What type of sutures are recommended for facial lacerations?

Facial Laceration Suture Selection

For facial lacerations, use 5-0 or 6-0 monofilament non-absorbable sutures (nylon or polypropylene) as the first-line choice, as they provide optimal cosmetic outcomes with reduced infection risk. 1

Primary Suture Material Recommendations

Monofilament non-absorbable sutures are the gold standard for facial wounds because they cause less bacterial seeding and lower infection rates compared to other suture types. 1, 2

Specific Suture Sizes by Location:

• General facial lacerations: 5-0 or 6-0 monofilament non-absorbable (nylon or polypropylene) 1
• Lip lacerations: 5-0 or 6-0 monofilament non-absorbable sutures 1
• Scalp lacerations: 4-0 or 5-0 monofilament sutures 2

Suturing Technique Considerations

Use single-layer closure for minor, non-gaping facial lacerations (<10mm width) as it is faster (7 minutes quicker) and produces equivalent cosmetic outcomes compared to double-layer closure. 3 This study demonstrated no difference in scar width, visual analog scale scores, or wound evaluation scores between single and double-layer techniques at 90 days. 3

For deeper or gaping wounds, employ layered closure starting with the deeper muscular layer, then closing mucosal and skin layers separately. 1

Continuous non-locking suturing techniques are preferred as they distribute tension more evenly across the suture line, reducing tissue edema and necrosis risk. 1, 2

Critical Anatomic Considerations

Lip Lacerations:

• Precise alignment of the vermillion border is absolutely critical - misalignment results in permanent cosmetic deformity. 1, 4
• The rich vascular supply creates significant bleeding potential despite appearing minor. 1
• Increased mobility creates additional tension requiring careful suture selection. 1

Scalp Lacerations:

• Should be sutured in layers. 4
• Rich vascular supply can cause significant bleeding despite minor appearance. 2

Absorbable Suture Alternatives

While non-absorbable sutures remain first-line, absorbable monofilament options like poliglecaprone (Monocryl) or polyglyconate (Maxon) can be considered when suture removal follow-up is problematic. 1, 2

Important caveat: Research shows mixed results for absorbable sutures in facial wounds. One pediatric study found that blinded physicians rated fast-absorbing catgut inferior to nylon (mean VAS scores 57.6 vs 67.6), though the difference was small and caregivers actually preferred absorbable sutures. 5 Another study found plain gut provided slightly better long-term cosmesis than nylon with no increase in complications. 6

Rapidly absorbing synthetic sutures (polyglactin 910/Vicryl Rapide) eliminate suture removal but are not ideal for the cutaneous portion of facial wounds. 2

Avoid catgut sutures entirely - they are associated with more pain and higher resuturing rates. 1, 2

Suture Removal Timing

Remove non-absorbable facial sutures after 5-7 days to minimize scarring. 1 This timing balances adequate wound healing with optimal cosmetic outcome.

Post-Repair Management

• Keep wound clean and dry for first 24-48 hours. 1, 2
• For lip lacerations specifically: recommend soft diet to minimize movement and tension. 1
• Chlorhexidine 0.12% rinses twice daily for 1 minute for at least the first week for lip lacerations to reduce bacterial load. 1
• Follow-up within 24 hours for scalp wounds. 2

Common Pitfalls to Avoid

• Do not use adhesive steri-strips routinely - evidence shows no improvement in cosmetic outcomes or scar width when added to buried dermal sutures. 7
• Avoid overly tight sutures that can strangulate tissue and impair healing. 8
• Monitor for infection signs: increasing pain, redness, swelling, or purulent discharge. 1, 2
• Pain disproportionate to injury severity may suggest deeper complications. 2