Should absorbable sutures be used for a 45-year-old male with a 4 cm laceration to the thenar eminence of the hand?

Suture Selection for Thenar Eminence Hand Laceration

For a 4 cm laceration to the thenar eminence of the hand in a 45-year-old male, use absorbable monofilament sutures (4-0 or 5-0 poliglecaprone or polyglyconate) rather than non-absorbable sutures to avoid the pain and difficulty of suture removal in this high-mobility area while achieving equivalent healing outcomes. 1, 2

Rationale for Absorbable Sutures in Hand Lacerations

Absorbable sutures are particularly advantageous for hand lacerations because suture removal in the hand is painful, and the high mobility of this area benefits from the extended support that modern synthetic absorbables provide. 1, 3 A 5-year retrospective study of 102 hand laceration patients demonstrated that absorbable sutures (5-0 Vicryl) produced identical scar quality, healing outcomes, and infection rates compared to non-absorbable nylon, with no complications in either group. 2

Optimal Material Selection

• Monofilament absorbable sutures (poliglecaprone or polyglyconate) are preferred because they cause less bacterial seeding than multifilament sutures while maintaining excellent tensile strength for high-mobility areas like the thenar eminence. 1, 3

• Use 4-0 or 5-0 gauge sutures for hand lacerations, as this size provides optimal wound closure without excessive tissue trauma in this anatomically delicate region. 1, 3

• Polyglyconate specifically provides good tensile strength while maintaining absorbability, making it ideal for the high-tension thenar area. 1

Suturing Technique

• Employ a continuous non-locking technique rather than interrupted sutures, as this distributes tension more evenly across the suture line and reduces the risk of tissue edema and necrosis. 1, 3

• Use the "small bite" technique (approximately 5mm from wound edge and between stitches) to ensure adequate tension distribution and minimize tissue damage. 3

• Avoid locking sutures, as they cause excessive tension leading to tissue edema and necrosis in hand lacerations. 3

• Do not place sutures too tightly, as this strangulates tissue and impairs healing in high-mobility areas. 1

Anesthesia Protocol

• Apply topical LET (lidocaine, epinephrine, and tetracaine) to the wound and allow 10-20 minutes for it to work until wound edges appear blanched before beginning repair. 4, 5

• For supplemental anesthesia, inject lidocaine slowly using a small-gauge needle, and consider buffering with bicarbonate and warming the solution to minimize injection pain. 4, 5

Post-Repair Care and Monitoring

• Keep the wound clean and dry for the first 24-48 hours, and instruct the patient to avoid excessive tension on the hand during initial healing. 1, 3

• Elevate the injured hand if swollen to accelerate healing. 3

• Follow up within 24 hours by phone or office visit to ensure proper healing. 1, 3

Critical Complications to Monitor

• Watch for infectious complications including septic arthritis, osteomyelitis, subcutaneous abscess, and tendonitis, as hand wounds are often more serious than wounds to fleshy body parts. 3

• Pain disproportionate to injury severity near a bone or joint suggests periosteal penetration and requires urgent evaluation. 1, 3

• Monitor for noninfectious complications including nerve or tendon injury, compartment syndrome, and post-traumatic arthritis. 3

Common Pitfalls to Avoid

• Do not use catgut sutures, as they are associated with more pain and higher risk of requiring resuturing. 4, 3

• Avoid braided/multifilament sutures in hand lacerations, as they increase bacterial seeding and infection risk compared to monofilament options. 4, 1

• Do not underestimate healing time requirements—hand lacerations require 10-14 days for adequate healing due to high mobility and tension in this region. 3