What is the best suture material for hand lacerations?

Best Suture Material for Hand Lacerations

For hand lacerations, monofilament absorbable sutures are the recommended choice as they cause less bacterial seeding while maintaining good tensile strength in this high-mobility area. 1

Optimal Suture Material Selection

• Monofilament sutures are strongly recommended for hand lacerations due to their association with a significantly lower risk of infection and bacterial seeding compared to multifilament sutures 1
• Absorbable monofilament sutures eliminate the need for suture removal, which is particularly advantageous in the hand where removal can be painful and requires an additional visit 1
• Specific monofilament absorbable options include:
  • Poliglecaprone (MONOCRYL) - provides good handling and minimal tissue reactivity 1
  • Polyglyconate (Maxon) - offers excellent tensile strength for high-mobility areas like the hand 1
• A 4-0 or 5-0 suture size is typically appropriate for hand lacerations to achieve optimal wound closure while minimizing tissue trauma 1

Technique Considerations

• Continuous non-locking suturing technique is preferred over interrupted sutures as it distributes tension more evenly across the suture line, reducing the risk of tissue edema and necrosis 1
• The "small bite" technique (approximately 5mm from wound edge and between stitches) is recommended to ensure adequate distribution of tension and minimize tissue damage 2
• Avoid tight sutures that could strangulate wound edges in high-mobility areas like the hand 1
• Consider subcuticular closure for the final layer to minimize scarring in functionally important areas 1

Evidence Supporting Absorbable Sutures

• A 5-year retrospective study of 102 patients with hand lacerations found no difference in scar quality or healing complications between absorbable Vicryl sutures and nonabsorbable nylon at 6-month follow-up 3
• Modern synthetic absorbable sutures are designed for good tensile strength, easy handling, and low tissue reactivity 4
• Absorbable sutures eliminate the need for suture removal, which benefits both patients and healthcare providers 5

Special Considerations for Hand Wounds

• Hand lacerations require longer suture retention times (10-14 days) compared to other body areas due to high mobility and tension in this region 1
• The thumb webbing area specifically benefits from extended suture duration (12-14 days) to ensure complete healing before exposure to mechanical stress 1
• Hand wounds are often more serious than wounds to fleshy parts of the body and may require closer monitoring for complications 1

Post-Repair Care

• Keep the wound clean and dry for the first 24-48 hours 1
• Avoid excessive tension on the hand during the initial healing phase 1
• Elevation of the injured hand, especially if swollen, accelerates healing 1
• Follow up within 24 hours either by phone or during an office visit to ensure proper healing 1

Complications to Monitor

• Watch for signs of infection, including increasing pain, redness, swelling, or purulent discharge 1
• Pain disproportionate to the injury severity but located near a bone or joint should suggest periosteal penetration 1
• Potential complications include septic arthritis, osteomyelitis, subcutaneous abscess formation, tendonitis, nerve or tendon injury, compartment syndromes, post-traumatic arthritis, and bleeding 1