Does the patient require sutures for his wound?

Wound Closure Recommendations

Sutures are recommended for wound closure as they significantly reduce the risk of wound dehiscence compared to other closure methods. 1

Wound Assessment and Closure Decision Algorithm

When deciding whether a wound requires sutures, consider:

1. Wound Characteristics:

   • Depth: Wounds involving deeper tissue layers (beyond superficial dermis) require sutures
   • Length: Wounds longer than 1-2 cm typically benefit from suturing
   • Location: Wounds in high-tension areas or cosmetically sensitive regions need sutures
   • Edges: Wounds with gaping edges that cannot be easily approximated need sutures

2. Suture Material Selection:

   • Monofilament sutures are recommended as they are associated with a significantly lower risk of infection and incisional hernia than multifilament sutures 2
   • Slowly absorbable sutures are preferred over rapidly absorbable or non-absorbable options as they may decrease pain while maintaining adequate wound support 2
   • Antimicrobial-coated sutures (typically triclosan-impregnated) are strongly recommended for clean, clean-contaminated, and contaminated wounds to reduce surgical site infections 2

3. Suturing Technique:

   • The 'small bite' technique (5mm from wound edge, 5mm between stitches) is suggested over 'large bite' technique to prevent incisional hernia and wound complications 2
   • Maintain a suture-to-wound length ratio of at least 4:1 to reduce the risk of wound complications 2
   • For facial wounds or areas where cosmetic outcome is important, consider using Steri-Strips for additional support after suturing 1

Important Considerations

Wound Closure Alternatives

While sutures are generally preferred, alternative closure methods may be considered in specific situations:

• Adhesive strips (Steri-Strips): May be used for superficial wounds with minimal tension, but a Cochrane review found no evidence of differences between tissue adhesives and tapes for minimizing dehiscence or infection 2
• Tissue adhesives: Quicker to apply than sutures but associated with higher risk of wound breakdown (RR 3.35; 95% CI 1.53 to 7.33) 2

Wound Closure Pitfalls to Avoid

1. Inadequate wound cleaning: Always thoroughly clean wounds with betadine or chlorhexidine before closure 1
2. Excessive tension: Can lead to tissue ischemia and poor healing
3. Improper suture selection: Using rapidly absorbable sutures may lead to premature loss of tensile strength 2
4. Ignoring signs of infection: Never close infected wounds; consider delayed primary closure for contaminated wounds 1

Post-Closure Care

• Keep the wound hydrated and protected from sun exposure for at least 6 months 1
• Remove non-absorbable transcutaneous sutures after 7-10 days to minimize scarring 1
• Monitor for signs of infection and wound dehiscence

Conclusion

Based on the most recent and highest quality evidence, sutures provide superior wound closure compared to alternatives like tissue adhesives, particularly for reducing the risk of wound dehiscence. Monofilament, slowly absorbable, and antimicrobial-coated sutures using the 'small bite' technique represent the optimal approach for most wounds requiring closure.