What are the best sutures for laceration repair on toes?

Best Sutures for Laceration Repair on Toes

For toe laceration repair, monofilament sutures are preferred due to less bacterial seeding and reduced infection risk, which is particularly important in the toe area where infection can significantly impact mobility and quality of life.

Suture Material Selection

Preferred Options:

• Monofilament sutures (5-0 or 6-0):
  • Cause less bacterial seeding compared to multifilament options 1
  • Reduce infection risk in toe areas which are prone to contamination 2
  • Provide minimal tissue reaction

Alternative Options:

• Rapidly absorbing synthetic sutures:
  • Eliminate the need for suture removal visits 2
  • Particularly beneficial for patients who may have difficulty returning for follow-up
  • Despite higher cost, may be more convenient for both patient and provider 1

Sutures to Avoid:

• Catgut sutures:
  • Associated with more pain and higher risk of requiring resuturing 1
  • Not recommended for toe lacerations

Suturing Technique

Recommended Approach:

• Continuous non-locking suturing technique:
  • Distributes tension more evenly across the suture length 1
  • Associated with less pain (RR, 0.76; 95% CI, 0.66-0.88) 1
  • Reduces need for analgesia (RR, 0.70; 95% CI, 0.59-0.84) 1
  • Decreases need for suture removal (RR, 0.56; 95% CI, 0.32-0.98) 1

For Skin Closure:

• Continuous subcuticular closure:
  • Avoids damage to nerve endings on skin surface
  • Minimizes pain and improves cosmetic outcome 1
  • Particularly important in toe area where mobility can be affected by painful sutures

Wound Preparation and Management

Before Suturing:

• Thorough irrigation to remove debris and reduce infection risk 3
• Appropriate antiseptic preparation (povidone-iodine or chlorhexidine if iodine allergic) 2
• Ensure adequate anesthesia for proper pain control during repair 2

Post-Repair Care:

• Apply white petrolatum ointment (as effective as antibiotic ointment) 4
• Keep wound clean and dry for first 24 hours
• Patient can wet the wound after 12 hours without increased infection risk 4
• Consider immobilization in functional position to protect repair 2

Special Considerations for Toe Lacerations

Anatomical Challenges:

• Toes have thin skin covering with minimal subcutaneous tissue
• High mobility area requiring sutures that maintain integrity during movement
• Prone to contamination due to proximity to ground/footwear

Pitfalls to Avoid:

• Excessive tension: Can cause tissue necrosis and poor healing 2
• Improper suture size: Using too large sutures can cause scarring and discomfort
• Inadequate wound cleaning: Increases infection risk in this contamination-prone area
• Failure to assess for foreign bodies: Not all foreign bodies are visible on plain radiographs 3

Follow-up and Suture Removal

• For non-absorbable sutures: Remove after 7-10 days
• Monitor for signs of infection or dehiscence
• Begin gentle range of motion exercises as tissue healing permits 2

By following these guidelines, toe laceration repair can achieve optimal functional and cosmetic outcomes while minimizing complications that could affect mobility and quality of life.