Which suture sizes are recommended for skin and deep closure of hand lacerations, and what is the appropriate removal timing for skin sutures in adults, including adjustments for elderly, diabetic, immunocompromised, or high‑tension wounds?

Hand Laceration Suture Selection and Removal Timing

Recommended Suture Sizes

For hand lacerations, use 4-0 or 5-0 monofilament absorbable sutures for skin closure and 4-0 monofilament absorbable sutures for deeper layer approximation. 1, 2

Skin Closure

• 4-0 or 5-0 poliglecaprone (Monocryl) or polyglactin (Vicryl) are the optimal choices for subcuticular or simple interrupted skin closure 1, 2
• Monofilament sutures cause less bacterial seeding within their structure compared to braided materials, reducing infection risk in hand wounds where contamination is common 3
• These materials retain 50-75% tensile strength after 1 week and 20-30% after 2 weeks, providing adequate support through the critical healing period 1

Deep Layer Closure

• 4-0 slowly absorbable monofilament suture (poliglecaprone or polyglyconate) for approximating deeper structures including fascia, tendon sheaths, or muscle 1, 4
• Avoid multifilament braided sutures in deeper layers as they harbor bacteria within interstices and increase infection rates 5

Suture Removal Timing for Non-Absorbable Sutures

Remove non-absorbable skin sutures from hand wounds at 10-14 days in standard adult patients. 3

Standard Adult Patients

• 10 days is the baseline removal time for most hand lacerations in healthy adults 3
• This timing balances adequate wound healing with prevention of suture track marks and infection 3

High-Risk Populations Requiring Extended Time

Elderly patients (>65 years):

• Extend removal to 12-14 days due to slower collagen deposition and delayed wound healing 3

Diabetic patients:

• Extend removal to 14 days minimum as hyperglycemia impairs fibroblast function and collagen synthesis 3

Immunocompromised patients:

• Extend removal to 14 days to account for impaired inflammatory response and delayed healing 3

High-tension wounds:

• Extend removal to 14 days for wounds over joints (MCP, PIP, DIP) or areas subject to frequent movement 6
• Consider reinforcing with adhesive strips (Steri-Strips) after suture removal to provide continued support 6

Critical Technique Considerations

Continuous vs. Interrupted Sutures

• Continuous subcuticular technique with absorbable sutures eliminates the need for removal and reduces superficial dehiscence by 92% (RR 0.08) compared to interrupted transcutaneous sutures 6
• If using interrupted sutures, place them 5mm from wound edges and 5mm apart to minimize tissue trauma 7

Avoiding Common Pitfalls

• Never remove sutures before 10 days in hand wounds, as premature removal causes dehiscence in high-motion areas 6
• Avoid placing sutures under excessive tension, which strangulates tissue and impairs blood flow to wound edges 7
• Do not use rapidly absorbable sutures (e.g., Vicryl Rapide) for hand wounds, as they lose tensile strength too quickly for areas subject to frequent movement 3

Antimicrobial Considerations

• Consider triclosan-coated sutures for contaminated hand wounds (dirty injuries, delayed presentation >6 hours), as they reduce surgical site infection risk (OR 0.72) 6

Absorbable Suture Advantages

Using absorbable monofilament sutures (4-0 or 5-0 poliglecaprone) for skin closure eliminates removal entirely while providing equivalent or superior outcomes 3, 1

• Complete absorption occurs between 91-119 days with minimal tissue reaction 1
• Patients experience less pain compared to non-absorbable suture removal 3
• No risk of premature removal causing dehiscence 6