What are the best sutures to use for a chin laceration?

Best Sutures for Chin Laceration Repair

For chin lacerations, monofilament non-absorbable sutures (5-0 or 6-0) are the optimal choice to minimize infection risk and provide excellent wound approximation with minimal scarring. 1

Suture Selection Algorithm

Material Type

1. Non-absorbable monofilament sutures are preferred for chin lacerations due to:

   • Lower bacterial seeding compared to multifilament sutures 1
   • Better tension distribution across the wound
   • Reduced tissue reaction
   • Optimal for facial areas with movement

2. Specific non-absorbable options:

   • Polypropylene (Prolene) 5-0 or 6-0
   • Nylon (Ethilon) 5-0 or 6-0

Suturing Technique

1. Continuous non-locking technique is recommended over interrupted sutures because it:

   • Distributes tension more evenly across the entire wound 1
   • Results in less pain during healing
   • Requires less suture material
   • Provides better cosmetic outcomes

2. Layer-specific approach:

   • Deep layers: Close with absorbable sutures if needed (e.g., 4-0 Monocryl)
   • Dermis: Consider fascial tension reduction sutures to minimize tension on skin 2
   • Skin: 5-0 or 6-0 non-absorbable monofilament sutures 1

Special Considerations for Chin Lacerations

Why Chin Lacerations Require Special Attention

• Higher risk of dehiscence compared to other facial locations (difference of 1.6%; 95% CI: 0.5-3.6%) 3
• Subject to movement and tension during talking, eating, and facial expressions
• Prominent location with high cosmetic importance

Alternative Options

1. Tissue adhesives:

   • Not recommended as primary closure for chin lacerations due to:
     • Higher movement area increases dehiscence risk
     • Chin lacerations have higher baseline dehiscence rates 3
   • May be considered for very superficial lacerations in compliant patients

2. Absorbable sutures:

   • While some studies show comparable cosmetic outcomes between absorbable and non-absorbable sutures in facial wounds 4, the chin's mobility makes non-absorbable sutures preferable

Practical Tips for Optimal Outcomes

• Wound preparation:

  • Adequate anesthesia (consider buffering lidocaine to reduce pain)
  • Thorough irrigation (tap water is acceptable) 5
  • Meticulous debridement of devitalized tissue

• Suture removal:

  • Remove facial sutures within 5-7 days to prevent tracking marks
  • Consider alternating suture removal (every other suture) if wound tension remains a concern

• Post-procedure care:

  • White petrolatum ointment is as effective as antibiotic ointment 5
  • Advise minimal movement of chin area during initial healing phase
  • Protect from sun exposure after healing to minimize hyperpigmentation

Common Pitfalls to Avoid

1. Excessive tension on suture line causing tissue ischemia and poor healing
2. Inadequate deep layer closure leading to dead space and potential hematoma
3. Delayed suture removal resulting in permanent suture marks
4. Improper suture technique with uneven wound edge approximation
5. Using tissue adhesive alone in a high-movement area like the chin

By following these guidelines and selecting appropriate non-absorbable monofilament sutures with proper technique, optimal cosmetic and functional outcomes can be achieved for chin laceration repairs.