From the Guidelines
When suturing elderly frail skin, use the smallest possible needle and thinnest appropriate suture material (typically 5-0 or 6-0 monofilament) to minimize trauma. Apply minimal tension on the sutures to prevent tearing through the skin, and consider using a running subcuticular technique rather than interrupted sutures to distribute tension more evenly. Place sutures farther from the wound edge (5-7mm) than you would in younger skin to prevent tearing. Tissue adhesives like Dermabond can be useful adjuncts or alternatives for superficial closures. Prior to suturing, handle the skin gently and ensure adequate local anesthesia with minimal volume (1% lidocaine with epinephrine 1:100,000) to prevent tissue distortion. Consider using wound closure strips (Steri-Strips) to support the suture line and reduce tension. Remove sutures earlier than usual (typically 5-7 days for facial wounds, 7-10 days elsewhere) to prevent suture marks, and apply wound support after removal. These techniques accommodate the reduced elasticity, decreased vascularity, and thinned dermis characteristic of elderly skin, which make it more prone to tearing and delayed healing 1, 2, 3.
Some key considerations when managing elderly trauma patients include:
- Early trauma protocol activation in patients aged ≥ 55 years old 4
- Careful evaluation of injured patients aged ≥ 55-year-old for potential high risk of mortality and avoidance of under-triage 4
- Assessment of frailty in all elderly trauma patients 4
- Use of a multidisciplinary approach to care, including early involvement of palliative care teams and shared decision making 5, 6
- Consideration of the patient's directives, family feelings, and representatives' desires when making end-of-life decisions 7
It is essential to prioritize the management of elderly trauma patients based on their unique physiological and anatomical characteristics, as well as their comorbidities and frailty status 8, 5, 6. By using a multidisciplinary approach and considering the patient's individual needs and preferences, healthcare providers can improve outcomes and reduce morbidity and mortality in this vulnerable population.
From the Research
Suturing Elderly Frail Skin: Tips and Considerations
- When suturing elderly frail skin, it is essential to consider the fragility of the skin and the potential for wound complications 9.
- The use of tissue adhesives, such as cyanoacrylate, may be a suitable alternative to traditional sutures for superficial, small, and tension-free skin incisions or lacerations 10, 11, 12, 13.
- Tissue adhesives have been shown to have several advantages over conventional sutures, including ease of use, excellent bacteriostatic properties, decreased repair time, and comparable short- and long-term cosmetic outcomes 10, 12, 13.
- However, tissue adhesives may not be suitable for all types of wounds, and the decision to use them should be made on a case-by-case basis, taking into account the individual patient's needs and the specific characteristics of the wound 10, 9.
- When using traditional sutures, it is crucial to select the optimal suture material and technique to minimize tissue trauma and promote wound healing 9.
- The use of barbed sutures and modern skin adhesives can also help to improve wound closure and reduce the risk of complications 9.
- In terms of specific techniques, studies have shown that cyanoacrylate tissue adhesive can be used to maintain an airtight seal in negative pressure wound therapy, reducing the risk of air leaks and promoting wound healing 11.
- Additionally, the use of octyl-2-cyanoacrylate tissue adhesive has been shown to be faster and more effective than traditional subcuticular suturing for the closure of maxillofacial incisions 13.