What is the preferred suture material between 4-0 prolene (polypropylene) and 4-0 nylon for hand suturing?

Hand Suturing: 4-0 Prolene vs 4-0 Nylon

For hand lacerations, use 4-0 monofilament nylon (or absorbable monofilament like poliglecaprone) rather than 4-0 prolene, as monofilament sutures reduce bacterial seeding in high-mobility areas, and prolene is less suitable for long-term tensile loads in areas requiring extended wound support. 1, 2

Optimal Material Selection for Hand Wounds

Monofilament nylon is preferred over polypropylene (Prolene) for hand suturing because:

• Monofilament sutures cause less bacterial seeding and reduce infection risk in mobile areas like the hand 1
• Prolene demonstrates inferior performance under long-term tensile loads compared to other monofilament materials, which is problematic for hands that require 10-14 days of suture retention due to high mobility 2, 1
• Nylon requires a minimum of 4 throws to create a secure knot, while polypropylene requires only 3 throws, but nylon's superior long-term tensile strength outweighs this minor technical difference 3

Alternative: Absorbable Monofilament Sutures

Consider using 4-0 absorbable monofilament sutures (poliglecaprone/MONOCRYL) as the optimal choice:

• Absorbable monofilament sutures maintain 50-75% of tensile strength after one week, providing extended wound support during the critical healing phase 4, 1
• They eliminate the need for suture removal, which is particularly advantageous in hands where removal at 10-14 days can be inconvenient for patients 1
• Poliglecaprone causes minimal tissue reactivity and is excellent for routine lacerations 1
• Continuous absorbable subcuticular sutures show significantly lower rates of superficial wound dehiscence (RR 0.08; 95% CI 0.02 to 0.35) compared to interrupted non-absorbable sutures 4

Technical Considerations

Suturing technique matters as much as material choice:

• Use continuous non-locking subcuticular technique rather than interrupted sutures, as it distributes tension more evenly and provides better seal against bacterial invasion 1
• Avoid overly tight sutures that can strangulate wound edges and impair healing 1
• Hand lacerations specifically require longer suture retention times (10-14 days) if using non-absorbable materials due to high mobility 1
• Thumb webbing benefits from extended suture duration (12-14 days) 1

Why Not Prolene for Hands?

Prolene has specific limitations that make it suboptimal for hand wounds:

• Biomechanical testing demonstrates that polypropylene is less suitable for long-term tensile loads compared to other monofilament materials 2
• Hands are high-mobility areas requiring extended wound support, where Prolene's inferior long-term performance becomes clinically significant 2, 1
• While Prolene performs adequately in cardiovascular and other specialized surgical applications where it's commonly used, these contexts differ significantly from hand laceration repair 4

Common Pitfalls to Avoid

• Do not use braided sutures in hand wounds, as they increase infection risk through bacterial seeding 1
• Do not place sutures too tightly, which strangulates tissue and impairs healing 1
• Do not remove non-absorbable sutures before 10-14 days in hand wounds, as premature removal risks wound dehiscence due to inadequate tensile strength in high-mobility areas 1
• Do not fail to consider absorbable alternatives, which eliminate removal complications and provide superior wound dehiscence rates 4, 1