What are the best dissolvable sutures to use for pediatric facial lacerations?

Best Dissolvable Sutures for Pediatric Facial Lacerations

For pediatric facial lacerations, rapidly absorbing synthetic sutures such as polyglactin 910 (Vicryl Rapide) are the best choice to minimize pain, avoid suture removal, and achieve excellent cosmetic outcomes.

Rationale for Using Dissolvable Sutures in Children

Dissolvable sutures offer significant advantages for pediatric facial wounds:

• Eliminate the need for suture removal, which can be traumatic for children 1
• Reduce pain and anxiety associated with follow-up visits 1
• Provide comparable cosmetic outcomes to non-absorbable sutures 2, 3
• Improve patient/caregiver satisfaction 2

Optimal Suture Selection Algorithm

First-line Choice: Rapidly Absorbing Synthetic Sutures

• Polyglactin 910 (Vicryl Rapide) - fast absorption, excellent handling, and minimal tissue reactivity 4
  • Spontaneously eliminates, avoiding conventional stitch removal
  • Well-tolerated in pediatric patients
  • Provides good cosmetic results and improved child comfort

Alternative Options:

1. Small-gauge absorbable monofilament sutures (7-0)

   • Excellent for delicate facial tissues
   • Studies show excellent outcomes with 7-0 absorbable sutures combined with tissue adhesive and tape 5
   • Very low complication rates (0.8%) and excellent scar appearance 5

2. Fast-absorbing catgut (FAC)

   • Studies show non-inferior cosmetic outcomes compared to nylon 3
   • Caregivers significantly prefer FAC over nylon for facial lacerations 2

Technical Considerations

Suture Size and Technique

• Use the smallest gauge appropriate for the wound (typically 5-0 to 7-0 for facial lacerations)
• Consider continuous suturing technique rather than interrupted sutures to reduce pain 1
• Employ "small bite" technique (5mm from wound edge, 5mm between stitches) for optimal wound healing 1

Important Precautions

• Avoid overly tight sutures on the face, as suture marks may be visible in approximately 25% of cases 4
• Consider tissue adhesives (e.g., octyl cyanoacrylate) for low-tension wounds as they provide essentially painless closure 1
• For multi-layer repairs, use absorbable sutures for deep layers and rapidly absorbing sutures for skin closure

Pain Management Considerations

• Apply topical anesthetics before laceration repair to minimize procedural pain 1
• Topical anesthetic/vasoconstrictor combinations (e.g., lidocaine, epinephrine, and tetracaine) provide excellent wound anesthesia in 20-30 minutes 1
• Consider tissue adhesives for small, low-tension wounds to avoid sutures altogether 1

Wound Care Instructions

• Keep the wound clean and dry
• No need for suture removal with rapidly absorbing sutures
• Follow-up only if complications develop (infection, dehiscence)
• Expect complete absorption of rapidly absorbing sutures within 7-14 days

Potential Complications and Management

• Infection rates are similar between absorbable and non-absorbable sutures 2, 3
• Wound dehiscence is rare with proper technique (reported at <1% in studies) 5
• Unfavorable scarring is uncommon (1.5% in one large pediatric study) 5

By using rapidly absorbing synthetic sutures for pediatric facial lacerations, you can achieve excellent cosmetic results while minimizing the trauma and anxiety associated with suture removal in children.