Is Vicryl (Polyglactin 910) suitable for facial suturing?

Vicryl Use on the Face for Wound Closure

Vicryl (polyglactin 910) can be used for facial suturing, but monofilament sutures (5-0 or 6-0) are generally preferred for facial skin closure due to less bacterial seeding, reduced infection risk, and minimal tissue reaction. 1

Considerations for Facial Suturing

Suture Material Selection

• Preferred options for facial skin closure:
  • Monofilament sutures (5-0 or 6-0) are recommended as first-line for facial skin closure 1
  • Vicryl (polyglactin 910) is more appropriate for deep tissue layers rather than skin closure on the face
  • Rapidly absorbing synthetic sutures (like Vicryl Rapide) may be considered when suture removal would be challenging 1

Evidence for Vicryl in Facial Applications

• Studies have shown that Vicryl can be used safely in facial areas:
  • 7-0 Vicryl and 7-0 Vicryl Rapide demonstrated excellent wound healing in ophthalmic plastic surgery with minimal tissue reaction 2
  • Vicryl Rapide (irradiated polyglactin 910) has shown good outcomes in oral and scalp wounds with no hypertrophic scarring 3

Tissue Reaction Considerations

• Polyglactin 910 (Vicryl) elicits a foreign body inflammatory response proportional to suture gauge:
  • Larger gauge (5-0) produces significantly larger granuloma diameter compared to smaller gauge (7-0) 4
  • This inflammatory response may affect cosmetic outcomes, which is particularly important on the face

Suture Extrusion Risk

• Vicryl (polyglactin 910) has shown higher extrusion rates (11.4%) compared to other absorbable sutures like poliglecaprone-25 (3.1%) 5
• This higher extrusion rate could compromise cosmetic outcomes on the face

Best Practices for Facial Wound Closure

Layer-Specific Recommendations

• Deep tissue layers:

  • Vicryl can be appropriately used for deep tissue closure with continuous non-locking sutures 1
  • Triclosan-coated Vicryl may be beneficial in higher-infection risk scenarios 6

• Skin closure:

  • Monofilament sutures are preferred for facial skin closure
  • If using Vicryl for skin, consider smaller gauge (7-0) to minimize tissue reaction 4
  • Continuous subcuticular closure technique is recommended for improved cosmetic outcomes 1

Timing Considerations

• Facial sutures typically require removal after 5-7 days 1
• If using Vicryl Rapide, it eliminates the need for suture removal visits 1

Potential Pitfalls and Caveats

• Vicryl may cause more tissue reaction than monofilament sutures, potentially affecting cosmetic outcomes on the face
• Standard Vicryl requires removal if used for skin closure, unlike Vicryl Rapide
• Facial wounds are highly visible, making optimal cosmetic outcome particularly important
• Consider nerve block anesthesia for facial procedures as it may provide better anesthesia with less tissue distortion than infiltrative anesthesia 6

When choosing between Vicryl and other suture materials for facial closure, consider the specific wound characteristics, layer being closed, and the importance of cosmetic outcome in the particular facial region.