What suture material and size is recommended for routine lacerations in a primary care clinic?

Suture Material and Size for Routine Lacerations in Primary Care

For routine lacerations in primary care settings, monofilament absorbable sutures (such as 4-0 or 5-0 poliglecaprone/MONOCRYL) in a continuous non-locking subcuticular technique are recommended as they provide optimal wound healing with reduced risk of dehiscence while eliminating the need for suture removal. 1, 2

Optimal Suture Material Selection

• Monofilament sutures are preferred over multifilament (braided) sutures as they cause less bacterial seeding and may reduce infection risk in mobile areas 1, 2
• Absorbable monofilament options provide several advantages:
  • Poliglecaprone (MONOCRYL) - excellent for routine lacerations due to minimal tissue reactivity 2
  • Polyglyconate (Maxon) - provides good tensile strength for areas under tension 2
  • Rapidly-absorbing polyglactin 910 (VICRYL RAPIDE) - eliminates need for suture removal 2
• Absorbable sutures maintain 50-75% of tensile strength after one week, providing extended wound support 3
• Non-absorbable options (nylon, polypropylene) may be considered for high-tension areas but require removal 4

Suture Size Recommendations

• For most routine lacerations: 4-0 or 5-0 suture size is appropriate 1, 2
• For facial lacerations: 5-0 or 6-0 for optimal cosmetic results 4
• For hand lacerations: 4-0 or 5-0 is typically recommended 1
• For scalp lacerations: 4-0 or 5-0 is generally appropriate 5

Suturing Technique

• Continuous non-locking subcuticular suturing technique is preferred over interrupted sutures as it:
  • Distributes tension more evenly across the suture line 3
  • Results in lower rates of superficial wound dehiscence (RR 0.08; 95% CI 0.02 to 0.35) 3
  • Provides better seal against bacterial invasion 3
• Avoid overly tight sutures that can strangulate wound edges 3
• Consider leaving skin unsutured or using skin adhesive for superficial closures to reduce pain 3

Anatomical Considerations

• Hand lacerations require special attention:
  • Monofilament absorbable sutures (4-0 or 5-0) provide comparable outcomes to non-absorbable sutures 6
  • Longer suture retention times (10-14 days) may be needed due to high mobility 1
  • Thumb webbing specifically benefits from extended suture duration (12-14 days) 2
• Facial lacerations:
  • Smaller suture sizes (5-0 or 6-0) for optimal cosmetic outcomes 4
  • Subcuticular closure minimizes visible scarring 2

Evidence for Absorbable vs. Non-absorbable Sutures

• Multiple studies show comparable cosmetic outcomes between absorbable and non-absorbable sutures 6, 7
• A randomized trial of pediatric lacerations found plain gut absorbable sutures provided slightly better cosmesis than non-absorbable nylon 7
• A study comparing Vicryl (braided) and Monocryl (monofilament) found comparable rates of surgical site infection and wound complications 8

Post-Repair Care Instructions

• Keep the wound clean and dry for the first 24-48 hours 2
• Avoid excessive tension on the wound during initial healing 2
• Use acetaminophen or ibuprofen for pain management 3
• Follow up within 24 hours either by phone or during an office visit to ensure proper healing 1

Complications to Monitor

• Signs of infection: increasing pain, redness, swelling, or discharge 5
• Pain disproportionate to injury severity may suggest deeper complications 5
• Monitor for wound dehiscence, especially in high-mobility areas 3

Common Pitfalls to Avoid

• Using braided sutures in contaminated wounds (increases infection risk) 2
• Placing sutures too tightly, which can strangulate tissue and impair healing 3
• Using inappropriate suture size for the anatomical location 1, 2, 5
• Failing to consider the mobility of the area when selecting suture material 1