From the Guidelines
Using 4-0 Vicryl (polyglactin 910) for the deep suture and 3-0 Ethilon (nylon) for skin closure is not the most appropriate choice for a forearm laceration, as the use of antimicrobial-coated sutures, such as triclosan-coated Vicryl, has been shown to reduce the risk of surgical site infections (SSI) compared to non-coated sutures 1.
Suture Selection Considerations
When selecting sutures for a forearm laceration, it's essential to consider the type of suture material, its absorbability, and its potential to reduce the risk of SSI.
- The use of antimicrobial-coated sutures, such as triclosan-coated Vicryl, has been associated with a lower risk of SSI compared to non-coated sutures 1.
- A study by Wu et al. demonstrated that triclosan-coated sutures significantly reduced SSI risk (OR 0.72,95% CI 0.59–0.88, P = 0.001) 1.
- Another study by Uchino et al. found that antimicrobial-coated sutures were superior in reducing the incidence of incisional SSI (RR 0.67,95% CI 0.48–0.94, P = 0.02) 1.
Recommendations
Based on the available evidence, it is recommended to use antimicrobial-coated sutures, such as triclosan-coated Vicryl, for deep sutures and a monofilament non-absorbable suture, such as 3-0 Ethilon, for skin closure.
- The deep Vicryl sutures, preferably triclosan-coated, will provide good wound support and reduce the risk of SSI.
- The 3-0 Ethilon sutures will provide secure skin closure and can be removed after 7-14 days, depending on the location and tension of the wound.
Wound Management
Proper wound management is crucial to prevent SSI and promote healing.
- Ensure proper wound cleaning and debridement if necessary.
- Consider local anesthetic infiltration for patient comfort.
- Monitor the wound for signs of infection and take prompt action if necessary.
From the Research
Suture Material Selection for Forearm Laceration
The selection of suture materials for closing a forearm laceration involves considering the properties of different sutures, including their tensile strength, knot security, and potential for bacterial adherence.
- Deep Suture: The use of 4-0 vicryl (polyglactin 910) for the deep suture is a common practice. Vicryl is an absorbable, braided suture that provides good tensile strength and is often used for subcuticular closure 2.
- Skin Closure: For skin closure, 3-0 ethilon (nylon) is a monofilament, non-absorbable suture. It is known for its high tensile strength, low tissue reaction, and resistance to infection, making it suitable for skin closure 3.
Bacterial Adherence and Wound Healing
Studies have investigated the bacterial adherence properties of different suture materials. One study found that vicryl had the highest bacterial adherence among the tested sutures, suggesting that absorbable braided sutures like vicryl may not be ideal for closing contaminated wounds or wounds at risk of infection 3. However, another study comparing coated vicryl plus antibacterial suture with traditional coated vicryl suture found no significant difference in wound healing characteristics, except for reduced postoperative pain with the antibacterial suture 4.
Clinical Evidence
Clinical evidence on the specific combination of 4-0 vicryl for deep sutures and 3-0 ethilon for skin closure in forearm lacerations is limited. However, the choice of suture material can depend on various factors, including the surgeon's preference, the type of wound, and the patient's overall health status 2, 3, 4.
- Intraoral Surgery: A study on intraoral surgery found that triclosan-coated suture material did not offer an advantage in reducing bacterial adherence compared to uncoated suture material 5.
- Wound Healing: Another study evaluating the effect of coated vicryl plus antibacterial suture on wound healing in a guinea pig model found no significant difference in wound strength or histopathologic effects compared to traditional coated vicryl suture 6.