When to suture a laceration?

From the Guidelines

Suturing a laceration is recommended if the cut is deep, gaping, or longer than 1/2 inch, and ideally should be done within 6-8 hours of injury to reduce infection risk and promote optimal healing. When considering suturing a laceration, several factors should be taken into account, including:

• Depth of the cut: Cuts deeper than 1/4 inch typically require sutures 1
• Edge separation: Wounds with jagged or widely separated edges may need sutures to promote proper healing
• Location: Injuries on areas of high tension or movement, such as joints, may require sutures to minimize scarring and promote healing
• Exposure of underlying tissues: Cuts exposing fat, muscle, or bone should be sutured to reduce the risk of infection and promote healing
• Facial lacerations: These should be sutured to minimize scarring, especially if they are copiously irrigated and treated with preemptive antimicrobial therapy 1 It is essential to clean the wound immediately with soap and water and apply direct pressure with a clean cloth to control bleeding while seeking care. If unsure, it's always best to have a medical professional assess the wound to determine if sutures are necessary, as they can evaluate the wound and provide guidance on the best course of treatment 1.

From the Research

Decision to Suture a Laceration

The decision to suture a laceration depends on various factors, including the location, size, and depth of the wound.

• Lacerations on the face, over joints, on the hands and feet, and other areas that impede the use of a stapling device typically require suture repair 2.
• Linear lacerations of the scalp, trunk, and extremities are often suitable for staple closure, which may be less traumatic and quicker than suturing 2.
• Deep, dirty, or wounds that may contain a foreign body should be locally cleansed with antimicrobial agents and irrigated vigorously before closure 2.

Suture Techniques

Different suture techniques can be used to close lacerations, including:

• The subcutaneous loop technique, which combines the advantages of the classic mattress suture and the buried subcutaneous suture, allowing for the closure of both deep and superficial layers of skin in one single suture 3.
• The "round block" purse-string suture, a simple method to close skin defects with minimal scarring, which can be used to close difficult wounds and reduce scarring 4.
• Buried intradermal running suture technique, which can optimize cosmetic outcomes by reducing the risk of wound overgrowth and 'railroad track' suture marks 5.

Comparison of Suture and Staple Closure

Studies have compared the outcomes of suture and staple closure for skin incisions, including:

• A retrospective cohort study that found suture closure to be associated with a significantly lower rate of wound complications compared to staple closure for high-order cesarean deliveries 6.
• The use of subcuticular suture closure was preferred over staple closure after 2011 in one practice, with a lower rate of wound complications observed in the suture closure group 6.