
There is growing use of absorbable sutures for skin closure in children to avoid the stress and discomfort of suture removal. Studies show absorbable sutures provide comparable cosmetic results to non-absorbable sutures in many situations.
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Suture Sizes
Sutures are sized using a numbering system with the letter "O" (pronounced "oh"). The system works inversely: the larger the number before the "O", the smaller the suture diameter.
| Size | Diameter | Common Pediatric Uses |
|---|---|---|
| 6-0 | Very fine | Facial wounds in young children, delicate tissue repair |
| 5-0 | Fine | Face, neck, hands in children |
| 4-0 | Fine-medium | Face, trunk, extremities, general pediatric use |
| 3-0 | Medium | Trunk, extremities in older children, deeper layers |
| 2-0 | Thick | Areas under high tension, older adolescents |
General Principle:
Healthcare providers choose the smallest suture size that can effectively hold the wound edges together. Smaller sutures cause less tissue trauma and typically result in less scarring.
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How Sutures Are Used: Step-by-Step Process
Understanding the suturing process can help parents prepare their children and know what to expect.
Before Suturing
- Wound Assessment: Healthcare provider examines the wound depth, location, and contamination level
- Cleaning: The wound is thoroughly cleaned with sterile solution to remove dirt and debris
- Anesthesia: Local numbing medication is injected around the wound to prevent pain during suturing
- Preparation: The area is draped with sterile materials to maintain cleanliness
During Suturing
- Needle Selection: Appropriate suture material and needle size are chosen based on wound characteristics
- Technique Selection: The provider decides between simple interrupted, continuous, or other specialized techniques
- Placement: Sutures are placed to bring wound edges together evenly, typically starting from the wound center
- Knot Tying: Each suture is secured with appropriate knots to hold tension without being too tight
- Layer Closure: Deep wounds may require multiple layers of sutures at different tissue depths
After Suturing
- Cleaning: Blood and excess solution are cleaned from around the sutured area
- Dressing Application: Sterile bandage is applied to protect the wound
- Instructions: Detailed care instructions are provided to parents or caregivers
- Follow-up Planning: Removal date is scheduled for non-absorbable sutures
Common Suturing Techniques
| Technique | Description | When Used |
|---|---|---|
| Simple Interrupted | Individual stitches, each tied separately | Most common, reliable, one stitch breaking does not affect others |
| Continuous (Running) | Single thread running along wound length | Longer wounds, faster placement, distributed tension |
| Subcuticular | Suture placed under the skin surface | Better cosmetic results, commonly used on face |
| Deep (Buried) | Sutures placed in deeper tissue layers | Reduces tension on skin surface, deep wounds |
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Home Care for Sutured Wounds
Proper wound care at home is essential for optimal healing and preventing complications.
First 24-48 Hours
Critical First Day Rules:
- Keep the wound completely dry for first 24 hours (4 hours for skin glue if used)
- Use sponge baths instead of showers or baths
- Keep dressing clean and dry
- Limit activity to prevent wound stress
Daily Wound Care Instructions
- Cleaning: After 24 hours, gently clean the area with warm water once daily or when dirty. Pat dry with clean cloth.
- Antibiotic Ointment: Apply thin layer of antibiotic ointment (such as Polysporin) 3 times daily to prevent infection and reduce scab formation. Note: Do NOT use ointment if skin glue was applied.
- Dressing Changes: Change bandages when wet or dirty. Once wound edges are closed (usually 48 hours), dressing may not be needed unless sutures catch on clothing.
- Keep Dry: Avoid swimming, baths, or soaking until sutures are removed. Brief showers are allowed after 24 hours.
