What are the indications and usage of Ethilon (nylon) sutures in adult patients for skin closure and tissue repair?

Ethilon (Nylon) Sutures: Indications and Usage

Ethilon (nylon) sutures are non-absorbable monofilament sutures primarily indicated for skin closure in adult patients, particularly for facial wounds requiring 5-7 day removal, and for any wound requiring long-term tensile strength beyond 60 days. 1, 2

Primary Indications for Ethilon Sutures

Facial and Cosmetically Sensitive Areas

• Use 5-0 or 6-0 Ethilon (nylon) or Prolene (polypropylene) for the cutaneous portion of facial wounds, including through-and-through lip lacerations. 3, 4
• Remove these sutures at 5-7 days for facial wounds to minimize scarring while ensuring adequate healing. 3, 5
• For clean facial wounds in adults, long-term cosmetic outcomes are equivalent whether using non-absorbable (like Ethilon) or rapidly absorbable sutures, though absorbable sutures eliminate the need for removal. 4

Superficial Skin Closure

• Ethilon is appropriate for superficial (epidermal) interrupted sutures when you need precise wound edge approximation and plan to remove sutures within 7-9 days. 2, 6
• Use 6-0 or 7-0 Ethilon for delicate superficial skin closure where minimal tissue reaction is desired. 2
• Non-absorbable sutures like Ethilon maintain tensile strength for longer than 60 days, making them suitable when prolonged wound support is needed. 1

When NOT to Use Ethilon

Avoid for Subcuticular Closure

• Do not use Ethilon for subcuticular continuous closure—this technique requires absorbable monofilament sutures (4-0 poliglecaprone or polyglactin) that don't require removal. 7, 8, 5
• Continuous subcuticular absorbable sutures reduce superficial wound dehiscence by 92% (RR 0.08; 95% CI 0.02-0.35) compared to interrupted non-absorbable transcutaneous sutures. 8, 6
• The dramatic reduction in dehiscence occurs because absorbable subcuticular sutures retain 50-75% tensile strength after 1 week and don't require removal at 7-9 days when the wound is still vulnerable. 7, 8

Avoid for Deep Tissue Layers

• Never use non-absorbable sutures like Ethilon for deep fascial or muscle closure—these layers require absorbable sutures (polydioxanone or polyglactin) to avoid permanent foreign material in deep tissues. 7, 2
• For deep fascia, use 0 or 2-0 polydioxanone (PDS II); for dermal layers if needed, use 4-0 or 5-0 PDS II. 2

Avoid for Mucosal Surfaces

• Do not use Ethilon for intraoral or mucosal closure—these areas require absorbable monofilament sutures (5-0 or 6-0) to eliminate uncomfortable suture removal inside the mouth. 3

Optimal Technique When Using Ethilon

Interrupted vs. Continuous Technique

• Use interrupted Ethilon sutures for transcutaneous skin closure when you plan removal at 7-9 days, but recognize this carries higher dehiscence risk than continuous absorbable subcuticular technique. 7, 6
• In trials comparing techniques, 22 of 23 superficial wound dehiscences occurred in the interrupted non-absorbable suture group versus the continuous absorbable group. 6
• The higher dehiscence rate with interrupted non-absorbable sutures occurs because removing them at 7-9 days eliminates wound support during a critical healing period. 8, 6

Suture Removal Timing

• Remove Ethilon sutures at 5-7 days for facial wounds and 7-9 days for other body locations—premature removal increases dehiscence risk, while delayed removal worsens scarring. 3, 5, 6
• If dehiscence occurs after Ethilon removal, this suggests either premature removal or inadequate wound tensile strength. 5

Critical Pitfalls to Avoid

Premature Suture Removal

• Never remove Ethilon sutures before 7-9 days for non-facial wounds, as this is the most common cause of superficial wound dehiscence. 5, 6
• Non-absorbable sutures removed at 7-9 days is considered appropriate timing, but wounds remain vulnerable during this period. 7

Wrong Material for Wrong Layer

• Avoid leaving any non-absorbable suture material in deep tissues or contaminated wounds—this significantly increases infection risk and creates permanent foreign body reaction. 5, 1
• For contaminated or infection-prone wounds requiring skin closure, consider triclosan-coated absorbable sutures instead, which reduce surgical site infection (OR 0.72; 95% CI 0.59-0.88). 8

Ignoring Superior Alternatives

• Recognize that for most skin closures, continuous subcuticular absorbable sutures are superior to interrupted Ethilon—they reduce dehiscence, eliminate removal, decrease pain, and provide equivalent cosmetic outcomes. 8, 4, 6
• The only clear advantage of Ethilon is easier handling and tying for surgeons unfamiliar with absorbable materials. 4

Post-Closure Monitoring

• Monitor for infection signs (increasing pain, redness, swelling, purulent discharge) and wound dehiscence, particularly in the first 7-10 days before and immediately after suture removal. 8, 5
• Keep wounds clean and dry for the first 24-48 hours regardless of suture material chosen. 3, 5
• For facial wounds, pain disproportionate to injury severity may indicate deeper complications requiring further evaluation. 3