Prolene (Polypropylene) for Facial Lacerations
For healthy adults with facial lacerations, use 5-0 or 6-0 Prolene (polypropylene) monofilament non-absorbable sutures as the first-line choice, as they provide optimal cosmetic outcomes with the lowest infection risk. 1, 2
Primary Suture Selection
Prolene (polypropylene) is specifically recommended by the American College of Surgeons as the gold standard for facial lacerations because monofilament non-absorbable sutures cause less bacterial seeding and have lower infection rates compared to all other suture types. 1, 2
The appropriate size is 5-0 or 6-0 for facial skin—this provides adequate tensile strength while minimizing tissue trauma and optimizing cosmetic results. 1, 2
Prolene's monofilament structure reduces bacterial adherence compared to multifilament sutures, making it superior for infection prevention in facial wounds. 3, 1
Suturing Technique with Prolene
Use continuous non-locking suturing techniques with Prolene, as this distributes tension more evenly across the suture line and reduces the risk of tissue edema and necrosis. 1, 4, 2
For deeper or gaping facial wounds, employ a layered closure approach: close the deeper muscular layer first with absorbable sutures (4-0 or 5-0 poliglecaprone), then close the skin with Prolene. 1, 2
When repairing lip lacerations specifically, precise alignment of the vermillion border is critical—misalignment creates permanent cosmetic deformity that cannot be easily corrected. 1, 4, 2
Suture Removal Timing
Remove Prolene sutures after 5-7 days to minimize scarring—this timing balances adequate wound healing with prevention of suture track marks. 2
Earlier removal (closer to 5 days) is preferable for areas of high cosmetic concern like the central face. 2
Evidence Supporting Prolene Over Absorbable Alternatives
A 2003 randomized controlled trial comparing Prolene to Vicryl Rapide for facial wounds found no difference in long-term cosmetic outcomes at 6 months, with no infections or premature suture rupture in either group. 5
However, a 2024 prospective study found that non-absorbable sutures (including Prolene) showed statistically significantly better results at both 2 weeks and 6 weeks compared to absorbable sutures, particularly for elasticity, irregularity, and overall patient satisfaction. 6
A 2013 pediatric study found that while caregivers preferred absorbable sutures, blinded physicians rated non-absorbable sutures (nylon, similar to Prolene) as superior for cosmetic outcomes. 7
When Absorbable Alternatives May Be Considered
If suture removal follow-up is problematic or impossible, absorbable monofilament options like poliglecaprone (Monocryl) or rapidly-absorbing polyglactin 910 (Vicryl Rapide) can be used as second-line alternatives. 2, 5
For trunk and extremity lacerations (not facial), absorbable sutures show non-inferior cosmetic outcomes and may be preferred to avoid suture removal. 8
Avoid catgut sutures entirely—they are associated with more pain and higher resuturing rates. 3, 2
Post-Repair Management
Keep the wound clean and dry for the first 24-48 hours after repair. 2
For lip lacerations specifically, recommend a soft diet to minimize movement and tension on the suture line. 4, 2
For intraoral components of through-and-through lip lacerations, prescribe chlorhexidine 0.12% rinses twice daily for 1 minute for at least the first week to reduce bacterial load. 1, 4
Critical Pitfalls to Avoid
Do not tie Prolene sutures too tightly—overly tight sutures can strangulate tissue, impair healing, and worsen scarring. 2
Do not routinely add adhesive steri-strips over Prolene sutures—evidence shows no improvement in cosmetic outcomes or scar width when added to properly placed sutures. 2
Monitor for infection signs including increasing pain, redness, swelling, or purulent discharge—though infection rates with Prolene are low, vigilance is still required. 2
Be aware that facial wounds have excellent vascular supply, allowing for primary closure up to 24 hours after injury (compared to 12 hours for other body locations), provided thorough debridement is performed. 2