A suture scar may be painful or itchy. It may be darkened, raised, flat or concave. It may be lumpy or a combination of these. Scar tissue will go through many changes over time.
Look at the wound in good light. A mirror might be needed, depending on the wound location. Normal healing occurs in stages: an immediate two- to five-day inflammatory stage, when swelling and tenderness are normal; a proliferative phase of two days to three weeks, when granulation takes place, and a remodeling stage that lasts from three weeks to two years. Determine which stage the wound is in and assess for normal healing. Is the suture scar one week old with some yellow granulation? That would be normal. Is it three weeks old and swollen and tender? That would be abnormal. Check to see if edges are aligned, or if gaps have opened along the suture line. Because many interrupted sutures are typically used to repair wounds, it is usually not a problem if one or two of them break or come out. But if there are visible gaps, notify the physician. Depending on the stage of healing, edges are usually not realigned, but may require some changes in care to prevent infection.
Palpate the suture scar. Wash hands thoroughly before touching wounds. A suture scar in the remodeling phase is forming new collagen. The scar fibers will be hard at first and may remain so for some time. Expect softening to occur gradually over a period of months or years, until the scar fades and becomes nearly like the surrounding skin, although even when well-healed it may have up to 20 percent less than its original strength.
Assess for Hypertrophic scar formation. These are characterized by red or dark scar tissue that is raised and grows along the suture scar line but not beyond it. They might be tender and itchy. This type of scar tissue forms in the first weeks of wound healing. Hypertrophic scarring is usually temporary but may take up to a year to resolve. Surgical removal of hypertrophic scarring is possible.
Assess for keloid formation. Keloid scars develop beyond the borders of the original wound. They are more common in people of dark races. Red or dark clusters of keloid tissue may appear as late as one year after the original injury. Currently, there is no simple surgical treatments for keloid scars because they reoccur easily and may grow even larger if removed. However, a 2006 Italian study suggests that low dose ACE inhibitors, normally used to control hypertension, may prevent or reduce the severity of keloid scars.
Assess concave or contracted scarring. Not usually present unless a chunk of skin is missing, these types of scars tend to pucker and pull as they heal and may be unsightly or uncomfortable. Surgical procedures such as skin flaps and grafts can improve the appearance and feel of these scars in most cases.
Sutured scars should be massaged early and often to increase circulation, soften tissues and prevent adhesion. If the area is tender, rub gently from outside to center between sutures with one finger. As tenderness subsides, pull the scar up and away from the body and knead gently with the thumb and index finger.
Seek immediate emergency care in case of fever. Report increased pain, swelling, redness or heat at the suture site to a physician. These can be signs of serious infection.