What is the management for a non-adhering sutures site?

Management of Non-Adhering Suture Sites

For non-adhering suture sites, continuous subcuticular sutures are recommended over interrupted sutures to reduce the risk of wound dehiscence, while considering antimicrobial-coated sutures to minimize infection risk. 1

Assessment of Non-Adhering Suture Sites

• Evaluate for signs of wound dehiscence, which is more common with tissue adhesives than with sutures (RR 3.35; 95% CI 1.53 to 7.33) 1
• Check for suture abscesses, which may occur with or without adhesive strips (documented in both scenarios in clinical studies) 1
• Monitor for signs of infection such as increasing pain, redness, swelling, or discharge 2
• Assess for spitting sutures, which can occur at sites without adhesive strips 1

Management Approach

Primary Interventions

• Consider replacing non-adhering sutures with continuous subcuticular sutures, which show lower rates of superficial wound dehiscence compared to interrupted sutures (RR 0.08; 95% CI 0.02 to 0.35) 1
• Use sutures rather than tissue adhesives when wound integrity is compromised, as sutures are significantly better for minimizing dehiscence 1
• For contaminated wounds or those at high risk of infection, use triclosan-coated antimicrobial sutures, which significantly reduce surgical site infection risk (OR 0.72; 95% CI 0.59–0.88, P = 0.001) 1

Adjunctive Measures

• Adding adhesive strips to non-adhering suture sites does not significantly improve outcomes or reduce scar width (mean scar width 1.1 [0.8] mm for both methods, P = .89) 1
• Keep the wound clean and dry for 24-48 hours after reapplication of closure material 2
• Consider fibrin sealants as an adjunct to sutures in complex wounds or areas where additional support is needed 3

Specific Suture Selection

• For wounds requiring extended support, choose suture materials that retain 50-75% of their original tensile strength after 1 week (such as 4-0 poliglecaprone or 4-0 polyglactin) 1
• For high-tension areas prone to dehiscence, avoid tissue adhesives as they have higher failure rates compared to sutures 4
• In cases where infection is present or suspected, antimicrobial sutures (particularly triclosan-coated) should be used as they demonstrate consistent results in reducing infection risk 1

Special Considerations

• Pain disproportionate to the severity of the wound may suggest deeper complications requiring more aggressive intervention 2
• In patients with factors that may impair wound healing (diabetes, immunosuppression, etc.), sutures are preferable to tissue adhesives due to lower dehiscence rates 4
• For cosmetically sensitive areas, note that there is no significant difference in cosmetic outcomes between sutures with or without adhesive strips (patient assessment scale scores of 14.0 [7.6] vs 14.7 [7.6], P = .39) 1

Pitfalls to Avoid

• Avoid using tissue adhesives alone in high-tension areas as they have a higher risk of dehiscence compared to sutures 1
• Do not assume that adding adhesive strips to sutures will improve outcomes, as evidence shows no significant benefit 1
• Continuous tightly pulled sutures can strangulate wound edges, compromising healing 1
• When replacing sutures, recognize that the number needed to treat to prevent one dehiscence when choosing sutures over tissue adhesives is 43 1