What type of suture is recommended for a hand laceration?

Hand Laceration Suture Selection

For hand lacerations, use monofilament absorbable sutures such as 5-0 poliglecaprone (MONOCRYL) or polyglyconate (Maxon), as they minimize infection risk while providing adequate tensile strength and eliminate the need for suture removal. 1, 2

Optimal Suture Material

• Monofilament absorbable sutures are the preferred choice because they cause less bacterial seeding compared to multifilament options and reduce infection risk in hand wounds 1, 2, 3

• Specific recommended materials include:

  • Poliglecaprone (MONOCRYL) - slowly absorbable monofilament 4, 1
  • Polyglyconate (Maxon) - slowly absorbable monofilament 4, 2
  • Polyglactin 910 (VICRYL) - acceptable alternative, though multifilament 5

• Use 5-0 suture size for optimal wound closure in hand lacerations, as this minimizes tissue trauma while providing adequate strength 2

Why Monofilament Over Multifilament

• Monofilament sutures have lower resistance when passed through tissues and reduced risk of suture sinus formation 3
• Multifilament sutures (like braided VICRYL) have higher tensile strength but greater tissue friction and increased infection risk 3
• The hand's rich vascular supply and frequent exposure to contamination make infection prevention critical 2

Why Absorbable Over Non-Absorbable

• Absorbable sutures eliminate the need for suture removal, which is particularly advantageous in hand wounds where return visits may be challenging 1, 5
• A 5-year retrospective study of 102 hand laceration patients showed no difference in scar quality, healing, or complication rates between 5-0 VICRYL and nylon at 6 months 5
• A prospective randomized trial in elective hand surgery confirmed no statistically significant difference in aesthetic outcomes between absorbable and non-absorbable sutures 6

Slowly Absorbable vs Rapidly Absorbable

• Choose slowly absorbable sutures over rapidly absorbable options for hand lacerations to maintain adequate tensile strength during the critical healing period 4
• Rapidly absorbable sutures (like VICRYL RAPIDE) lose strength too quickly for areas requiring sustained support 4, 2
• Hand wounds require approximately 3-6 weeks for the healing tissue to provide primary tensile strength, making slowly absorbable materials essential 7

Suturing Technique Considerations

• Use continuous non-locking technique to distribute tension evenly across the wound and reduce tissue edema 1, 2
• Avoid locking sutures as they cause excessive tension leading to tissue ischemia and necrosis 1, 3
• Select the smallest suture size that accomplishes closure (typically 5-0) to minimize tissue trauma and foreign material 3

Critical Pitfalls to Avoid

• Never use catgut sutures - they are associated with more pain and higher risk of requiring resuturing 2
• Avoid overly tight sutures that can strangulate tissue and impair healing, particularly important in the hand's mobile tissues 1, 8
• Do not use non-absorbable sutures like stainless steel - while strongest initially, they are difficult to work with, create bulky knots, and require removal 7
• Avoid multifilament sutures in contaminated wounds due to increased bacterial harboring in the braided structure 3

Enhanced Options When Available

• Consider antimicrobial-coated sutures (triclosan-coated VICRYL Plus) if available, as they demonstrate reduced surgical site infection rates with an odds ratio of 0.62 1
• This is particularly valuable in clean-contaminated or contaminated hand wounds 4, 1

Post-Repair Monitoring

• Keep the wound clean and dry for 24-48 hours 2
• Monitor for signs of infection: increasing pain, redness, swelling, or discharge 2, 8
• Pain disproportionate to injury severity may suggest deeper complications such as tendon or nerve involvement 2
• Follow-up within 24 hours to ensure proper healing 2