What is the best suture material for minor head wounds?

Best Suture for Minor Head Wounds

For minor head wounds, use slowly absorbable monofilament sutures (4-0 or 5-0 poliglecaprone or polyglactin) with a continuous subcuticular technique. 1

Suture Material Selection

Monofilament sutures are superior to multifilament (braided) sutures because they minimize tissue drag, reduce trauma during passage through tissue, and eliminate the risk of bacterial harboring in interstices that occurs with braided constructions. 2, 3

Optimal Material Characteristics

• Slowly absorbable sutures retain 50-75% of their tensile strength after 1 week, which covers the critical wound healing period for scalp wounds. 1, 3
• Poliglecaprone 25 (Monocryl) provides excellent handling properties, minimal tissue resistance, and maintains 20-30% breaking strength retention at 2 weeks with complete absorption by 91-119 days. 4, 3
• Polyglactin (Vicryl) is an acceptable alternative with similar performance characteristics. 1

Size Recommendation

• 4-0 or 5-0 gauge is appropriate for scalp wounds, balancing adequate tensile strength with minimal scarring. 1

Suture Technique

Use continuous subcuticular technique rather than interrupted sutures, as this dramatically reduces superficial wound dehiscence by 92% (RR 0.08; 95% CI 0.02-0.35). 1

Technical Execution

• Place sutures 5mm from wound edges with 5mm spacing between stitches to ensure proper tension distribution. 2
• Maintain a suture-to-wound length ratio of at least 4:1 to minimize wound complications and dehiscence. 2
• Avoid pulling sutures too tightly, as this strangulates wound edges and causes tissue ischemia. 1

Special Considerations for Contaminated Wounds

If the head wound is contaminated or at high risk for infection, use triclosan-coated antimicrobial sutures (such as Vicryl Plus), which significantly reduce surgical site infection risk (OR 0.72; 95% CI 0.59-0.88). 2, 1

• Antimicrobial-coated sutures demonstrate consistent infection reduction across wound types without increasing dehiscence risk. 2
• The number needed to treat is approximately 14 patients to prevent one surgical site infection. 2

Critical Pitfalls to Avoid

• Never use rapidly absorbable sutures (such as plain gut or fast-absorbing synthetic materials), as they lose tensile strength too quickly and increase wound dehiscence rates. 2
• Avoid tissue adhesives as the primary closure method for scalp wounds, as they have a 3.35-fold higher risk of wound breakdown compared to sutures (RR 3.35; 95% CI 1.53-7.33). 1
• Do not include hair or adipose tissue in suture bites, as this increases infection risk and compromises wound integrity. 1
• Avoid non-absorbable transcutaneous sutures when absorbable subcuticular options are available, as they require removal and provide no advantage in head wounds. 1

Monitoring

• Watch for signs of infection including increasing pain, erythema, swelling, or purulent discharge in the first 7-10 days. 1, 5
• Monitor for wound dehiscence, particularly during the first week when mechanical support is most critical. 1