Suture and clip removal with wound review
PLAB 2 & PRES 3 · practical skills / surgery · easy · 8 minutes
Candidate brief
You are an FY2 doctor in a GP treatment room. Mrs Patricia Shaw, 63, had an open appendicectomy seven days ago and attends today for review of her surgical wound and removal of the skin clips, as advised on her discharge summary. Please assess the wound, remove the clips if appropriate, and agree the follow-up plan with her. Verbalise your assessment and each step as you perform it.
What examiners look for
Assess first, remove second: the examination decides whether removal happens at all today. A wound that is infected, gaping or dehiscing does not need its clips removed by you — it needs a surgical review, and the competence being examined is recognising the difference between a wound that is ready and one that is not. Alternate clips first is a built-in stress test. Removing every other clip and re-inspecting tells you whether the wound's own strength is sufficient before you take out the rest. If the wound starts to separate, you stop — half the clips remain, the wound is supported, and you escalate. It converts a blind act into a reversible one. Know what normal healing looks like so you can name the abnormal: mild edge redness, tightness and a small amount of early serous ooze that dries up are healing; spreading erythema, increasing pain after initial improvement, pus, gaping and fever are infection or dehiscence. This patient's slightly oozy lower end, now dry, with a well patient and apposed edges, sits on the healing side — and saying WHY is the mark-earning move. Count out what you take out: twelve clips in, twelve clips in the sharps bin. A retained clip discovered weeks later is a documented incident and a distressed patient; counting is the same discipline as the surgical swab count, at a smaller scale. Removal timing is site- and wound-specific — face 3–5 days, scalp 7–10, abdomen and trunk 7–10 (this wound, appropriately today), limbs 7–10, over joints 10–14 — and is set by the operating team's summary, not by the patient's preference or the clinic's convenience. Aftercare is a clinical intervention: showering guidance, graded lifting/driving advice, and infection red flags in plain language with a named route back. Most wound problems are caught by patients, not professionals — the safety net you give her IS her monitoring system.
Guideline references
- https://geekymedics.com/simple-interrupted-suture-osce-guide/
- https://www.nhs.uk/conditions/cuts-and-grazes/
Practise this station
Role-play it with an AI patient and get feedback against the full marking scheme. Create a free account — 3 stations per month free.