From the Guidelines
For an 84-year-old male requiring sutures on the right lower extremity, I strongly recommend using monofilament sutures due to their association with a significantly lower risk of incisional hernia and wound complications, as supported by the most recent and highest quality study 1. When considering the type of suture material for a laceration on the lower extremity of an elderly patient, several factors come into play, including the risk of wound complications, incisional hernia, and the patient's overall health status.
- The patient's age and potential for compromised wound healing due to reduced vascularity and thinner skin on the lower extremity must be taken into account.
- Monofilament sutures, as recommended by the World Society of Emergency Surgery guidelines 1, are the preferred choice due to their lower risk of incisional hernia and potential for reduced wound complications.
- Key characteristics of monofilament sutures, such as minimal tissue reactivity and lower capillary action, make them an ideal choice for reducing the risk of infection in high-risk areas like the lower extremity. Some important considerations for the use of monofilament sutures in this context include:
- Suture size: 4-0 or 5-0 is often recommended for skin closure in elderly patients to minimize tissue trauma and promote healing.
- Suture material: Non-absorbable monofilament materials like nylon (Ethilon) or polypropylene (Prolene) are suitable options.
- Suture technique: A simple interrupted technique may be preferred to allow for better wound edge adjustment and the removal of individual sutures if complications arise.
- Post-closure care: Proper wound cleaning, elevation of the extremity to minimize edema, and consideration of prophylactic antibiotics if the wound is contaminated are crucial for optimizing healing outcomes.
From the Research
Suture Material Recommendations
The choice of suture material for a laceration on the right lower extremity of an 84-year-old male depends on various factors, including the type of tissue, patient characteristics, and wound circumstances 2.
Types of Suture Materials
There are two main classes of suture materials: absorbable and nonabsorbable sutures 3. Absorbable sutures are further classified based on their origin, and their tensile strength in vivo is an important consideration. Nonabsorbable sutures, such as polybutester and expanded polytetrafluoroethylene (ePTFE), have unique properties that enhance their clinical performance.
Factors Influencing Suture Choice
When selecting a suture material, it is essential to consider the biological interaction between the material and the tissue, as well as the biomechanical properties of the wound 3. Additionally, the risk of infection and the potential for bacterial adherence to the suture material should be taken into account 4.
Suture Material Comparison
Studies have compared the clinical characteristics of different suture materials, including monofilament and multifilament sutures, as well as natural and synthetic sutures 5. The results suggest that monofilament synthetic sutures, such as polypropylene, may offer superior soft tissue healing and reduced risk of postoperative infection.
Key Considerations
When choosing a suture material for a laceration on the right lower extremity of an 84-year-old male, the following factors should be considered:
- The type of tissue and wound circumstances
- The risk of infection and potential for bacterial adherence
- The biomechanical properties of the wound and the suture material
- The clinical characteristics of different suture materials, including monofilament and multifilament sutures, and natural and synthetic sutures 3, 4, 5