What type of suture is recommended for facial skin closure?

Optimal Suture Selection for Facial Skin Closure

For facial skin closure, monofilament sutures are strongly recommended as they cause less bacterial seeding and are less likely to cause infection compared to braided sutures. 1

Recommended Suture Materials for Facial Wounds

Primary Recommendation

• Monofilament sutures should be used for facial skin closure due to:
  • Lower risk of bacterial seeding and infection 1
  • Minimal inflammatory response 2
  • Better cosmetic outcomes 3

Specific Options

1. Absorbable monofilament options:

   • Poliglecaprone (Monocryl) - excellent for deep tissue closure 3
   • Rapidly absorbing polyglactin 910 (Vicryl Rapide) - good for superficial closure 3

2. Non-absorbable monofilament options:

   • Polypropylene (Prolene) - excellent for superficial closure 3
   • Monofilament nylon - associated with significantly less inflammatory response than polyglycolic acid sutures 2

Suture Size Selection

• For facial wounds in adults: 5-0 or 6-0 sutures
• For facial wounds in children: 7-0 absorbable sutures (eliminates need for removal and reduces trauma) 4

Technique Considerations

Closure Method

1. Deep tissue closure:

   • Use 4-0 or 5-0 absorbable monofilament sutures (e.g., poliglecaprone/Monocryl) 3
   • Close by planes to minimize tension 1

2. Superficial closure options:

   • Interrupted sutures - easier to partially remove if signs of infection appear 1
   • Subcuticular continuous sutures - lower rates of wound dehiscence and better cosmetic results 1
   • Consider horizontal mattress sutures for patients with factors that may impair wound healing 1

Special Techniques for Facial Wounds

• Suspension sutures should be considered when:
  • Fixing closure line at junction of cosmetic units
  • Preventing distortion of free margins (e.g., ectropion)
  • Reforming a fold that would be obliterated by tissue movement
  • Preventing tenting across concavities 5

Post-Closure Care

• Apply occlusive dressing and maintain for minimum of 48 hours 1
• Keep wound hydrated and protect from sun exposure for at least 6 months 1
• For children, consider combination of absorbable sutures, glue, and tape to optimize outcomes 4

Suture Removal Timing

• Optimal window for removing non-absorbable sutures from facial wounds: 5-7 days 1
• If using absorbable sutures, no removal is needed, saving time and reducing patient anxiety 3

Important Considerations

• No significant difference in long-term cosmetic results between absorbable and non-absorbable sutures in clean facial wounds 3
• Monofilament nylon demonstrates superior performance for intradermal closure with less inflammatory response 2
• For pediatric patients, a 7-0 absorbable suture with glue and tape shows excellent outcomes with rare complications (0.8%) 4

Pitfalls to Avoid

• Avoid braided sutures on the face due to higher risk of infection and inflammatory response
• Avoid removing facial sutures too early (risk of dehiscence) or too late (risk of "railroad track" scarring) 1
• Do not use antiseptics such as povidone-iodine for irrigation as they may delay healing 1

The choice between absorbable and non-absorbable sutures can be based on surgeon preference and patient factors, as long-term cosmetic outcomes are comparable when using monofilament materials 3.