Suture Selection for Thenar Eminence Laceration
For a 4 cm laceration on the thenar eminence, use monofilament absorbable sutures such as poliglecaprone (MONOCRYL) or polyglyconate (Maxon) with a continuous non-locking technique. 1
Rationale for Absorbable Monofilament Sutures
Monofilament absorbable sutures are the optimal choice for hand lacerations because they eliminate the need for suture removal (which is particularly painful and anxiety-provoking in the hand), cause less bacterial seeding than multifilament sutures, and maintain adequate tensile strength in this high-mobility area. 1
- The thenar eminence is a high-mobility area requiring sutures that can accommodate movement while maintaining wound integrity 1, 2
- Monofilament sutures reduce infection risk compared to braided (multifilament) sutures by minimizing bacterial seeding 1, 2
- Absorbable sutures eliminate the need for a painful suture removal visit, which is especially beneficial in hand wounds 1
Specific Suture Material Recommendations
- Poliglecaprone (MONOCRYL) is recommended as it provides good tensile strength, excellent handling characteristics, and appropriate absorption time for hand wounds 1
- Polyglyconate (Maxon) is an alternative monofilament with excellent tensile strength specifically suited for high-mobility areas 1, 2
- Use 4-0 or 5-0 suture size appropriate for hand tissue 1
Suturing Technique
Employ a continuous non-locking suturing technique rather than interrupted sutures. 1, 2
- Continuous non-locking technique distributes tension more evenly across the suture line, which is critical in the mobile thenar area 1, 2
- This technique results in less pain during healing and reduces analgesic requirements 1, 2
- It reduces risk of tissue edema and necrosis by avoiding excessive tension 2
- Consider subcuticular closure for the final layer to minimize scarring in this functionally important area 1
Critical Pitfalls to Avoid
- Do not place excessive tension on sutures in this high-mobility area, as tight sutures can strangulate wound edges and impair healing 1, 2
- Avoid multifilament (braided) sutures due to increased bacterial seeding and infection risk 1, 2
- Do not use rapidly-absorbing sutures that lose tensile strength too quickly for this location 3
Evidence Supporting Absorbable vs. Non-Absorbable Sutures
While some research shows mixed cosmetic outcomes between absorbable and non-absorbable sutures 4, 5, 6, the practical advantages of absorbable sutures in hand wounds—particularly avoiding painful suture removal—outweigh any theoretical cosmetic differences 1. Studies demonstrate that absorbable sutures provide comparable or superior outcomes with no increase in infection or dehiscence rates 4, 6.
Post-Repair Care
- Keep the wound clean and dry for the first 24-48 hours 1
- Avoid excessive tension on the thenar eminence during initial healing phase 1
- Use acetaminophen or ibuprofen for pain management 1
- Monitor for signs of infection 1
- No routine antibiotic prophylaxis is needed unless the wound is heavily contaminated 1