What is the best dissolvable suture for pediatric facial lacerations?

Best Dissolvable Suture for Pediatric Facial Laceration

For pediatric facial lacerations, rapidly absorbing polyglactin 910 (Vicryl Rapide) is the best dissolvable suture option as it eliminates the need for suture removal while providing excellent cosmetic outcomes and reducing pain and anxiety in children. 1

Rationale for Using Dissolvable Sutures in Pediatric Facial Lacerations

Dissolvable sutures offer significant advantages for pediatric facial lacerations:

• Eliminate the need for suture removal, which can be traumatic and anxiety-producing for children 1
• Reduce pain and distress associated with follow-up visits
• Provide comparable or better cosmetic outcomes compared to non-absorbable sutures 2

Optimal Dissolvable Suture Selection

First Choice: Rapidly Absorbing Synthetic Sutures

• Polyglactin 910 (Vicryl Rapide) is the preferred option because:
  • Fast absorption rate (5-7 days) which is ideal for facial wounds 3, 4
  • Spontaneous elimination avoids conventional stitch removal 3
  • Good tolerability and cosmetic results in pediatric surgery 3
  • Reduces pain and anxiety in children 1

Alternative Options:

• Monofilament absorbable sutures (e.g., poliglecaprone/Monocryl)

  • Cause less bacterial seeding and may reduce infection risk 1
  • Smooth passage through tissue
  • Less tissue drag and trauma

• Plain gut absorbable sutures

  • Shown to provide slightly better cosmesis than non-absorbable sutures in some studies 2
  • Natural material with predictable absorption

Suturing Technique Considerations

• Use continuous non-locking suturing technique for facial lacerations

  • Distributes tension more evenly across the suture line 1
  • Results in less short-term pain 1
  • Avoid locking sutures as they can cause excessive tension leading to tissue edema and necrosis 1

• Consider tissue adhesives (e.g., octyl cyanoacrylate) for low-tension wounds as an alternative to suturing

  • Provides essentially painless closure 1
  • Good cosmetic outcomes for appropriate wounds

Pain Management During Procedure

For optimal pain control during facial laceration repair:

• Apply topical anesthetic early in the treatment process:

  • LET (lidocaine, epinephrine, tetracaine) provides excellent wound anesthesia in 20-30 minutes 1
  • Apply to open wound and cover with occlusive dressing
  • Dosing: 3 mL for children >17 kg; 0.175 mL/kg in children <17 kg 1

• If injectable anesthesia is needed:

  • Use buffered lidocaine (with bicarbonate)
  • Warm the lidocaine before injection
  • Inject slowly with a small-gauge needle 1

Important Caveats and Considerations

• Avoid using rapidly absorbing sutures in areas of high tension

  • May lead to premature suture failure before adequate wound healing

• Facial location considerations:

  • For wounds near eyes, mouth, or other mobile areas, ensure suture strength matches the expected mechanical forces

• Proper wound assessment is crucial:

  • Exclude wounds requiring specialty consultation (involving nerves, tendons, cartilage)
  • Ensure adequate cleansing and debridement before closure

• Contraindications for standard closure:

  • Grossly contaminated wounds
  • Animal/human bites
  • Puncture/crush wounds
  • Wounds older than 12 hours 2

By using rapidly absorbing synthetic sutures like Vicryl Rapide for pediatric facial lacerations, providers can achieve optimal cosmetic outcomes while minimizing the pain and anxiety associated with suture removal in children.