Activity Guidelines
- Avoid strenuous activities that could stress the wound
- No sports or rough play until cleared by healthcare provider
- Protect the wound from sun exposure
- For facial sutures, maintain soft diet if eating causes wound movement
- Keep young children from picking at sutures
Pain Management
- Give acetaminophen (Tylenol) or ibuprofen (Advil) as needed for discomfort
- Follow age-appropriate dosing on medication package
- Some pain is normal for first few days
- Severe or increasing pain should be reported to healthcare provider
Suture Removal Timeline
| Body Location | Removal Time |
|---|---|
| Face | 3-5 days |
| Scalp | 7-10 days |
| Trunk (chest, abdomen) | 7-10 days |
| Arms and legs | 7-14 days |
| Joints (knees, elbows) | 10-14 days |
| Hands and feet | 10-14 days |
Do Not Miss Removal Appointment:
Leaving sutures in too long can cause skin marks, scarring, and make removal more difficult. If you cannot attend the scheduled appointment, contact your healthcare provider immediately.
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Precautions and Safety
Signs Requiring Immediate Medical Attention
Contact Healthcare Provider Immediately If:
- Increasing redness spreading beyond wound edges
- Swelling that worsens after first 48 hours
- Pus or yellow-green drainage from wound
- Fever above 100.4°F (38°C)
- Red streaks extending from wound
- Wound edges separating or opening
- Severe pain not controlled by medication
- Foul odor from wound
- Sutures coming out before scheduled removal
- Excessive bleeding that does not stop with pressure
Wound Infection Prevention
- Wash hands thoroughly before touching wound or changing dressing
- Keep wound clean and dry as instructed
- Use only clean towels and washcloths
- Prevent child from touching or picking at sutures
- Keep pets away from sutured area
- Change bedding regularly during healing period
Allergic Reactions
While rare, some children may have allergic reactions to suture materials. Watch for:
- Excessive itching beyond normal healing itch
- Rash or hives around suture site
- Unusual swelling
- Blisters near sutures
Scarring Considerations
- All wounds leave some degree of scarring
- Proper wound care significantly reduces scar visibility
- Facial wounds typically heal with minimal scarring in children
- After suture removal, protect area from sun exposure for several months
- Massage scar gently after complete healing to improve appearance
- Discuss scar management options with healthcare provider if concerned
Special Precautions for Different Age Groups
| Age Group | Special Considerations |
|---|---|
| Infants (0-12 months) | Higher preference for absorbable sutures, extra protection from picking, frequent monitoring |
| Toddlers (1-3 years) | Difficult to keep still, may need creative wound protection, consider absorbable sutures |
| Preschool (3-5 years) | Can follow some instructions, may need distraction during care, supervision important |
| School Age (6-12 years) | Better cooperation, can assist with care, monitor during play activities |
| Adolescents (13+ years) | Increased independence, cosmetic concerns important, can manage own care with guidance |
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When Sutures Come Out Early
Sometimes sutures may come out before the scheduled removal date. How to handle this depends on timing and wound status.
Facial Wounds
- Contact healthcare provider immediately regardless of time since placement
- Facial wounds may need re-suturing at any time point
- Apply clean bandage and avoid stretching the area
Body Wounds - Less Than 48 Hours Since Placement
- Call healthcare provider right away
- Wound may need to be re-sutured if gaping open
- Keep area clean and covered
Body Wounds - More Than 48 Hours Since Placement
- Contact healthcare provider for advice
- Re-suturing rarely done after 48 hours (except face)
- May be reinforced with medical tape or butterfly bandages
- If wound edges are closed, usually heals without problems
Temporary Fix:
If sutures come out early and wound is gaping, close edges with medical tape or butterfly bandage until you can see healthcare provider. Keep area clean and dry.
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Alternatives to Traditional Sutures
Not all wounds require traditional sutures. Healthcare providers may use alternatives based on wound characteristics:
Skin Adhesive (Medical Glue)
- Brand names: Dermabond, LiquiBand
- Used for small, clean cuts with minimal tension
- Painless application, no removal needed
- Falls off naturally in 7-10 days
- Must stay completely dry for first 4 hours
- Cannot use ointments or creams over glue
Surgical Staples
- Used on scalp and areas with thick skin
- Faster application than sutures
- Require special removal tool
- Similar care to sutures
Adhesive Strips (Steri-Strips)
- Small, thin adhesive bandages
- Used for minor cuts or after suture removal for support
- Fall off naturally or removed after 5-7 days
- Can get wet after 24-48 hours
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Frequently Asked Questions
Q: How long does it take for sutures to heal?
