What is the best suture to use for lacerations of the hand and finger?

Best Suture for Hand and Finger Lacerations

Use monofilament absorbable sutures (4-0 or 5-0 poliglecaprone or polyglyconate) with a continuous non-locking technique for hand and finger lacerations, as they reduce bacterial seeding, eliminate the need for painful suture removal, and provide excellent cosmetic outcomes in this high-mobility area. 1

Suture Material Selection

Monofilament Absorbable Sutures (Preferred)

• Monofilament sutures are the optimal choice because they cause less bacterial seeding and reduce infection risk compared to multifilament options, which is particularly important in the hand where mobility and contamination risk are high 1, 2
• Specific monofilament options include:
  • Poliglecaprone (MONOCRYL) - provides good handling characteristics and absorption profile 1
  • Polyglyconate (Maxon) - offers excellent tensile strength for high-mobility areas like the hand 1
• The major advantage of absorbable sutures is eliminating the need for suture removal, which is particularly beneficial in the hand where removal can be painful and requires a return visit 1
• Use 4-0 or 5-0 suture size for optimal wound closure in hand lacerations 1

Alternative Options (Acceptable but Less Ideal)

• 5-0 Vicryl (polyglactin 910) is an acceptable alternative with demonstrated safety and equivalent scar quality at 6 months in hand lacerations 3
• Standard synthetic multifilament sutures like polyglycolic acid (Dexon) show similar infection rates but lack the reduced bacterial seeding advantage of monofilaments 4
• Avoid catgut sutures - they are associated with more pain and higher risk of requiring resuturing 5
• Nylon (nonabsorbable monofilament) requires removal at 10-14 days but has comparable outcomes to absorbable options 3

Suturing Technique

Continuous Non-Locking Method (Strongly Preferred)

• Use continuous non-locking suturing technique rather than interrupted sutures because it distributes tension more evenly across the suture line, which is critical in high-mobility areas like the hand 1
• Locking sutures should be avoided as they cause excessive tension leading to tissue edema and necrosis 5
• Employ the "small bite" technique (approximately 5mm from wound edge and between stitches) to ensure adequate tension distribution and minimize tissue damage 1

Layer-Specific Approach

• Consider subcuticular closure for the final layer to minimize scarring in functionally important areas of the hand 1
• Avoid overly tight sutures that could strangulate wound edges in high-mobility areas 1

Special Considerations for Hand Lacerations

Extended Healing Time Requirements

• Hand lacerations require longer suture retention times (10-14 days) compared to other body areas due to high mobility and tension 1
• The thumb webbing area specifically benefits from extended suture duration (12-14 days) to ensure complete healing before mechanical stress exposure 1

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
• Elevate the injured hand if swollen to accelerate healing 1
• Follow up within 24 hours to ensure proper healing 1

Critical Pitfalls to Avoid

Infection Risk

• Hand wounds are often more serious than wounds to fleshy parts of the body and may require closer monitoring 1
• Prophylactic antibiotics are unnecessary for simple hand lacerations and are no replacement for meticulous wound management 6
• Monitor for infectious complications including septic arthritis, osteomyelitis, subcutaneous abscess, and tendonitis 1

Warning Signs

• Pain disproportionate to injury severity near a bone or joint should suggest periosteal penetration 1
• Watch for noninfectious complications including nerve or tendon injury, compartment syndromes, post-traumatic arthritis, and bleeding 1