What type of suture is recommended for a facial laceration, considering factors such as skin type and history of keloid formation?

Facial Laceration Suture Selection

Use monofilament absorbable sutures—specifically 5-0 or 6-0 poliglecaprone 25 (MONOCRYL) or polyglyconate (Maxon)—for facial lacerations to optimize cosmetic outcomes while minimizing infection risk. 1

Primary Suture Material Recommendation

• Monofilament absorbable sutures are the gold standard for facial wounds because they cause significantly less bacterial seeding compared to multifilament options, directly reducing infection risk in this cosmetically sensitive area 1
• Poliglecaprone 25 (MONOCRYL) is specifically recommended by the American College of Surgeons for its excellent handling characteristics and predictable absorption profile 1
• Polyglyconate (Maxon) serves as an alternative option providing good tensile strength while maintaining the benefits of monofilament design 1

Suture Size Selection

• Use 5-0 or 6-0 suture size for facial lacerations to minimize tissue trauma while providing adequate strength for optimal cosmetic results 1, 2
• Smaller gauge sutures (6-0 or 7-0) may be considered for particularly delicate facial areas where minimizing visible scarring is paramount 2

Optimal Suturing Technique

• Employ continuous non-locking technique to distribute tension evenly across the wound, which reduces tissue edema and necrosis 1
• Use subcuticular (intradermal) closure for the final skin layer to avoid visible suture marks and optimize scar aesthetics 1
• Apply small bite technique (approximately 5mm from wound edge) to ensure adequate tension distribution while minimizing tissue damage 1
• Never use locking sutures as they create excessive tension points leading to tissue strangulation 1

Enhanced Options When Available

• Consider triclosan-coated sutures (VICRYL Plus) to reduce surgical site infection rates, with demonstrated odds ratio of 0.72 (95% CI 0.59-0.88) compared to non-coated sutures 1
• These antimicrobial-coated sutures prevent microbial colonization without compromising wound healing 1

Alternative Closure for Select Low-Tension Wounds

• Tissue adhesives (octyl cyanoacrylate) may be used for low-tension facial wounds as they provide essentially painless closure with similar cosmetic outcomes, infection rates, and patient satisfaction compared to sutures 1, 3
• However, sutures remain superior for preventing wound dehiscence (RR 3.35; 95% CI 1.53-7.33), so reserve adhesives strictly for wounds under minimal tension 1
• Research demonstrates no difference in cosmetic outcomes between adhesives and sutures at 3 months (visual analog cosmesis scores 67mm vs 68mm; P=0.65), but adhesives are significantly faster (3.6 vs 12.4 minutes) and less painful (pain scores 7.2 vs 18.0mm) 3

Special Considerations for Keloid-Prone Patients

• Monofilament absorbable sutures remain the preferred choice even in patients with keloid history, as they elicit minimal inflammatory response compared to multifilament or non-absorbable options 1, 4
• The reduced tissue reactivity of monofilament materials helps minimize excessive scar formation 4
• Subcuticular closure technique is particularly important in keloid-prone patients to avoid surface suture marks that could serve as niduses for keloid formation 1

Critical Pitfalls to Avoid

• Never overtighten sutures, as this strangulates tissue and impairs healing—particularly problematic in mobile facial tissues 1
• Avoid multifilament sutures entirely due to increased infection risk from bacterial harboring in the braided structure 1
• Do not place sutures too close together, as this creates excessive tension points rather than distributing force evenly 1
• Avoid adding adhesive strips over buried sutures, as this shows no improvement in cosmetic outcomes or scar width 1

Absorbable vs Non-Absorbable Debate

While some surgeons historically preferred non-absorbable sutures for ease of tying and minimal inflammatory response, current evidence supports absorbable sutures as equally effective cosmetically while eliminating the need for removal 5. A randomized trial of 41 facial wound closures found no difference in long-term cosmetic results between permanent and absorbable sutures at 6-month follow-up, with absorbable sutures offering the advantage of eliminating removal-related patient anxiety and discomfort 5.

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
• Follow-up within 24 hours to ensure proper healing trajectory 1