A: Healing time varies by wound location. Facial wounds heal fastest (3-5 days), while joints and extremities may take 10-14 days. Complete healing with full strength takes several weeks even after suture removal.
Q: Will my child feel pain during suture placement?
A: The area is numbed with local anesthetic before suturing. Your child will feel the initial needle prick for anesthetic, then the area should be numb. Some pressure sensation during suturing is normal but should not be painful.
Q: Can we use regular tape instead of medical tape if sutures come out?
A: No. Use only medical tape, butterfly bandages, or adhesive strips designed for skin. Regular tape can cause skin irritation and does not provide appropriate wound support.
Q: How do I know if sutures are absorbable or need removal?
A: Your healthcare provider will inform you at time of placement. Generally, if you are given a specific removal appointment date, the sutures need removal. Absorbable sutures may still be trimmed at follow-up even though they dissolve.
Q: Can my child take a bath with sutures?
A: No baths, swimming, or soaking until sutures are removed. Brief showers are permitted after first 24 hours. For young children who cannot shower, use sponge baths.
Q: What if my child picks at the sutures?
A: Keep sutures covered with dressing if possible. For young children, consider using clothing that covers the area or distraction techniques. If picking is persistent, contact healthcare provider about possible earlier removal or additional protection methods.
Q: Is it normal for the area around sutures to be hard?
A: Some firmness is normal as part of healing. This represents tissue repair and inflammation. However, increasing hardness, redness, or warmth may indicate infection and should be evaluated.
Q: Can sutures be removed at home?
A: No. Suture removal should only be done by healthcare professionals using sterile technique and proper instruments. Attempting home removal risks infection, incomplete removal, or wound reopening.
Q: Why do some children get absorbable sutures while others get regular sutures?
A: The choice depends on wound location, depth, tension, and child's ability to return for removal. Absorbable sutures are increasingly preferred for children to avoid removal stress, especially for trunk and extremity wounds.
Q: How can we minimize scarring?
A: Follow all wound care instructions carefully, protect from sun exposure for 3-6 months after healing, avoid picking scabs, keep area moisturized after complete healing, and discuss scar management products with healthcare provider if needed.
Q: What causes a small pimple where the suture goes through skin?
A: This often indicates minor inflammation or low-grade infection around the suture material. Keep area clean, apply antibiotic ointment, and inform healthcare provider, especially if multiple pimples develop or area becomes more red.
Q: Is it safe to use ice on sutured wounds?
A: Ice can be used in the first 24-48 hours to reduce swelling, but never apply ice directly to skin or sutures. Wrap ice pack in clean cloth and apply for 15-20 minutes at a time with breaks in between.
Safe Storage and Handling (For Healthcare Facilities)
Sutures used in medical facilities must be stored and handled properly to maintain sterility and effectiveness.
Storage Requirements
- Store in clean, dry environment away from moisture sources
- Keep at least 8-10 inches from floor, 5 inches from ceiling, 2 inches from walls
- Avoid storage near sinks, water pipes, or outside walls
- Use closed cabinets or containers when possible
- Maintain appropriate temperature and humidity levels
- Keep away from direct sunlight
Package Integrity
- Check expiration dates before use
- Inspect packaging for tears, holes, or moisture
- Verify sterilization indicators have changed appropriately
- Discard any packages with compromised integrity
- Do not use if packaging is wet or soiled
Handling Practices
- Use aseptic technique when opening sterile packages
- Wash hands thoroughly before handling
- Do not stack packages in ways that cause crushing or bending
- Avoid excessive handling of sterile items
- Open packages only when ready to use
- Follow manufacturer's instructions for specific products
Sterilization Methods
Healthcare facilities use several sterilization methods for reusable suture needles and instruments:
- Steam sterilization (autoclaving) - most common for heat-resistant items
- Ethylene oxide gas sterilization - for heat-sensitive materials
- Radiation sterilization - for single-use commercial sutures
- Hydrogen peroxide plasma - for delicate instruments
Additional Important Information
For Healthcare Professionals
- Consider absorbable sutures as default for pediatric skin closure when appropriate
- Use smallest effective suture size to minimize trauma and scarring
- For facial wounds in children 12 years and under, consider 6-0 or 7-0 absorbable sutures with skin glue
- Document suture type, size, and planned removal date in medical records
- Provide clear written instructions to parents or caregivers
- Consider child's ability to return for follow-up when choosing suture type
For Parents and Caregivers
- Keep written instructions from healthcare provider in accessible place
- Take photos of wound appearance at different stages to track healing
- Mark suture removal date on calendar with reminder
- Prepare child for removal appointment with age-appropriate explanation
- Keep emergency contact information readily available
- Do not hesitate to contact healthcare provider with concerns
Cultural and Regional Considerations
While suture techniques and materials are largely standardized internationally, availability of specific products may vary by region. Healthcare providers worldwide follow similar principles of wound management, though specific brand names and product availability differ by country and healthcare system.
