What is the best suture for closing the subcutaneous layer in pediatric facial lacerations?

Best Suture for Closing Subcutaneous Layer in Pediatric Facial Lacerations

Monofilament absorbable sutures such as poliglecaprone (Monocryl) are preferred for subcutaneous closure of pediatric facial lacerations due to less bacterial seeding, reduced infection risk, and excellent cosmetic outcomes.

Rationale for Suture Selection

Monofilament vs. Multifilament

Monofilament sutures are preferred for subcutaneous closure in facial wounds for several important reasons:

• Lower infection risk: Monofilament sutures cause less bacterial seeding and may be less likely to cause infection compared to multifilament sutures 1
• Tissue reaction: Monofilament sutures generally cause less tissue reaction than multifilament alternatives
• Smooth passage: They pass through tissue with less drag, potentially causing less trauma

Absorbable vs. Non-absorbable

For subcutaneous closure in pediatric facial wounds, absorbable sutures offer significant advantages:

• No removal needed: Eliminates the need for suture removal, which is particularly beneficial in children who may be anxious or uncooperative 2
• Comparable outcomes: Studies show comparable or even better cosmetic outcomes with absorbable sutures compared to non-absorbable sutures 3, 4
• Patient comfort: Reduces anxiety and discomfort associated with suture removal 4

Specific Suture Recommendations

First Choice: Poliglecaprone (Monocryl)

• Monofilament structure
• Excellent handling characteristics
• Minimal tissue reactivity
• Appropriate tensile strength for facial wounds
• Maintains adequate strength during critical wound healing phase

Alternative Options:

• Polyglyconate (Maxon): Another monofilament option with similar benefits 1
• Fast-absorbing synthetic sutures: Such as Vicryl Rapide may be considered for more superficial subcutaneous closure 1, 4

Technical Considerations

Suturing Technique

• Use a continuous, non-locking suture technique for subcutaneous closure
• This distributes tension more evenly across the suture line 1
• Non-locking technique prevents excessive tension that could lead to tissue edema and necrosis 1

Wound Closure Approach

For optimal outcomes in pediatric facial lacerations:

1. Ensure adequate anesthesia before wound manipulation 1
2. Consider topical anesthetics like LET (lidocaine, epinephrine, tetracaine) for initial pain control 1
3. Close subcutaneous layer with monofilament absorbable suture
4. Consider subcuticular closure for skin layer with absorbable sutures to avoid traumatic suture removal 2
5. For very superficial wounds, consider tissue adhesives or Steri-Strips as alternatives to sutures 1

Common Pitfalls and Caveats

• Avoid catgut: Associated with more pain and higher risk of requiring resuturing compared to synthetic options 1
• Avoid excessive tension: Can lead to tissue ischemia and poor cosmetic outcomes
• Consider wound location: Facial wounds in children require particular attention to cosmetic outcome
• Wound hematoma prevention: Meticulous hemostasis is essential to prevent hematoma formation, which can increase infection risk 1
• Patient cooperation: In children, consider the need for sedation or distraction techniques during suturing to ensure optimal placement

By following these recommendations, clinicians can achieve optimal functional and cosmetic outcomes while minimizing discomfort and anxiety for pediatric patients with facial lacerations.