From the Research
For a leg laceration in an elderly patient, I recommend using 4-0 or 5-0 non-absorbable sutures such as nylon or polypropylene for the skin closure, as these smaller gauge sutures help minimize tissue trauma while providing adequate wound closure. The choice of suture size is crucial in elderly patients due to their thinner and more fragile skin, which is prone to tearing and has delayed wound healing 1.
When considering the type of sutures to use, it's essential to prioritize the method of skin closure that promotes rapid wound healing and long-term cosmetic appearance. According to a recent systematic review and meta-analysis 1, continuous sutures, either transdermal or subcuticular, have been shown to have superior outcomes compared to interrupted sutures in terms of wound healing and cosmetic appearance.
The deeper layers should be closed with 3-0 or 4-0 absorbable sutures like polyglactin (Vicryl) or poliglecaprone (Monocryl) if needed. Key considerations in the management of leg lacerations in elderly patients include:
- Proper wound cleaning and debridement of devitalized tissue
- Appropriate antibiotic prophylaxis
- Tetanus prophylaxis if the patient's immunization status is not up to date or unknown
- Gentle suture placement technique with minimal tension to avoid tissue tearing
- Use of adhesive strips (Steri-Strips) as additional support after suture removal
- Leaving the sutures in place for 10-14 days, longer than the typical 7-10 days for younger patients, due to delayed wound healing in elderly individuals 1.