Recommended Suture for Forehead Skin Closure
For forehead skin closure, use 4-0 or 5-0 absorbable synthetic monofilament suture (poliglecaprone-25 or polyglactin 910) placed as a continuous subcuticular suture.
Rationale Based on Evidence
The 2020 World Society of Emergency Surgery guidelines provide clear direction on optimal skin closure technique, prioritizing outcomes of wound dehiscence, infection, and cosmetic results 1.
Technique: Continuous vs. Interrupted
Continuous subcuticular suturing significantly reduces superficial wound dehiscence (RR 0.08; 95% CI 0.02 to 0.35) compared to interrupted transcutaneous sutures, with no difference in surgical site infection rates or hospital stay 1. This represents a Grade 1B recommendation (strong recommendation, moderate-quality evidence) 1.
Suture Material Selection
The guidelines specifically identify 4-0 poliglecaprone-25 or 4-0 polyglactin 910 as the preferred absorbable materials for continuous skin closure 1. These synthetic absorbable sutures:
- Retain 50-75% of tensile strength after 1 week in situ
- Provide extended wound support during critical healing phases
- Eliminate need for suture removal (improving patient experience and reducing follow-up burden)
- Undergo predictable hydrolytic degradation rather than unpredictable enzymatic breakdown
Facial-Specific Evidence
For facial wounds specifically, recent high-quality research supports this approach:
A 2026 randomized trial (n=105 facial Mohs surgery patients) demonstrated that rapidly absorbable polyglactin 910 (5-0 Vicryl Rapide) produced superior cosmetic outcomes compared to fast-absorbing gut suture at 6 months, with statistically significant improvements on multiple validated scar assessment scales 2
A 2010 split-scar study showed 5-0 poliglecaprone-25 achieved equivalent cosmetic results to 6-0 polypropylene (nonabsorbable) for facial closures, with 85% showing no difference at 4-month follow-up 3
Practical Application for Forehead Closure
Step-by-step approach:
- Close deep layers with buried dermal sutures (5-0 poliglecaprone-25 or polyglactin)
- For skin layer: Use remaining absorbable suture (or fresh 4-0 to 5-0 poliglecaprone-25/polyglactin) in continuous subcuticular running pattern
- Avoid interrupted transcutaneous (through-and-through) sutures, which increase dehiscence risk
- Avoid tissue adhesives or steri-strips as primary closure—they don't reduce infection rates and may increase dehiscence risk (Grade 1B) 1
Important Caveats
- Avoid nonabsorbable transcutaneous sutures on the forehead—they require removal at 7-9 days and show higher dehiscence rates 1
- Tissue adhesives alone are inferior: A Cochrane review demonstrated sutures significantly reduce wound dehiscence compared to adhesives (RR 3.35; 95% CI 1.53-7.33) 1
- Steri-strips add no benefit when proper subcuticular closure is performed 1
- For high-tension closures, ensure adequate deep dermal support before skin approximation
Suture Size Considerations
For forehead wounds, 5-0 is generally preferred over 4-0 for the superficial layer to minimize tissue trauma and optimize cosmetic outcome, while 4-0 provides adequate strength for deeper layers 2, 3. Use the smallest diameter that accomplishes secure closure.