What type of suture is recommended for closing the skin after a sebaceous cyst excision and when should it be removed?

Suture Selection and Removal for Sebaceous Cyst Excision

For skin closure after sebaceous cyst excision, use 4-0 or 5-0 monofilament non-absorbable sutures (nylon or polypropylene) with removal at 7-10 days for most body locations, or 5-7 days for facial lesions.

Suture Material Selection

Monofilament non-absorbable sutures are the optimal choice for sebaceous cyst excision closure because they cause less bacterial seeding and reduce infection risk compared to multifilament (braided) sutures 1, 2. The specific recommendations are:

• For facial sebaceous cysts: Use 5-0 or 6-0 monofilament non-absorbable sutures (nylon or polypropylene) 2
• For trunk and extremity locations: Use 4-0 or 5-0 monofilament non-absorbable sutures 1
• For scalp lesions: Use 4-0 or 5-0 monofilament sutures 2

Alternative: Absorbable Monofilament Sutures

If suture removal follow-up is problematic or patient compliance is a concern, absorbable monofilament options can be considered 1, 2:

• Poliglecaprone (Monocryl): Provides good cosmetic outcomes while eliminating need for removal 1
• Polyglyconate (Maxon): Offers excellent tensile strength, maintains approximately 50-75% of original strength after 1 week, and completes absorption between 90-110 days 3, 4
• Rapidly-absorbing polyglactin 910 (Vicryl Rapide): Eliminates removal need but provides less prolonged wound support 1

Important caveat: While absorbable sutures eliminate the need for removal, non-absorbable sutures remain the gold standard for optimal cosmetic outcomes, particularly on visible areas 2.

Suturing Technique

Use continuous non-locking subcuticular technique rather than interrupted sutures for the following evidence-based reasons 3, 1:

• Distributes tension more evenly across the entire suture line 3, 1
• Results in less short-term pain (up to 10 days postoperatively) 3
• Reduces need for postoperative analgesia 3
• Provides better cosmetic outcomes with less superficial wound dehiscence 3
• Lowers the need for suture removal when absorbable material is used 3

Critical technical points:

• Avoid locking the continuous suture, as this creates excessive tension leading to tissue edema and necrosis 3
• Avoid overly tight sutures that can strangulate wound edges 3, 1
• For deeper cysts requiring layered closure, close the deeper layer first with absorbable suture, then close skin with the technique above 2

Suture Removal Timing

The timing of suture removal depends on anatomical location to minimize scarring while ensuring adequate wound strength:

• Facial locations: Remove at 5-7 days 2
• Scalp, trunk, and extremities: Remove at 7-10 days 3

This timing is based on the principle that facial wounds heal faster due to excellent vascular supply, while other locations require longer support 2. Removal within these timeframes minimizes scarring while preventing premature dehiscence 3.

Common Pitfalls to Avoid

• Do not use multifilament (braided) sutures as they cause more bacterial seeding and higher infection risk 1
• Do not use catgut sutures as they are associated with more pain and higher resuturing rates 2
• Do not routinely add adhesive steri-strips as evidence shows no improvement in cosmetic outcomes when added to properly placed sutures 2
• Do not leave non-absorbable sutures in place beyond recommended timeframes as this increases scarring risk 2

Post-Operative Care

• Keep wound clean and dry for first 24-48 hours 1, 2
• Use acetaminophen or ibuprofen for pain management 1
• Monitor for infection signs: increasing pain, redness, swelling, or purulent discharge 2
• No routine antibiotic prophylaxis needed unless wound is heavily contaminated 1