When is suturing recommended for a laceration?

When to Suture a Wound

Suture lacerations when they involve deeper tissue layers (muscle, fascia, or mucosa), are under tension, have gaping edges that won't approximate naturally, or are in cosmetically sensitive areas—while simple superficial lacerations in low-tension areas can often be managed with tissue adhesives or may heal by secondary intention.

General Indications for Suturing

The decision to suture depends on wound characteristics rather than arbitrary time limits. Wounds can be safely closed even 18-24 hours after injury depending on location and contamination level, as there is no evidence-based "golden period" beyond which closure becomes unsafe 1, 2.

Primary Closure is Indicated When:

• Deeper structures are involved - Any laceration extending through dermis into subcutaneous tissue, muscle, fascia, or involving mucosal surfaces requires layered closure 3
• Wound edges are gaping - Lacerations with edges that cannot naturally approximate need closure to optimize healing 1
• High-tension areas - Wounds over joints, hands (requiring 10-14 days of suture retention), or areas subject to movement benefit from suturing 4
• Cosmetically sensitive locations - Face, visible areas where optimal scar formation is priority 1, 5
• Hemostasis cannot be achieved - Active bleeding requiring more than simple pressure 6

Alternatives to Suturing

Tissue adhesives are equally effective as sutures for low-tension wounds with linear edges that can be evenly approximated, offering advantages of painless application, shorter procedure time (2-3 minutes), less pain during healing, and similar cosmetic outcomes 6, 5, 7.

Consider Tissue Adhesives When:

• Superficial lacerations in low-tension skin areas 1, 5
• Linear wound edges that approximate easily 6
• Pediatric patients where reducing anxiety and pain is priority 6
• Minor upper lip frenulum lacerations 6

Wounds That May Not Require Closure:

• Minor superficial lacerations that can heal by secondary intention without functional or cosmetic compromise 4
• Small frenulum lacerations without active bleeding, as unnecessary suturing increases pain and provides minimal benefit over natural healing 6

Suturing Technique Selection

When suturing is indicated, continuous non-locking suturing techniques are superior to interrupted techniques, providing faster closure (0.276 cm/min vs 0.175 cm/min), using less suture material, and resulting in less pain without increased complication rates 3, 8.

Suture Material Preferences:

• Monofilament sutures are preferred as they cause less bacterial seeding and reduce infection risk 3, 4
• Rapidly-absorbing synthetic sutures avoid need for removal, though at increased cost 3
• Avoid catgut sutures which cause more pain and higher resuturing rates 3

Critical Pitfalls to Avoid

• Do not unnecessarily suture minor lacerations that would heal well without intervention—this increases pain, anxiety, and tissue trauma without benefit 6, 4
• Do not use locking continuous sutures as they cause excessive tension leading to tissue edema and necrosis 3
• Do not overlook deeper injuries - Always assess for involvement of tendons, nerves, joints, or bone which require specialist referral 2
• Do not forget tetanus prophylaxis - Administer if no booster in past 10 years 1, 2
• Do not assume wounds must stay dry - Wounds can get wet within 24-48 hours without increasing infection risk 2

Wound Preparation Essentials

• Irrigation is the most important step - Use sterile saline or potable tap water (equally effective) 1, 2
• Adequate anesthesia is mandatory - Local anesthetic with epinephrine 1:100,000 is safe even for digits 1
• Non-sterile gloves are acceptable and do not increase infection risk compared to sterile gloves 1