Scalp Laceration Suture Size Recommendations
Both 3-0 and 5-0 sutures are acceptable for scalp laceration closure, but 3-0 is the preferred size for most scalp wounds due to the high-tension nature of the scalp and need for adequate tensile strength.
Optimal Suture Size Selection
Adults
- 3-0 absorbable suture is recommended for galeal layer closure in scalp lacerations, as this provides adequate strength for the high-tension scalp environment 1, 2
- The galea should be closed with 3-0 absorbable suture using a running subcutaneous technique to minimize tension on the skin closure 1
- For superficial skin closure after galeal approximation, finer sutures or staples can be used 2
Pediatric Patients
- 3-0 absorbable symmetric barbed sutures have been successfully used in pediatric scalp defects ranging 23.0 ± 6.5 mm, demonstrating effective closure without complications 1
- The same 3-0 size for galeal closure applies to pediatric patients, with excellent cosmetic outcomes (mean postoperative hairless scar width of 3.3 ± 0.8 mm) 1
Suture Material Considerations
Absorbable vs Non-Absorbable
- Slowly absorbable monofilament sutures are preferred for scalp closure, as they minimize infection risk while providing adequate tensile strength during the critical healing period 3
- Non-absorbable sutures may be used for the galeal layer when long-term tension reduction is needed, particularly in wide defects 2
Monofilament vs Multifilament
- Monofilament sutures cause less bacterial seeding and have lower infection risk compared to multifilament options 4
- Absorbable symmetric barbed sutures (such as 3-0 Stratafix) provide strong closure for high-tension areas without requiring knot tying 1
Layered Closure Technique
Deep Layer (Galea)
- Close the galea with 3-0 absorbable suture using continuous non-locking technique 1, 2
- Consider double relaxation suturing of the galea to minimize skin tension and prevent scar widening 2
- This deep layer closure is critical for reducing tension on the superficial closure 2
Superficial Layer (Skin)
- After galeal approximation, superficial skin closure can be accomplished with finer sutures, staples, or tissue adhesive 2, 5
- Staples are significantly faster and less painful than sutures for skin closure, with equivalent cosmetic outcomes 6, 5
- Modified hair apposition technique with cyanoacrylate glue can be used for wounds in areas with hair ≥1 cm long 7
Common Pitfalls to Avoid
- Never use overly tight sutures that can strangulate tissue and impair healing 4
- Avoid locking continuous sutures which increase tension and can cause tissue edema and necrosis 4
- Do not skip galeal closure in scalp lacerations, as this leads to increased tension on skin closure and wider scars 2
- Ensure adequate hemostasis before closure, as continued bleeding after pressure necessitates suture/staple closure rather than alternative methods 7
Special Considerations
- For wide scalp defects, use relaxing suture techniques with 3-0 absorbable barbed sutures to approximate wound edges before final closure 1
- Consider beveling incisions at 30 degrees to hair follicles to preserve deep follicles and allow hair growth into the scar 2
- Triclosan-coated sutures (such as Vicryl Plus) reduce surgical site infection rates and should be considered when available 3, 4