What type of suture material is recommended for a patient with a skin laceration beside the right eye, considering factors such as age, medical history (e.g. diabetes, bleeding disorders), and mechanism of injury?

Suture Selection for Periocular Skin Laceration

For a skin laceration beside the right eye, use 6-0 monofilament absorbable suture (poliglecaprone or polyglyconate) with a continuous non-locking subcuticular technique to optimize cosmetic outcome while minimizing infection risk and eliminating the need for suture removal. 1

Optimal Suture Material

Monofilament absorbable sutures are the definitive choice for periocular facial lacerations because they cause less bacterial seeding compared to multifilament options and significantly reduce infection risk in this cosmetically sensitive area. 1, 2

Specific Material Recommendations

• Poliglecaprone (MONOCRYL) or polyglyconate (Maxon) are the preferred slowly absorbable monofilament sutures that provide adequate tensile strength during the critical healing period while eliminating suture removal 1
• These materials maintain strength long enough for facial wound healing (typically 2-3 weeks) before absorption begins 2

Why Monofilament Over Multifilament

• Monofilament sutures have lower resistance when passed through delicate periocular tissues and reduced risk of suture sinus formation 1, 2
• The periocular area's rich vascular supply makes infection prevention critical, and monofilament design minimizes bacterial harboring 1

Suture Size Selection

Use 6-0 suture size for periocular facial lacerations to minimize tissue trauma and optimize cosmetic outcome while providing adequate strength. 3 This is finer than the 5-0 recommended for hand lacerations, reflecting the thinner, more delicate periocular skin and higher cosmetic demands.

Suturing Technique

Employ continuous non-locking subcuticular technique to distribute tension evenly across the wound, reduce tissue edema, and avoid visible suture marks on this cosmetically critical area. 4, 1, 3

Technical Considerations

• Avoid locking stitches as they cause excessive tension leading to tissue edema and necrosis 4
• Subcuticular placement avoids damage to nerve endings on the skin surface, reducing pain 4
• Ensure knots are buried to prevent palpable irregularities and optimize cosmetic result 4

Critical Pitfalls to Avoid

• Never use catgut sutures - they are associated with more pain and higher risk of requiring resuturing 1, 3
• Avoid overly tight sutures that can strangulate tissue and impair healing, particularly important in mobile periocular tissues 1, 5
• Do not use braided (multifilament) sutures like Mersilene polyester as they may contribute to tissue erosion and infection 4

Enhanced Options

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 periocular wounds where infection could threaten vision.

Special Patient Considerations

Diabetes

• Healing may be delayed; ensure meticulous technique and consider closer follow-up 1
• The monofilament absorbable approach remains optimal as it minimizes infection risk

Bleeding Disorders

• Ensure adequate hemostasis before closure 4
• The continuous technique helps distribute tension and may reduce bleeding risk compared to interrupted sutures

Mechanism of Injury

• Contaminated wounds may benefit from antimicrobial-coated sutures if available 1
• High-tension injuries may require deeper dermal layer closure before skin approximation

Post-Repair Care

• Keep wound clean and dry for 24-48 hours 1, 3
• Monitor for signs of infection: increasing pain, redness, swelling, or discharge 1, 5, 3
• Follow-up within 24 hours to ensure proper healing, particularly important given proximity to the eye 1, 3
• Pain disproportionate to injury severity may suggest deeper complications requiring urgent evaluation 3