Is Ethilon (polyethylene terephthalate) 4 suitable for facial skin closure?

Using Ethilon 4 Suture on the Face

Ethilon 4 suture is not recommended for facial skin closure as it is too large and would likely result in poor cosmetic outcomes, increased scarring, and patient discomfort.

Optimal Suture Selection for Facial Wounds

Facial skin closure requires special consideration due to the cosmetic importance and visibility of these wounds. The following factors should guide suture selection:

Suture Size

• For facial wounds, much smaller suture sizes are appropriate:
  • 5-0 or 6-0 sutures are typically recommended for facial skin closure 1
  • 4-0 sutures may be used for deeper tissue layers but are too large for facial skin 2

Suture Material Considerations

• Monofilament sutures are preferred for facial wounds as they:
  • Cause less bacterial seeding
  • May be less likely to cause infection 2
  • Create less tissue drag during placement

Absorbable vs. Non-absorbable Options

• Both absorbable and non-absorbable sutures can provide good cosmetic outcomes on the face 3
• Non-absorbable sutures like Ethilon (nylon) in smaller sizes (5-0,6-0) are commonly used for facial wounds due to:
  • Minimal tissue reactivity
  • Excellent tensile strength
  • Smooth passage through tissue

Wound Closure Technique for Facial Wounds

When closing facial wounds, consider:

1. Layered Closure Approach:

   • Close deeper tissues with 4-0 absorbable sutures
   • Close skin with 5-0 or 6-0 sutures 2

2. Suturing Technique:

   • Simple interrupted or running subcuticular techniques are preferred for facial wounds
   • Horizontal mattress sutures may be considered for patients with factors that impair wound healing 1

3. Wound Support:

   • Consider using Steri-Strips to provide additional support to facial wounds after suture removal, especially in areas where cosmetic outcome is important 1

Timing of Suture Removal

• Facial sutures should typically be removed earlier than other body areas:
  • 3-5 days for facial wounds
  • This minimizes the risk of "railroad track" scarring that can occur with longer suture retention 1

Alternative Closure Methods

If concerned about cosmetic outcomes, consider these alternatives:

1. Tissue Adhesives:

   • May provide comparable cosmetic results to sutures in select facial wounds
   • Require thorough wound cleaning and completely dry wound base 1

2. Subcuticular Closure:

   • Using 5-0 or 6-0 absorbable sutures in a subcuticular pattern
   • May provide excellent cosmetic results without the need for suture removal 4

Potential Complications of Using Ethilon 4 on the Face

Using Ethilon 4 (which is too large) would likely result in:

• Prominent suture marks ("railroad track" scarring)
• Increased tissue trauma during placement
• Greater inflammatory response
• Poorer cosmetic outcome
• Increased patient discomfort

Post-Closure Care

• Keep the wound clean and dry
• Apply occlusive dressing for at least 48 hours
• Monitor for signs of infection
• Protect from sun exposure for at least 6 months 1

In conclusion, while Ethilon is an acceptable suture material for facial wounds, size 4 is inappropriate for facial skin closure. A much smaller size (5-0 or 6-0) would be required for optimal cosmetic outcomes.