Recommended Suture Material for Facial Lacerations in Adults
For facial lacerations in healthy adults, use 5-0 or 6-0 monofilament absorbable sutures such as poliglecaprone (MONOCRYL) or polyglyconate (Maxon), which provide optimal cosmetic outcomes while eliminating the need for suture removal. 1
Primary Suture Material Selection
Monofilament absorbable sutures are the gold standard for facial wounds because they cause significantly less bacterial seeding compared to multifilament options, reducing infection risk in cosmetically sensitive areas 2, 1. The face's rich vascular supply makes infection prevention critical, and monofilament sutures have lower tissue resistance during passage, minimizing trauma 1.
Specific Material Recommendations:
- Poliglecaprone 25 (MONOCRYL): Preferred for its excellent handling characteristics and predictable absorption 1, 3
- Polyglyconate (Maxon): Alternative option providing good tensile strength 1
- Coated irradiated polyglactin 910 (VICRYL Rapide): Rapidly absorbing option that produces equivalent cosmetic results to non-absorbable sutures 3
Suture Size:
- 5-0 or 6-0 gauge for facial skin closure to minimize tissue trauma while providing adequate strength 1, 3
- 4-0 gauge for deeper dermal layers if needed 3
Why Absorbable Over Non-Absorbable
A high-quality randomized study comparing absorbable versus non-absorbable sutures in 41 facial wound closures found no difference in long-term cosmetic outcomes at 6 months, with no infections or premature suture rupture in either group 3. Absorbable sutures eliminate the anxiety and discomfort of suture removal, saving both physician time and patient distress 3. This is particularly valuable in facial wounds where patient compliance with follow-up may be variable 1.
Critical Materials to Avoid
Never use catgut sutures for facial lacerations—they are associated with significantly more pain and higher risk of requiring resuturing compared to synthetic options 2, 4. Catgut also elicits greater inflammatory response, compromising cosmetic outcomes 5.
Suturing Technique Considerations
- Use continuous non-locking technique to distribute tension evenly across the wound, reducing tissue edema and necrosis 2, 1
- Employ subcuticular (intradermal) closure for the final skin layer to avoid visible suture marks and optimize scar aesthetics 1, 5
- Small bite technique (approximately 5mm from wound edge) ensures adequate tension distribution while minimizing tissue damage 6
- Avoid locking sutures as they create excessive tension leading to tissue strangulation 2, 6
Enhanced Options When Available
Consider triclosan-coated sutures (such as VICRYL Plus) if available, as they significantly reduce surgical site infection rates with an odds ratio of 0.72 (95% CI 0.59-0.88) compared to non-coated sutures 2. This antimicrobial coating prevents microbial colonization of suture material without compromising wound healing 2.
Alternative Closure Methods for Select Cases
For low-tension facial wounds, tissue adhesives (octyl cyanoacrylate) provide essentially painless closure with similar cosmetic outcomes, infection rates, and patient satisfaction compared to sutures 2, 7. However, a Cochrane review found sutures significantly better than tissue adhesives for minimizing wound dehiscence (RR 3.35; 95% CI 1.53-7.33), so adhesives should be reserved for wounds under minimal tension 2.
Common Pitfalls to Avoid
- Overtightening sutures: This strangulates tissue and impairs healing, particularly problematic in mobile facial tissues 1, 6
- Using multifilament sutures: These harbor bacteria in their interstices and increase infection risk 2, 8
- Placing sutures too close together: This creates excessive tension points rather than distributing force evenly 6
- Adding adhesive strips over buried sutures: Studies show no improvement in cosmetic outcomes or scar width with this practice 2
Post-Repair Care
Keep the wound clean and dry for 24-48 hours, and monitor for signs of infection including increasing pain, redness, swelling, or discharge 1, 4. Follow-up within 24 hours ensures proper healing trajectory 1, 4.