From the Research
For a palmar laceration repair, 4-0 or 5-0 non-absorbable sutures such as nylon or polypropylene are typically recommended. The palm has thicker skin than other areas of the hand and requires stronger suture material to withstand the mechanical stresses of daily hand use 1.
Key Considerations
- For deeper layers, 4-0 absorbable sutures like Vicryl may be used to close the dermis before final skin closure.
- When repairing palmar lacerations, ensure adequate local anesthesia (1-2% lidocaine with epinephrine), thorough irrigation, and careful examination for tendon, nerve, or vascular injuries before closure 2.
- Sutures should generally be removed in 10-14 days to allow for proper healing while minimizing scarring.
- The palm's high-tension environment and frequent movement necessitate secure closure, and patients should be advised to keep the wound clean and dry, with limited hand use during the initial healing phase to prevent dehiscence.
Suture Selection
- The smallest suture size that will accomplish the purpose should be chosen to minimize tissue trauma and foreign material within tissues 1.
- Monofilament suture has lower resistance when passed through tissues, whereas multifilament sutures possesses higher tensile strength and flexibility but greater tissue friction and pose risks of suture sinus and infection 1.
- Nonabsorbable sutures typically cause an inflammatory reaction that eventually encapsulates by fibrous tissue formation, and excess reaction leads to chronic inflammation, suboptimal scarring, or suture extrusion 1.