Optimal Suture Selection for Superficial Face Lacerations
For superficial face lacerations, 5-0 or 6-0 monofilament non-absorbable sutures such as nylon or polypropylene are the recommended first choice due to their reduced bacterial seeding properties and lower infection risk. 1
Primary Recommendations
- Monofilament non-absorbable sutures (nylon or polypropylene) in sizes 5-0 or 6-0 are optimal for facial lacerations as they minimize tissue trauma while providing excellent wound closure 1
- Continuous non-locking suturing techniques are preferred as they distribute tension more evenly across the suture line, reducing the risk of tissue edema and necrosis 1
- A layered closure approach should be used for facial lacerations to ensure proper wound approximation 1
Alternative Options
- If considering absorbable options, monofilament absorbable sutures like poliglecaprone (MONOCRYL) or polyglyconate (Maxon) can be used, though they're generally not first-line for facial lacerations 1, 2
- Rapidly absorbing synthetic sutures such as polyglactin 910 (VICRYL RAPIDE) may be considered to eliminate the need for suture removal, but are not ideal for the cutaneous portion of facial wounds 1, 2
- Catgut sutures should be avoided as they are associated with more pain and higher risk of requiring resuturing 3, 1
Evidence Comparison
- Studies comparing absorbable with non-absorbable sutures for facial wounds have shown no significant difference in long-term cosmetic results, but non-absorbable sutures are still preferred for their minimal inflammatory response 4, 5
- Monofilament nylon has been associated with significantly less inflammatory response than polyglycolic acid sutures when used intradermally in facial lacerations 5
- Some research suggests that rapid-absorbing gut suture, octylcyanoacrylate, or nylon suture all provide similar cosmetic outcomes at 9-12 months for facial lacerations 6
Technical Considerations
- For optimal cosmetic results, prepare the skin margins with slight beveling of the edges and precise undermining with even thickness at the wound margin 7
- When suturing areas with natural tension or movement (like around the mouth), proper suture selection is particularly important to prevent wound dehiscence 1
- Precise alignment is critical for both functional and cosmetic outcomes, especially at cosmetically sensitive areas 1
Post-Repair Care
- Keep the wound clean and dry for the first 24-48 hours 1
- Non-absorbable sutures should be removed after 5-7 days to minimize scarring 1
- Monitor for signs of infection, including increasing pain, redness, swelling, or purulent discharge 1
Common Pitfalls to Avoid
- Avoid excessive tension when closing facial wounds as this can lead to wider scars and poor cosmetic outcomes 1, 7
- Do not use locking suture techniques on facial wounds as they can cause excessive tension leading to tissue edema and necrosis 3, 1
- Misalignment of natural facial landmarks or borders can result in permanent cosmetic deformity, requiring meticulous attention during repair 1