What are the best sutures for facial lacerations in children?

Best Sutures for Facial Lacerations in Children

For facial lacerations in children, 4-0 or 5-0 absorbable monofilament sutures are the optimal choice, providing excellent cosmetic outcomes while eliminating the need for suture removal, which can be traumatic for pediatric patients. 1

Suture Material Selection

Recommended Suture Types

• Monofilament sutures are preferred over multifilament sutures due to:
  • Lower bacterial seeding
  • Reduced infection risk 1
  • Better cosmetic outcomes

Specific Recommendations by Age and Location

• For facial wounds in children:
  • 5-0 or 6-0 absorbable monofilament sutures for most facial lacerations
  • 7-0 absorbable sutures for delicate areas or visible cosmetic zones 2
  • Fast-absorbing gut sutures are a viable alternative with comparable cosmetic results to nonabsorbable sutures 3

Evidence Supporting Absorbable Sutures

• Research demonstrates that absorbable sutures provide cosmetic outcomes equal or superior to nonabsorbable sutures in pediatric facial lacerations 4, 3
• A randomized controlled trial found that plain gut absorbable sutures provided slightly better cosmesis than nonabsorbable nylon sutures with no difference in dehiscence or infection rates 4
• Another study using 7-0 absorbable sutures for facial wounds in children showed excellent results with only 0.8% complication rate and 1.5% unfavorable scarring 2

Suturing Technique

Recommended Approach

• Place stitches 5mm from wound edge and 5mm apart
• Maintain a suture length to wound length ratio of at least 4:1
• Use non-locking technique to avoid tissue edema and necrosis 1
• Consider single-layer closure for non-gaping, minor facial lacerations (<3 cm) as it's faster with similar cosmetic outcomes to double-layer closure 5

Special Considerations for Children

• Primary wound closure is recommended for facial wounds, even when closure might not be recommended for wounds in other locations 1
• Consider tissue adhesives for small, clean facial lacerations (<4 cm length, <0.5 cm width) as they are:
  • Less painful (24.7 vs 43.7 mm on pain scale)
  • Faster to apply (7.9 vs 15.6 minutes)
  • Provide similar cosmetic results to sutures 6

Post-Closure Management

Wound Care Instructions

• After 24-48 hours, gently clean the wound daily with mild soap and warm water
• Apply thin layer of antibiotic ointment (if no known allergies)
• Cover with clean, dry dressing until wound has sealed (usually 2-3 days) 1
• Apply ice packs with a thin barrier for 15-20 minutes to reduce swelling

Suture Removal Timing

• For facial wounds, remove non-absorbable sutures after 5-7 days to minimize scarring
• When using absorbable sutures, no removal is necessary, which is a significant advantage in pediatric patients 1, 2

Scar Management

• Protect the scar from sun exposure with SPF 30+ sunscreen for at least 6 months
• After complete healing (2-4 weeks), perform gentle massage of the scar with moisturizer
• Note that scar formation continues for up to 12 months 1

Pitfalls and Caveats

• Avoid leaving non-absorbable sutures in place too long as this can lead to permanent suture marks and increased scarring
• Be aware that children are less likely to protect the suture line postoperatively, making absorbable sutures particularly advantageous 2
• Consider using tissue adhesive in combination with absorbable sutures for optimal results in appropriate cases 2
• Avoid NSAIDs if possible due to increased bleeding risk; use acetaminophen for pain management 1

By following these evidence-based recommendations for suture selection and technique, providers can achieve optimal cosmetic outcomes while minimizing trauma and complications in pediatric facial lacerations.