What type of sutures are recommended for a large laceration on the dorsum of the hand?

Suture Recommendations for Large Lacerations on the Dorsum of the Hand

For large lacerations on the dorsum of the hand, monofilament sutures are recommended due to less bacterial seeding and reduced infection risk, with absorbable monofilament options like poliglecaprone (Monocryl) being particularly suitable.

Optimal Suture Selection

Suture Type

• Monofilament vs. Multifilament:
  • Monofilament sutures are preferred for hand lacerations as they cause less bacterial seeding and may reduce infection risk
  • While multifilament sutures offer higher tensile strength and flexibility, they create greater tissue friction and increase infection risk

Absorbable vs. Non-absorbable Options

• Absorbable options:

  • Monofilament: Poliglecaprone (Monocryl) and polyglyconate (Maxon) are excellent choices
  • Poliglecaprone (Monocryl) provides approximately 20-30% breaking strength retention after 2 weeks (critical wound healing period) and complete absorption between 91-119 days with minimal tissue reaction 1
  • Research shows absorbable sutures are an acceptable alternative for hand lacerations with no difference in complications or scar quality compared to non-absorbable options 2

• Non-absorbable options:

  • 5-0 or 6-0 monofilament sutures can be used when extended tensile strength is required
  • These typically require removal after 7-10 days

Suturing Technique

• Use a layered closure approach for large lacerations:

  1. Deep tissue layers: Close with absorbable sutures
  2. Skin closure: Consider continuous non-locking subcuticular technique for better cosmetic outcomes and reduced tension

• Ensure proper tension to prevent tissue necrosis while maintaining wound approximation

• For dorsum of hand specifically, consider:

  • Placing sutures perpendicular to tension lines
  • Using slightly wider spacing than facial wounds due to increased movement in this area

Evidence-Based Considerations

• A 5-year retrospective study of 102 patients with hand lacerations showed no difference in complications, infections, or scar quality between absorbable (Vicryl) and non-absorbable (nylon) sutures 2
• Multiple studies have demonstrated comparable cosmetic outcomes between absorbable and non-absorbable sutures in various body locations 3, 4

Important Caveats and Pitfalls

• Avoid common mistakes:

  • Using too large suture material (use the smallest effective size to minimize tissue trauma)
  • Placing sutures too tightly (causes tissue ischemia and poor healing)
  • Neglecting proper wound preparation and irrigation before closure

• Special considerations for dorsum of hand:

  • This area has thin skin with minimal subcutaneous tissue
  • High mobility region requires sutures that maintain strength during early healing
  • Consider immobilization in functional position to protect repair during initial healing
  • Begin gentle range of motion exercises as healing permits to prevent stiffness

• When to consider alternatives:

  • For very superficial lacerations, tissue adhesives or Steri-Strips may be considered
  • For contaminated wounds, delayed primary closure may be preferable

By following these recommendations, optimal healing and cosmetic outcomes can be achieved for large lacerations on the dorsum of the hand.