What type of suture is recommended for knee wounds?

Recommended Sutures for Knee Wounds

For knee wounds, slowly absorbable monofilament sutures are recommended as they provide optimal wound healing with reduced infection risk while maintaining adequate tensile strength during the critical healing period. 1

Suture Material Selection

Deep Tissue/Fascial Closure

• First choice: Slowly absorbable monofilament sutures
  • Examples: Poliglecaprone (MONOCRYL) or Polyglyconate (Maxon) 2, 1
  • Benefits: Maintain tensile strength during critical healing period, less bacterial seeding, reduced infection risk 2
  • Avoid rapidly absorbable sutures as they may result in higher hernia rates 1

Subcutaneous Layer

• Recommended: 4-0 poliglecaprone or 4-0 polyglactin 1
  • These retain 50-75% tensile strength after 1 week, providing extended wound support
  • Continuous suture technique is preferred over interrupted sutures 1

Skin Closure Options

1. Subcuticular closure:

   • 4-0 absorbable monofilament suture (preferred over 2-0) 3
   • Benefits: Reduces incidence of fatty liquefaction, frequency of gauze change, and improves cosmetic appearance 3

2. Alternative options:

   • Metal staples: Faster application (81 seconds vs 290 seconds for conventional sutures) with similar complication rates 4
   • Skin adhesives: Can eliminate need for skin sutures while providing occlusive dressing 5

Suturing Technique

Key Principles

• Use "small bite" technique (5mm from wound edge, 5mm between stitches) 1
• Maintain suture-to-wound length ratio of at least 4:1 2, 1
• Use continuous suture technique rather than interrupted sutures for faster closure with no difference in complication rates 1

Important Considerations and Pitfalls

Avoid These Common Mistakes

• Avoid barbed sutures for subcuticular closure: Associated with increased risk of wound infection in knee arthroplasty 6
• Avoid multifilament sutures in contaminated wounds: Higher infection risk due to bacterial seeding 2, 1
• Avoid excessive tension: Leads to tissue necrosis, poor scarring, and potential wound dehiscence 1

Special Considerations

• For contaminated knee wounds, consider antimicrobial-coated sutures to reduce surgical site infections 1
• Remove facial sutures after 5-7 days, and consider applying Steri-Strips for 3-5 days after suture removal for additional support 1
• When using absorbable sutures, patients show improved outcomes with reduced hospital length of stay and better cosmetic appearance compared to non-absorbable sutures 3

By following these evidence-based recommendations for suture selection and technique in knee wounds, you can optimize healing outcomes, reduce infection risk, and improve patient satisfaction with the cosmetic result.