What type of stitch and suture material is suitable for different wound types and patient conditions?

Optimal Suture Selection and Techniques for Different Wound Types

For optimal wound healing and reduced complications, use monofilament slowly absorbable sutures for most wound closures, with the small bite technique for abdominal fascial closure to minimize incisional hernia risk. 1

Abdominal Wound Closure

Fascial Closure

• Technique: Continuous suture technique is recommended over interrupted sutures

  • Provides faster closure with no difference in incisional hernia or dehiscence rates 1
  • Use "small bite" technique (5mm from wound edge, 5mm between stitches) to reduce incisional hernia risk 1
  • Maintain suture-to-wound length ratio of at least 4:1 1

• Material:

  • Use slowly absorbable monofilament sutures for fascial closure 1
  • Monofilament sutures significantly decrease incisional hernia incidence compared to multifilament 1
  • Consider antimicrobial-coated sutures (triclosan-impregnated) for clean, clean-contaminated, and contaminated wounds to reduce surgical site infections 1

• Avoid:

  • Separate closure of peritoneum (not recommended) 1
  • Rapidly absorbable sutures (associated with higher hernia rates) 1
  • Retention sutures (insufficient evidence for routine use) 1

Skin Closure

• Technique:

  • Subcuticular continuous suture technique reduces superficial wound dehiscence compared to interrupted sutures 1
  • No significant difference in SSI incidence between continuous vs. interrupted skin closure 1

• Material:

  • 4-0 poliglecaprone or 4-0 polyglactin for subcuticular continuous closure 1
  • These sutures retain 50-75% tensile strength after 1 week, providing extended wound support 1

Oral Mucosa Repair

• Material:

  • Monofilament non-absorbable sutures (5-0 or 6-0) are recommended for oral mucosa repair 2
  • Polypropylene (Prolene) or nylon (Ethilon) minimize bacterial seeding, infection risk, and tissue reaction 2
  • For non-keratinized oral mucosa, monofilament sutures strongly preferred to minimize inflammation 2
  • Alternative: Rapidly absorbing synthetic sutures (polyglactin 910/Vicryl Rapide) eliminate need for removal 2

• Technique:

  • Continuous non-locking technique provides even tension distribution, less pain, and improved cosmetic outcome 2
  • Avoid excessive tension to prevent tissue necrosis and poor scarring 2
  • Ensure proper deep layer closure when needed to reduce tension on superficial closure 2

Facial Wound Closure

• Material choice:

  • Both absorbable and non-absorbable sutures provide equivalent long-term cosmetic results 3
  • Absorbable sutures (like 5-0 coated irradiated polyglactin 910/Vicryl Rapide) eliminate need for removal, reducing patient anxiety 3
  • Non-absorbable sutures (like 5-0 polypropylene/Prolene) are easier to tie and elicit minimal inflammatory response 3

• Timing of removal:

  • Facial sutures typically removed after 5-7 days 2
  • Consider applying Steri-Strips for 3-5 days after suture removal for additional support 2
  • Removing sutures too late can cause permanent suture marks; too early may result in wound dehiscence 2

Common Pitfalls and How to Avoid Them

1. Excessive tension:

   • Leads to tissue necrosis, poor scarring, and potential wound dehiscence
   • Solution: Ensure adequate deep layer closure and proper tension distribution

2. Inappropriate suture selection:

   • Using rapidly absorbable sutures for fascial closure increases hernia risk
   • Solution: Select slowly absorbable monofilament sutures for fascial closure

3. Improper technique:

   • Large bite technique for fascial closure increases incisional hernia risk
   • Solution: Use small bite technique (5mm from edge, 5mm between stitches)

4. Ignoring wound contamination:

   • Failure to use antimicrobial-coated sutures in contaminated wounds increases SSI risk
   • Solution: Use triclosan-impregnated sutures for clean-contaminated and contaminated wounds

5. Inappropriate suture removal timing:

   • Too early: risk of wound dehiscence
   • Too late: permanent suture marks and increased scarring
   • Solution: Follow appropriate timing guidelines (5-7 days for facial wounds)

By selecting the appropriate suture material and technique based on wound type, location, and contamination status, optimal wound healing can be achieved while minimizing complications such as infection, dehiscence, and poor cosmetic outcomes.