From the Research
For laceration repair at the knuckle, 5-0 or 6-0 non-absorbable monofilament suture such as nylon or polypropylene is typically recommended. The knuckle area requires special consideration due to its mobility and tension during hand movement.
Key Considerations
- Use simple interrupted sutures with knots placed away from the joint surface to minimize irritation.
- Sutures should be placed approximately 2-3 mm apart and 2-3 mm from the wound edge, taking care not to place them too tightly as this can compromise circulation and lead to tissue necrosis.
- The repair should be performed with the hand in a slightly flexed position to prevent dehiscence when the patient moves their fingers.
- Sutures should remain in place for 10-14 days due to the high-tension nature of this area and its slower healing time compared to other body regions. Prior to suturing, thorough irrigation and debridement are essential to prevent infection, and evaluation for potential tendon or joint capsule involvement is crucial as these may require specialized repair 1. Although other studies discuss the use of absorbable sutures, such as Vicryl, in hand lacerations 2, and the effectiveness of 8-0 polyglactin 910 suture in entropion repair 3, the most relevant and recent evidence for laceration repair at the knuckle supports the use of non-absorbable monofilament sutures. Additionally, a study comparing non-absorbable polypropylene and delayed absorbable polyglactin 910 suture material in mass closure of vertical laparotomy wounds found that non-absorbable sutures had a lower incidence of wound dehiscence 4. Another study on coated polyglactin 910 suture with triclosan showed favorable intraoperative handling and wound healing characteristics, but this is not directly applicable to knuckle laceration repair 5.