What is the recommended suture size for an adult forehead laceration?

Recommended Suture Size for Adult Forehead Laceration

For adult forehead lacerations, 5-0 or 6-0 monofilament non-absorbable sutures are recommended as the optimal choice to achieve the best cosmetic outcomes while minimizing infection risk. 1

Suture Material Selection

Optimal Suture Type

• Monofilament non-absorbable sutures are strongly preferred for facial lacerations due to:
  • Less bacterial seeding
  • Reduced infection risk
  • Minimal tissue reaction
  • Better cosmetic outcomes

Specific Recommendations

• 5-0 or 6-0 polypropylene (Prolene) or nylon (Ethilon) are ideal choices 1
• The smaller gauge (6-0) provides more precise cosmetic results but 5-0 offers slightly better tensile strength

Technique Considerations

Layered Closure Approach

1. Deep layer closure (if needed):

   • Use 5-0 absorbable monofilament suture (poliglecaprone-25/Monocryl) for subcutaneous tissue
   • This reduces tension on the superficial closure

2. Superficial (epidermal) closure:

   • Use 5-0 or 6-0 monofilament non-absorbable suture
   • Consider continuous non-locking technique for more even distribution of tension and improved cosmetic outcome 2

Evidence-Based Insights

• Research shows equal cosmetic outcomes between 5-0 absorbable poliglecaprone-25 and 6-0 polypropylene for superficial closures in facial wounds 3
• Applying proper tension is critical - excessive tension leads to tissue necrosis and poor scarring 1
• For small, low-tension forehead lacerations, tissue adhesives can be considered as an alternative with comparable cosmetic outcomes 1, 4

Suture Removal Timing

• Remove facial sutures after 5-7 days 1
• Consider applying Steri-Strips for additional support for 3-5 days after suture removal
• Removing sutures too late can cause permanent suture marks while removing them too early risks wound dehiscence 1

Common Pitfalls to Avoid

1. Using sutures that are too large (e.g., 4-0 or larger) on the face, which can lead to more visible scarring
2. Applying excessive tension during closure
3. Neglecting deep layer closure when needed
4. Leaving sutures in place too long, causing permanent track marks
5. Using multifilament sutures, which have higher bacterial adherence and infection risk

By following these evidence-based recommendations, optimal cosmetic and functional outcomes can be achieved for adult forehead lacerations while minimizing complications.