What type of suture is recommended for a simple laceration on the hand?

Suture Selection for Simple Hand Lacerations

For simple hand lacerations, use 4-0 or 5-0 monofilament absorbable sutures such as poliglecaprone (MONOCRYL) or polyglyconate (Maxon) with a continuous non-locking technique.

Suture Material

Monofilament absorbable sutures are the optimal choice for simple hand lacerations because they provide multiple clinical advantages over alternatives 1:

• Monofilament structure reduces infection risk by causing less bacterial seeding compared to multifilament (braided) sutures 2, 1, 3
• Absorbable sutures eliminate the need for removal, which is particularly beneficial in the hand where suture removal can be painful and anxiety-provoking for patients 1
• Poliglecaprone (MONOCRYL) provides excellent tensile strength for high-mobility areas like the hand while maintaining good cosmetic outcomes 1
• Polyglyconate (Maxon) is an alternative monofilament with good tensile strength specifically suited for high-mobility areas 2, 1

Suture Size

• Use 4-0 or 5-0 gauge for hand lacerations, as this size is appropriate for the hand's tissue thickness and provides adequate strength without excessive tissue trauma 1, 3
• For fingertip lacerations specifically, 5-0 or 6-0 monofilament may be preferred for more delicate tissue 3

Suturing Technique

Apply a continuous non-locking suturing technique rather than interrupted sutures 2, 1:

• Distributes tension more evenly across the suture line, which is critical in the high-mobility hand 2, 1
• Results in less pain during healing and reduces the need for postoperative analgesia 2
• Reduces risk of tissue edema and necrosis by avoiding excessive tension points 2
• Provides better cosmetic outcomes in areas of high mobility like the hand 1

Critical Technical Points

• Avoid placing excessive tension on sutures in this high-mobility area, as tight sutures can strangulate wound edges and impair healing 2, 1
• Consider subcuticular closure for the final layer to minimize scarring in this functionally important area 1

Evidence Supporting Absorbable Sutures in Hand Lacerations

A 5-year retrospective study of 102 patients with hand lacerations demonstrated that 5-0 Vicryl (absorbable) produced equivalent scar quality and healing compared to nylon (non-absorbable) at 6 months, with no infections or complications in either group 4. This supports the use of absorbable sutures as an acceptable alternative in hand laceration repair.

Additionally, a study of facial wounds showed no difference in long-term cosmetic results between absorbable and permanent sutures, with the added benefit of eliminating suture removal 5.

Common Pitfalls to Avoid

• Do not use multifilament (braided) sutures as they increase bacterial seeding and infection risk 2, 1, 3
• Avoid rapidly-absorbing sutures for hand lacerations, as they may lose tensile strength too quickly for this high-mobility area 1
• Do not overtighten sutures in the hand, as this high-mobility area requires some elasticity to accommodate movement 2, 1
• Avoid non-absorbable sutures unless specifically indicated, as they require removal which adds patient discomfort and an additional visit 1, 4

Post-Repair Care

• Keep the wound clean and dry for the first 24-48 hours 1
• Avoid excessive tension on the hand during the initial healing phase 1
• Use acetaminophen or ibuprofen for pain management 1
• Watch for signs of infection (increasing pain, redness, swelling, or discharge) 3
• No routine antibiotic prophylaxis is needed unless the wound is heavily contaminated 1