What type of suture is best used for a patient with no significant medical history requiring suturing on the palm?

Suture Selection for Palm Lacerations

For palm lacerations, use slowly absorbable monofilament sutures (such as poliglecaprone/Monocryl or polyglyconate/Maxon) with a continuous subcuticular technique for skin closure. 1, 2

Suture Material Selection

Monofilament absorbable sutures are the optimal choice for palm repairs because they:

• Cause less bacterial seeding and reduce infection risk compared to multifilament materials 1
• Eliminate the need for suture removal, which is particularly advantageous in the hand where suture removal can be uncomfortable and anxiety-provoking 2, 3
• Provide equivalent cosmetic outcomes to non-absorbable sutures at 6 months 4, 3

Slowly Absorbable vs. Rapidly Absorbable

Choose slowly absorbable sutures over rapidly absorbable options 5, 1. Slowly absorbable materials provide:

• Longer wound support during the critical healing phase 5
• Lower rates of wound dehiscence compared to rapidly absorbable sutures 5, 6
• Adequate tensile strength throughout the healing period for hand tissues 1

Suture Technique

Use a continuous subcuticular technique rather than interrupted transcutaneous sutures 1, 6. This approach offers:

• Significantly lower superficial wound dehiscence rates (RR 0.08; 95% CI 0.02 to 0.35) 6
• No difference in infection rates compared to interrupted sutures 6
• Avoidance of superficial nerve ending damage that causes pain with transcutaneous sutures 1
• No need for suture removal, reducing patient discomfort and healthcare visits 2, 3

Specific Recommendations

For palm lacerations without tendon, nerve, or bone involvement:

• Use 5-0 monofilament absorbable suture (poliglecaprone or polyglyconate) for skin closure 1, 4
• Place sutures in a continuous subcuticular pattern approximately 5mm from wound edges 1
• Close deeper layers first if the laceration extends beyond superficial skin 1

Evidence from Hand Surgery

Research specifically examining hand lacerations demonstrates:

• No complications or infections occurred with 5-0 Vicryl (absorbable) sutures in 102 hand laceration repairs over 5 years 4
• Scar quality at 6 months was equivalent between absorbable and non-absorbable sutures in hand wounds 4
• No difference in pain levels, functional outcomes (Quick DASH scores), or scar appearance (POSAS scores) between continuous absorbable and interrupted non-absorbable sutures after carpal tunnel surgery 7

Critical Pitfalls to Avoid

• Never use interrupted transcutaneous sutures on the palm - they damage superficial nerve endings causing unnecessary pain 1
• Avoid multifilament sutures - they harbor bacteria and increase infection risk 1
• Do not use rapidly absorbable sutures - they lose tensile strength too quickly, increasing dehiscence risk 5, 1
• Never place sutures under excessive tension - this strangulates tissue and impairs healing 1