What is the appropriate technique for closing a finger laceration using a running suture?

Running Suture Technique for Finger Laceration

For finger lacerations, a continuous non-locking running suture technique using a slowly absorbable monofilament suture is recommended as it provides optimal wound closure with less pain and better cosmetic outcomes.

Suture Material Selection

• Use a slowly absorbable monofilament suture for finger lacerations 1
  • Monofilament sutures cause less bacterial seeding and may be less likely to cause infection 1
  • Slowly absorbable materials provide adequate support during the critical healing phase
  • Examples include poliglecaprone (Monocryl) or polydioxanone (PDS)

Running Suture Technique Steps

1. Preparation:

   • Ensure adequate anesthesia (digital block)
   • Clean the wound thoroughly
   • Debride any devitalized tissue

2. Execution of Running Suture:

   • Anchor the suture at one end of the laceration
   • Use a continuous, non-locking technique throughout the closure 1
   • Place stitches approximately 5mm apart (small bite technique) 1
   • Maintain even tension throughout the suture line
   • Avoid excessive tension which can cause tissue ischemia
   • Complete the closure by tying at the opposite end

Advantages of Running Suture for Finger Lacerations

• Distributes tension more evenly across the entire length of the suture 1
• Results in less short-term pain compared to interrupted sutures 1
• Reduces the amount of suture material used 1
• Provides better cosmetic outcomes
• Faster placement than interrupted sutures

Key Technical Considerations

• Use non-locking technique as locking sutures can cause excessive tension leading to tissue edema and necrosis 1
• Small bite technique (5mm from wound edge, 5mm between stitches) allows for better tissue approximation 1
• Maintain even tension throughout the suture line to prevent wound dehiscence
• Avoid deep placement that might damage underlying structures (tendons, nerves, vessels)
• Consider the functional aspect of the finger when placing sutures to avoid restriction of movement

Pitfalls to Avoid

• Avoid excessive tension which can lead to tissue ischemia and necrosis
• Avoid locking sutures on fingers as they can cause excessive tension 1, 2
• Avoid transcutaneous interrupted suturing on sensitive skin surfaces as it can damage nerve endings and increase pain 1, 2
• Avoid suturing too deeply which might damage underlying structures
• Avoid inadequate wound edge approximation which can lead to poor cosmetic outcomes

The running suture technique for finger lacerations provides optimal wound closure with minimal tissue trauma, better cosmetic outcomes, and reduced patient discomfort during healing.