What type of non-absorbable suture is recommended for minor restoration wounds?

Non-Absorbable Suture Selection for Minor Restoration Wounds

For minor restoration wounds requiring non-absorbable sutures, use 5-0 or 6-0 monofilament polypropylene (or nylon) with interrupted or continuous technique, ensuring sutures are removed within 7-9 days to prevent complications.

Suture Material Selection

Monofilament Non-Absorbable Options

• 5-0 or 6-0 monofilament sutures are the standard for superficial skin closure in minor wounds, with the specific size chosen based on tissue thickness and tension requirements 1
• Polypropylene is superior to nylon due to better handling characteristics, easier knotting, and enhanced biocompatibility, while maintaining equivalent mechanical strength 2
• Polypropylene also provides better visual contrast against surrounding tissue, facilitating precise placement and subsequent removal 2

Size Selection Algorithm

• Use 6-0 for thin, delicate tissues where minimal scarring is desired (facial wounds, thin skin) 1
• Use 5-0 for areas with moderate tension or thicker skin (trunk, extremities) 1
• Both sizes provide adequate tensile strength for superficial wound closure while minimizing tissue trauma 1

Suturing Technique

Interrupted vs. Continuous Closure

• No significant difference exists in surgical site infection rates between interrupted and continuous techniques (RR 0.73; 95% CI 0.40-1.33) 1
• Continuous sutures may provide better wound edge sealing against bacterial invasion, though this must be balanced against risk of strangulation if pulled too tightly 1
• For continuous closures, maintain a suture-to-wound length ratio of at least 4:1 to reduce complications 3

Critical Technical Points

• Place sutures with appropriate spacing and tension to avoid compromising blood supply to wound edges 1
• Follow principles of single-layer stitching with uniform margins, appropriate density, and moderate knotting strength 1
• Ensure anastomosis without tension to optimize healing 1

Timing of Suture Removal

Standard Removal Timeline

• Remove non-absorbable sutures at 7-9 days post-surgery to prevent skin overgrowth and minimize scarring 1, 4
• Earlier removal may risk dehiscence; later removal increases risk of suture tracks and permanent scarring 4
• Check wound for signs of infection and dehiscence before removal 4

Important Caveats

When to Avoid Non-Absorbable Sutures

• Never leave non-absorbable sutures in body cavities or buried locations where removal is not possible, as they can cause chronic foreign body reactions 1
• For buried or deep layer closures, absorbable sutures are mandatory 3
• Consider patient compliance with follow-up for suture removal; if uncertain, use absorbable alternatives 4

Cost-Effectiveness Consideration

• While non-absorbable sutures like 6-0 polypropylene are traditional for superficial closure, 5-0 absorbable poliglecaprone-25 provides equivalent cosmetic outcomes and eliminates need for removal 5
• Recent large cohort data shows equipoise between absorbable and non-absorbable sutures with no difference in complication rates (surgical site infection 2.9%, delayed healing 2.2%) 6

Clinical Bottom Line

For minor restoration wounds where non-absorbable sutures are specifically requested or indicated, 5-0 or 6-0 monofilament polypropylene represents the optimal choice due to superior handling, biocompatibility, and mechanical properties compared to nylon 2. However, recognize that modern absorbable alternatives provide equivalent outcomes without requiring removal 5, 6, making the choice between absorbable and non-absorbable largely a matter of surgeon preference and patient follow-up reliability rather than clinical superiority 6.