What types of injuries typically require sutures?

What Injuries Require Sutures

Lacerations that penetrate through the dermis into subcutaneous tissue, wounds with gaping edges that cannot spontaneously approximate, and injuries requiring hemostasis or structural support should be sutured—provided they are seen within the appropriate time window and show no signs of active infection. 1, 2

Time-Critical Decision Making

The timing of wound presentation is crucial for determining suture eligibility:

• Most body locations: Wounds can be safely sutured up to 12-24 hours after injury, though earlier closure within 8 hours is preferable to minimize infection risk 2
• Facial wounds: Can be closed up to 24 hours post-injury due to excellent vascular supply and lower infection risk 1, 2
• Hand wounds: Require earlier closure compared to other locations due to higher infection risk and functional importance 1, 2
• Knee wounds: Should be closed within 24 hours (preferably within 8 hours) as they fall into an intermediate-risk category 2

Critical exception: Infected wounds should never be closed primarily, regardless of timing. 1, 2

Absolute Contraindications to Primary Suturing

Do not suture wounds with:

• Active infection signs: Increasing pain, erythema, purulent drainage, warmth, or systemic signs 2
• Significant devitalized tissue that cannot be adequately debrided 2
• Heavy contamination or foreign bodies that cannot be completely removed 2
• Bite wounds (animal or human): These should not be closed primarily except for facial wounds managed by experienced surgeons with meticulous wound care, copious irrigation, and prophylactic antibiotics 1

Wound Characteristics Requiring Sutures

Depth and Tissue Involvement

• Full-thickness lacerations penetrating through dermis into subcutaneous fat or deeper structures 3
• Wounds involving muscle, fascia, or deeper structures requiring anatomic layer-by-layer closure 1
• Injuries with significant gaping where wound edges cannot spontaneously approximate 3

Functional and Cosmetic Considerations

• High-tension areas (joints, extensor surfaces) where wound edges pull apart with movement 4
• Cosmetically sensitive areas (face, visible skin) where optimal scar formation is important 1, 3
• Wounds requiring hemostasis that cannot be controlled with pressure alone 3

Location-Specific Considerations

• Hand lacerations: Nearly always require suturing due to high mobility, functional importance, and increased infection risk. Hand wounds are often more serious than wounds to fleshy parts of the body 1, 4
• Scalp lacerations: Typically require suturing due to rich vascularity and bleeding 3
• Wounds near joints or over bony prominences: Need suturing to prevent dehiscence with movement 4

Alternative Closure Methods

For wounds that don't meet suturing criteria or present outside the optimal time window:

• Steri-Strips approximation followed by delayed primary closure or secondary intent healing for wounds presenting late 1, 2
• Tissue adhesives are equally effective for low-tension wounds with linear edges that can be evenly approximated 3
• Negative pressure wound therapy (NPWT) can extend the closure window to 7-10 days or longer for complex wounds 2

Common Pitfalls to Avoid

• Suturing bite wounds: Most bite wounds should not be sutured due to high infection risk (50-65% for cat bites, lower for dog bites). The exception is facial wounds managed by experienced providers 1
• Closing contaminated wounds: Superficial debris should be removed, but infected wounds must never be closed primarily 1, 2
• Ignoring the time window: Wounds presenting beyond 24 hours (or 8 hours for high-risk locations) should be managed with alternative strategies 2
• Overly tight sutures: Can strangulate tissue edges and impair healing 4, 2

Essential Pre-Suturing Requirements

Before placing sutures, ensure:

• Adequate wound preparation: Cleanse with sterile normal saline (no need for iodine- or antibiotic-containing solutions) and remove superficial debris 1
• Complete debridement: Remove all devitalized tissue, though avoid unnecessarily enlarging the wound 1, 2
• Tetanus prophylaxis: Ensure status is current; if outdated or unknown, administer 0.5 mL tetanus toxoid intramuscularly 1
• Adequate anesthesia and visualization: Essential for proper technique and patient comfort 5