From the Research
For palm lacerations, 4-0 or 5-0 non-absorbable sutures, such as nylon or polypropylene, are recommended due to their adequate tensile strength and minimal tissue reactivity, as supported by the most recent and highest quality study 1. The palm requires stronger sutures because of the constant movement and tension in this area during daily activities. When closing a palm laceration, it is essential to ensure thorough irrigation and debridement to prevent infection, and consider a layered closure for deeper wounds. Sutures should remain in place for 10-14 days due to the palm's slower healing rate and high-tension environment. Local anesthesia (1-2% lidocaine with epinephrine) should be used for patient comfort during repair, though epinephrine should be avoided in digital blocks, as noted in 2. After closure, recommend elevation of the hand, limited use of the affected area, and keeping the wound clean and dry. Prophylactic antibiotics may be considered if the wound is contaminated or if the patient has risk factors for infection such as diabetes or immunocompromise. Key considerations for suture selection include the material's influence on wound healing, microbial colonization, tissue reaction, and clinical features, as discussed in 1 and 3. Ultimately, the choice of suture material and technique should prioritize minimizing the risk of infection and promoting optimal wound healing, as emphasized in 2 and 1.
Some key points to consider when repairing palm lacerations include:
- Using non-absorbable sutures, such as nylon or polypropylene, for their strength and minimal tissue reactivity
- Ensuring thorough irrigation and debridement to prevent infection
- Considering a layered closure for deeper wounds
- Using local anesthesia for patient comfort, while avoiding epinephrine in digital blocks
- Recommending elevation, limited use, and keeping the wound clean and dry after closure
- Considering prophylactic antibiotics for contaminated wounds or patients with risk factors for infection.
It is also important to note that while older studies, such as 4 and 5, provide valuable insights, the most recent and highest quality study 1 should be prioritized when making recommendations for suture size and material in palm lacerations.