Cost Considerations
Suture costs vary significantly based on:
- Healthcare system and insurance coverage
- Type of facility (emergency department, clinic, urgent care)
- Suture material and complexity
- Geographic location
- Whether procedure is emergency or planned
Check with your healthcare provider or insurance company about coverage and expected costs.
When to Seek Medical Care
Immediate Emergency Care (Call Emergency Services)
- Severe bleeding that does not stop with direct pressure
- Wound from animal or human bite to face, hands, or genitals
- Wound with visible bone, tendon, or deep tissue
- Loss of sensation or movement below wound
- Signs of severe allergic reaction (difficulty breathing, facial swelling)
- Wound associated with broken bones or severe trauma
Urgent Care Within Hours
- Any cut that may need sutures (gaping, deep, or longer than half inch)
- Wounds on face longer than quarter inch
- Cuts to joints, hands, feet, or over bones
- Wounds with dirt or debris that cannot be cleaned at home
- Puncture wounds
- Wounds in children with diabetes or immune system problems
Contact Healthcare Provider
- Any signs of infection developing
- Questions about wound care
- Concerns about healing progress
- Need to reschedule suture removal appointment
- Sutures come out early
- Unusual symptoms around wound
Medical Disclaimer
This guide is for informational and educational purposes only and does not constitute medical advice.
The information provided about surgical sutures is intended to help parents, caregivers, and healthcare professionals understand wound closure in pediatric patients. However, this content should not replace professional medical judgment or consultation with qualified healthcare providers.
Important Points:
- Always follow the specific instructions provided by your child's healthcare provider, as they may differ from general information presented here
- Every child and wound is unique - treatment decisions must be individualized
- This guide does not cover all possible situations, complications, or variations in care
- Seek immediate professional medical attention for any emergency or concerning symptoms
- Information accuracy is maintained to the best extent possible, but medical knowledge and practices evolve
- Product names mentioned are for educational purposes and do not constitute endorsement
- Healthcare providers should refer to current clinical guidelines and their professional judgment
Liability: The authors, publishers, and distributors of this information assume no liability for any injury or damage resulting from the use or misuse of this information. Always consult with qualified medical professionals for diagnosis and treatment decisions.
Emergency Situations: If your child experiences a medical emergency, immediately call your local emergency number or go to the nearest emergency department. Do not delay seeking emergency care based on information from this or any educational resource.
Content Checked and Reviewed by: Dr. Pediatrician, PediaDevices
Last Updated: February 2026
Sources and References: Information compiled from peer-reviewed medical literature, professional medical guidelines, and established pediatric surgical practices. For detailed clinical information, healthcare professionals should consult:
- AORN Guidelines for Perioperative Practice
- American Academy of Pediatrics - Textbook of Pediatric Emergency Medicine
- Wounds and Lacerations: Emergency Care and Closure by Alexander Trott
- Current pediatric surgical and emergency medicine textbooks
- Professional medical society guidelines and standards
Labels: Surgical-Devices