Absorbable Clips for Wound Closure
For surgical wound closure, absorbable sutures (not clips) are recommended, specifically slowly absorbable monofilament materials, which maintain adequate tensile strength during the critical 2-4 week healing period while eliminating the need for removal. 1
Primary Recommendation for Wound Closure Materials
Use slowly absorbable monofilament sutures rather than clips or staples for optimal wound closure outcomes. 1, 2
- Slowly absorbable monofilament sutures demonstrate superior performance with lower incisional hernia rates and fewer wound complications compared to other closure methods 1
- These materials maintain tensile strength during the critical wound healing period (2-4 weeks) while eventually being absorbed by the body, preventing long-term foreign body reactions 1
- The American College of Surgeons supports this approach with 99.2% agreement among surgical experts based on high-quality evidence 1
Why Not Clips or Staples?
Staples and clips are associated with increased complications compared to sutures:
- Staples may increase the risk of adverse events (7.3% vs 3.5% for sutures) with a risk ratio of 2.00 3
- Staples cause significantly more postoperative pain compared to sutures 3, 4
- While staples are faster to apply (saving approximately 5.56 minutes per wound), this speed advantage does not outweigh the increased complication risk 4
- The evidence on wound infection rates is mixed, with some studies showing fewer infections with staples 4 while others show slightly more infections (6.75% vs 4.90% for sutures) 3
Optimal Suture Technique
When using absorbable sutures, employ the "small bite" continuous technique:
- Place sutures approximately 5mm from wound edges 1, 2, 5
- Space stitches 5mm apart 5
- Maintain a suture-to-wound length ratio of at least 4:1 for continuous closures 1, 2, 5
- Use monofilament materials (such as poliglecaprone/Monocryl or polyglyconate/Maxon) as they cause less bacterial seeding 5
Enhanced Infection Prevention
Consider triclosan-coated absorbable sutures for additional infection reduction:
- Antimicrobial-coated sutures significantly reduce surgical site infection rates (OR 0.62,95% CI 0.44-0.88) 5
- Triclosan-coated sutures are particularly beneficial for clean, clean-contaminated, or contaminated wounds 2
- Meta-analysis of 18 studies with 7,458 patients demonstrated significant SSI risk reduction (OR 0.72,95% CI 0.59-0.88) 6
Specific Clinical Applications
For contaminated/dirty wounds (such as open appendectomy):
- Primary skin closure with a unique absorbable intradermal suture is recommended over delayed primary closure 6
- This approach reduces seroma and abscess incidence while maintaining equivalent dehiscence rates 6
- The relative risk of complications with traditional non-absorbable separated stitches is 2.91 times higher compared to absorbable intradermal technique 6
- Delayed primary closure increases hospital stay and costs without reducing SSI risk 6
Common Pitfalls to Avoid
- Do not use tissue adhesives alone for high-tension closures: Sutures are significantly better than tissue adhesives for minimizing dehiscence (RR 3.35,95% CI 1.53-7.33), with a number needed to harm of 43 6
- Avoid multifilament sutures: Monofilament materials have lower incisional hernia risk (96.8% agreement rate among surgeons) 2
- Do not remove absorbable sutures: The primary advantage is elimination of removal, saving time and reducing patient discomfort 7
- Avoid large bite technique (>10mm): This increases incisional hernia risk through tissue devitalization 5
Cosmetic Outcomes
Absorbable sutures provide equivalent cosmetic results to non-absorbable materials:
- A 6-month follow-up study of facial wound closures showed no difference in scar formation between absorbable and non-absorbable sutures 7
- Patient satisfaction rates are comparable between sutures and staples (RR 0.99,95% CI 0.91-1.07) 3
- The advantage of absorbable sutures is elimination of removal-related anxiety and discomfort without compromising cosmetic outcome 7