What is recommended for external sutures?

Recommendations for External Sutures

For external suture closure, slowly absorbable monofilament sutures using a continuous "small bite" technique with a 4:1 suture-to-wound length ratio is recommended as the optimal approach for most wounds.

Optimal Suture Material Selection

Primary Recommendations

• Monofilament sutures are strongly preferred over multifilament sutures 1, 2

  • Monofilament sutures have lower bacterial adherence and infection risk
  • They cause less tissue trauma when passing through tissues
  • They significantly decrease incisional hernia incidence compared to multifilament alternatives

• Slowly absorbable materials are recommended over rapidly absorbable or non-absorbable options 1, 2

  • Examples include Poliglecaprone (MONOCRYL) or Polyglyconate (Maxon)
  • These maintain adequate tensile strength during critical healing periods
  • They provide better outcomes for incisional hernia prevention

• Antimicrobial-coated sutures should be used when available for clean, clean-contaminated, and contaminated wounds 1, 2

  • Triclosan-impregnated sutures significantly reduce surgical site infection rates

Specific Recommendations by Wound Type

• For facial wounds: 5-0 or 6-0 monofilament sutures, removed after 5-7 days 2
• For oral mucosa: 5-0 or 6-0 monofilament non-absorbable sutures 2, 3
• For subcuticular closure: 4-0 poliglecaprone or 4-0 polyglactin 2

Optimal Suture Technique

Technique Recommendations

• Continuous suture technique is superior to interrupted sutures 1, 2

  • Provides faster closure with no difference in incisional hernia or dehiscence rates
  • More efficient and equally effective

• "Small bite" technique is strongly recommended 1, 2

  • Place sutures 5mm from wound edge
  • Maintain 5mm distance between stitches
  • This technique significantly reduces incisional hernia risk

• Maintain a suture-to-wound length ratio of at least 4:1 1, 2

  • This is critical for optimal wound healing and strength
  • Should be documented and verified during closure

• Mass closure is preferred over layered closure for fascial layers 1

  • Equally effective but faster to perform
  • Particularly important in emergency settings

• Avoid separate peritoneal closure when closing abdominal wall 1

  • No benefit and increases operative time

Special Considerations

Wound Irrigation

• Prophylactic wound irrigation is recommended for clean, clean-contaminated, and contaminated wounds 1
• Avoid antibiotic irrigation solutions 1

Subcutaneous Tissue

• Routine use of subcutaneous drains is not recommended 1

Post-Closure Care

• For facial sutures, consider applying Steri-Strips for 3-5 days after suture removal 2
• Chlorhexidine 0.12% rinses twice daily for 1 minute for at least 3 weeks are recommended for oral surgical sites 1

Pitfalls to Avoid

1. Using multifilament sutures in contaminated wounds - increases infection risk significantly 2, 3
2. Excessive tension - leads to tissue necrosis, poor scarring, and potential wound dehiscence 2
3. Inappropriate suture size - always use the smallest suture size that will accomplish the purpose 4
4. Removing sutures too late - can cause permanent suture marks 2
5. Removing sutures too early - may result in wound dehiscence 2
6. Using rapidly absorbable sutures for fascial closure - results in higher hernia rates 1, 2

By following these evidence-based recommendations, optimal wound healing with minimal complications can be achieved for external suture closure.