What type of suture is recommended for facial wounds, considering factors such as skin type, wound location, and potential for scarring?

Facial Wound Suture Selection

For facial wounds, use 5-0 or 6-0 monofilament absorbable sutures (such as coated polyglactin 910 or poliglecaprone 25) for skin closure, as they provide equivalent cosmetic outcomes to non-absorbable sutures while eliminating the need for removal. 1, 2

Primary Suture Material Recommendations

Skin Layer

• 5-0 or 6-0 absorbable monofilament sutures are the optimal choice for facial skin closure, specifically coated polyglactin 910 (Vicryl Rapide) or poliglecaprone 25 (Monocryl) 1, 2
• A randomized controlled trial of 41 facial wound closures demonstrated no difference in long-term cosmetic results between absorbable and non-absorbable sutures at 6-month follow-up, with no wound infections or premature suture rupture 2
• Absorbable sutures eliminate patient anxiety and discomfort associated with suture removal while saving clinical time 2

Deep Layer (if applicable)

• Use 4-0 poliglecaprone 25 (Monocryl) for deep tissue closure to provide structural support 2
• This provides adequate tensile strength while the absorbable nature prevents long-term foreign body reaction 3

Suture Technique for Optimal Cosmesis

Layered Closure Approach

• Employ continuous subcuticular technique for skin closure, which reduces superficial wound dehiscence by 92% (RR 0.08; 95% CI 0.02-0.35) compared to interrupted sutures 4
• Use continuous non-locking suturing to distribute tension evenly and reduce tissue edema risk 1
• For through-and-through lacerations, close in layers: deep muscular layer first, then mucosal layer (if applicable), then skin 1

Critical Anatomic Landmarks

• The vermillion border requires precise alignment as misalignment causes permanent cosmetic deformity—this is the single most critical landmark in lip repair 1
• Anticipate significant bleeding despite seemingly minor wounds due to rich facial vascular supply 1

Suture Size Selection by Location

• Face (general): 5-0 or 6-0 monofilament 1, 2
• Lips (intraoral surface): 5-0 or 6-0 absorbable monofilament 1
• Lips (skin surface): 5-0 or 6-0 monofilament non-absorbable (nylon or polypropylene) if using traditional approach, though absorbable is now preferred 1, 2

The smallest suture size that accomplishes the purpose should be chosen to minimize tissue trauma and foreign material within tissues 3

Monofilament vs Multifilament

• Always choose monofilament sutures for facial wounds 1, 4, 2
• Monofilament has lower tissue resistance during passage and reduced infection risk compared to multifilament 3
• Multifilament sutures pose higher risks of suture sinus formation and infection despite having higher tensile strength 3

Post-Closure Management

Wound Care

• Keep the wound clean and dry for the first 24-48 hours 1, 5
• For intraoral components, prescribe chlorhexidine 0.12% rinses twice daily for at least one week 1
• Recommend soft diet to minimize tension on lip repairs 1

Suture Removal Timing (if non-absorbable used)

• Remove non-absorbable facial sutures after 5-7 days to prevent suture marks while ensuring adequate healing 1
• Never remove before 5 days as premature removal causes dehiscence 4

Monitoring for Complications

• Watch for infection signs: increasing pain, redness, swelling, or purulent discharge 1, 5
• Pain disproportionate to injury severity may indicate deeper complications requiring further evaluation 1, 5

Common Pitfalls to Avoid

• Never use rapidly absorbable sutures for structural closure as they lose tensile strength too quickly 4
• Avoid multifilament sutures on facial wounds due to increased infection risk and tissue drag 3
• Do not use tissue adhesives alone for high-tension facial wounds, as they have 3.35 times higher dehiscence risk compared to sutures 4, 5
• Avoid placing sutures under excessive tension, which causes tissue ischemia and poor healing 3