From the Guidelines
Suturing is not always the best method for cosmetic and laceration repair, as alternatives like skin adhesives may offer similar or better outcomes in certain situations, particularly for first- and second-degree perineal lacerations. When considering the best approach for laceration repair, it's essential to weigh the benefits and drawbacks of different methods, including suturing, skin adhesives, and nonsurgical management. For example, a prospective, non-inferiority, randomized controlled trial comparing skin adhesive with traditional suturing for the management of first-degree perineal lacerations found that cosmetic and functional results of skin adhesive use were not inferior to those of suturing 1. In fact, skin adhesive was associated with a shorter procedure time, less need for local anesthetic, less pain, and greater satisfaction.
Some key considerations for laceration repair include:
- The type and severity of the laceration, with first- and second-degree perineal lacerations potentially benefiting from skin adhesives or nonsurgical management 1
- The location of the laceration, with facial lacerations often requiring finer sutures and earlier removal to prevent track marks
- The patient's overall health and medical history, with certain conditions potentially affecting wound healing or increasing the risk of complications
- The potential benefits and drawbacks of different repair methods, including suturing, skin adhesives, wound closure strips, and staples
In terms of specific techniques, continuous suturing techniques have been associated with less pain and improved outcomes for second-degree perineal lacerations, compared to interrupted suturing techniques 1. However, the choice of technique will depend on the individual patient and the specific characteristics of the laceration. Ultimately, the goal of laceration repair is to achieve the best possible cosmetic and functional outcome, while minimizing the risk of complications and promoting optimal wound healing. The use of skin adhesives or nonsurgical management may be a viable alternative to suturing for certain types of lacerations, particularly those that are small, superficial, or in low-tension areas.
From the Research
Suturing Techniques for Cosmetic and Laceration Repair
- Proper suturing technique is essential for obtaining good cosmetic results and avoiding infection, scarring, and poor wound healing, as highlighted in 2.
- Various suturing techniques, including simple, running, and half-buried mattress (corner) sutures, are options for laceration repair, as discussed in 3.
- The choice of suturing technique depends on factors such as wound tension, desire for wound edge eversion/inversion, desired hemostasis, repair type, and skin integrity, as outlined in 4.
Comparison of Suturing with Other Methods
- Tissue adhesives are similar in patient satisfaction, infection rates, and scarring risk in low skin-tension areas and may be more cost-effective, as noted in 3.
- Tissue adhesives and wound adhesive strips can be used effectively in low-tension skin areas, as mentioned in 5.
- Staples and skin-closure tapes are also options for wound closure, as discussed in 3 and 4.
Considerations for Suture Selection
- The selection of suture materials is crucial to minimize ischaemia, excess wound tension, and tissue injury, as emphasized in 6.
- Modern suture materials should have predictable tensile strength, good handling, secure knot-tying properties, and could be enhanced with an antibacterial agent to resist infection, as described in 6.
- The smallest suture size that will accomplish the purpose should be chosen to minimize tissue trauma and foreign material within tissues, as recommended in 6.
Best Practices for Laceration Repair
- Good evidence suggests that local anesthetic with epinephrine in a concentration of up to 1:100,000 is safe for use on digits, as noted in 5.
- Wounds heal faster in a moist environment, and therefore occlusive and semiocclusive dressings should be considered when available, as mentioned in 5.
- Patient education and appropriate procedural coding are important after the repair, as highlighted in 3.