What is the best suture type for a thumb webbing laceration?

Best Suture Type for Thumb Webbing Laceration

For thumb webbing lacerations, monofilament absorbable sutures such as poliglecaprone (MONOCRYL) are the preferred choice due to less bacterial seeding and reduced risk of infection while maintaining good cosmetic outcomes and eliminating the need for suture removal. 1

Suture Material Selection

• Monofilament sutures are preferred over multifilament (braided) sutures as they cause less bacterial seeding and may reduce infection risk in this high-mobility area 1
• Absorbable synthetic options provide the best balance of tensile strength and minimal tissue reaction for hand wounds 2
• Recommended absorbable suture materials include:
  • Poliglecaprone (MONOCRYL) - ultra-pliable monofilament with excellent handling properties and minimal tissue drag 3
  • Polyglyconate (Maxon) - monofilament with good tensile strength for high-mobility areas 1
  • Rapidly-absorbing polyglactin 910 (VICRYL RAPIDE) - eliminates the need for suture removal, which is particularly beneficial in the hand area 1

Suturing Technique

• Continuous non-locking suturing technique is recommended over interrupted sutures as it:
  • Distributes tension more evenly across the suture line 1
  • Results in less pain during healing 1
  • Reduces the need for analgesia 1
  • Provides better cosmetic outcomes in areas of high mobility 1
• For optimal wound closure in the thumb webbing:
  • Use 4-0 or 5-0 suture size appropriate for the hand 1, 2
  • Consider subcuticular closure for the final layer to minimize scarring in this functionally important area 1
  • Avoid tight sutures that could strangulate wound edges in this high-mobility area 1

Evidence for Absorbable vs. Non-absorbable Sutures

• Long-term studies comparing absorbable versus non-absorbable sutures for extremity lacerations found no significant difference in cosmetic outcomes (mean VAS difference of only 0.5mm) 4
• Absorbable sutures eliminate the need for suture removal, which is particularly advantageous in the hand where:
  • Follow-up visits can be difficult for patients 2
  • Suture removal can be painful and anxiety-provoking 5
  • Mobility of the area can be restored sooner without concerns about suture removal 4

Alternative Closure Methods

• For very superficial thumb webbing lacerations, tissue adhesives may be considered as they:
  • Provide similar cosmetic outcomes to suturing 5
  • Result in shorter procedure time (2-3 minutes vs. 7-8 minutes for suturing) 5
  • Cause less pain during healing 6
  • Create a water-resistant protective coating beneficial for hand wounds 6
• However, tissue adhesives are only appropriate for superficial lacerations and should not be used if the laceration:
  • Extends into deeper tissue layers 6
  • Is under tension 6
  • Is in an area of high mobility that could disrupt the adhesive bond 6

Post-Repair Care

• Advise patients to:
  • Keep the wound clean and dry for the first 24-48 hours 5
  • Avoid excessive tension on the thumb webbing during the initial healing phase 5
  • Use acetaminophen or ibuprofen for pain management 5
  • Watch for signs of infection (increasing pain, redness, swelling, purulent discharge) 5
• No routine antibiotic prophylaxis is needed unless the wound is heavily contaminated 1