What are the best sutures for closing a forehead laceration?

Best Sutures for Forehead Laceration Repair

For forehead lacerations, monofilament sutures such as 5-0 or 6-0 polypropylene or nylon are recommended as they cause less bacterial seeding, reduce infection risk, and provide optimal cosmetic outcomes. 1, 2

Suture Selection Considerations

Material Type

• Monofilament sutures (preferred):

  • Polypropylene (Prolene) or nylon (Ethilon): 5-0 or 6-0 size 1, 2
  • Advantages: Less bacterial seeding, reduced infection risk, minimal tissue reaction 1, 3

• Rapidly absorbing synthetic sutures (alternative option):

  • Polyglactin 910 (Vicryl Rapide): 5-0 or 6-0 size
  • Advantages: No need for suture removal, reduced patient anxiety and discomfort 4
  • Consideration: Higher cost but eliminates follow-up visit for suture removal 1

Closure Technique

1. Deep layer closure (if needed):

   • Use 4-0 poliglecaprone (Monocryl) for subcutaneous tissue 4
   • Implement fascial tension reduction sutures to minimize tension on skin 2

2. Skin closure:

   • Use continuous non-locking technique rather than interrupted sutures 1
   • Benefits: More even distribution of tension, less pain, and improved cosmetic outcome 1

Timing for Suture Removal

• Remove facial sutures after 5-7 days to balance adequate wound healing with minimizing visible scarring 5
• Consider applying Steri-Strips for additional support for 3-5 days after suture removal 5

Special Considerations

High-Risk Factors

• Forehead is a high-mobility area with significant tension during facial expressions
• Leaving sutures too long can lead to permanent suture marks and increased scarring 5
• Removing sutures too early may result in wound dehiscence 5

Alternative Closure Methods

• For small, low-tension forehead lacerations, consider:
  • Tissue adhesives (octylcyanoacrylate)
  • Steri-Strips (less expensive than adhesives) 5, 6
  • Studies show comparable cosmetic outcomes between tissue adhesives and sutures in low-tension areas 6

Post-Closure Care

• Apply white petrolatum ointment (as effective as antibiotic ointment) 7
• Wound can be wet as early as 12 hours after repair without increasing infection risk 7
• Provide clear wound care instructions to optimize healing and cosmetic outcome

Common Pitfalls to Avoid

1. Using multifilament sutures, which increase bacterial seeding and infection risk 3
2. Applying excessive tension during closure, leading to tissue necrosis and poor scarring 1
3. Removing sutures too late, causing permanent suture marks 5
4. Neglecting deep layer closure when needed, resulting in increased tension on skin closure

By following these evidence-based recommendations for forehead laceration repair, you can achieve optimal functional and cosmetic outcomes while minimizing complications.