What type of suture material is recommended for different wound types and locations in emergency medicine settings?

Suture Selection in Emergency Medicine Settings

For emergency wound closure, monofilament slowly absorbable sutures are recommended for most wounds, with antimicrobial-coated options preferred for contaminated wounds to reduce infection risk and optimize healing outcomes. 1, 2

Abdominal Wound Closure

Fascial Closure

• Material: Slowly absorbable monofilament sutures (strong recommendation)
  • Significantly decreases incisional hernia risk compared to multifilament 1
  • Antimicrobial-coated sutures recommended for clean, clean-contaminated, and contaminated fields 1

Technique

• Use continuous suture technique (faster than interrupted with similar outcomes) 1, 2
• Employ "small bite" technique (5mm from wound edge, 5mm between stitches) 1, 2
• Maintain suture-to-wound length ratio of at least 4:1 1, 2
• Do NOT close peritoneum separately 1, 2
• Use mass closure rather than layered closure (faster with similar outcomes) 1

Special Considerations

• Retention sutures lack sufficient evidence for routine use 1
• Avoid subcutaneous drains (not supported by evidence) 1
• Consider delayed primary closure for contaminated/dirty wounds 1

Cutaneous Wound Closure

Material Selection Based on Location

1. Face/Cosmetically Sensitive Areas:

   • 6-0 or smaller monofilament sutures
   • Early removal (3-5 days) to prevent suture marks 2

2. Scalp/Extremities:

   • 4-0 or 5-0 monofilament sutures
   • Consider interrupted technique for high-tension areas

3. Oral Mucosa:

   • 5-0 or 6-0 monofilament non-absorbable sutures
   • Minimizes bacterial seeding and infection risk 2

4. High-Tension Areas:

   • Deep dermal layer: 4-0 absorbable sutures
   • Superficial closure: 4-0 or 5-0 monofilament

Contaminated Wounds

• Antimicrobial-coated sutures strongly recommended 1, 2
• Consider delayed primary closure for heavily contaminated wounds 1
• Prophylactic wound irrigation recommended (non-antibiotic solutions) 1

Practical Algorithm for Suture Selection

1. Assess wound characteristics:

   • Location
   • Depth
   • Contamination level
   • Tension

2. For deep tissue/fascial closure:

   • Choose slowly absorbable monofilament
   • Use continuous technique with small bites
   • Consider antimicrobial coating for contaminated wounds

3. For dermal closure:

   • Use 4-0 poliglecaprone or 4-0 polyglactin for subcuticular continuous closure 2

4. For epidermal closure:

   • Face: 6-0 or smaller monofilament
   • Trunk/extremities: 4-0 or 5-0 monofilament
   • High-mobility areas: Consider subcuticular continuous closure

Pitfalls to Avoid

• Using rapidly absorbable sutures for fascial closure (higher hernia rates) 1, 2
• Applying excessive tension (leads to tissue necrosis and poor scarring) 2
• Removing facial sutures too late (causes permanent suture marks) 2
• Using multifilament sutures in contaminated wounds (higher infection risk) 1
• Separate closure of peritoneum (unnecessary and time-consuming) 1, 2

By following these evidence-based recommendations for suture selection and technique, emergency medicine providers can optimize wound healing outcomes while minimizing complications such as infection, dehiscence, and poor cosmetic results.