What size needle is appropriate for suturing a typical adult hand laceration in an otherwise healthy individual?

Needle Size for Hand Wound Suturing

For suturing hand lacerations, use a 4-0 or 5-0 suture with a reverse cutting (PS-2 or PS-3) needle, which provides optimal balance between tissue strength and cosmetic outcome while minimizing tissue tearing.

Suture Gauge Selection

• 4-0 or 5-0 gauge sutures are appropriate for most adult hand lacerations, as these sizes provide adequate tensile strength for hand tissue while allowing for acceptable cosmetic results 1
• Larger diameter sutures (4-0 vs 5-0) significantly reduce tissue tearing (mean tear-through force 3.81 N vs 3.44 N, p < .001), which is particularly important in hand wounds where tissue integrity affects both healing and function 1
• 5-0 sutures may be preferred for areas requiring finer cosmetic closure (such as dorsal hand or areas with thin skin), while 4-0 provides greater strength for palmar surfaces or areas under tension 1

Needle Type Selection

• Reverse cutting needles (PS-2, PS-3) are the standard choice for hand skin closure, as they are specifically designed for tough tissue like skin and reduce the risk of suture pull-through compared to conventional cutting needles 2, 1
• Reverse cutting needles produce higher tear-through forces (3.75 N) compared to conventional cutting needles (3.26 N, p < .001), making them more resistant to tissue cutout during healing 1
• Conventional cutting needles (PC-3) should be avoided for hand suturing as they have the lowest tear-through resistance and highest risk of suture tearing through tissue 1
• Taper point needles (BB) are not appropriate for hand skin closure, as they are designed for easily penetrated tissues like fascia or bowel, not tough dermal tissue 2, 1

Critical Technical Considerations

• Hand lacerations require careful assessment for deeper structure involvement (tendons, nerves, vessels) before simple closure, as wounds on tendon pathways or with neurovascular injury require surgical exploration in a specialized hand center 3
• Extremely urgent hand injuries requiring immediate referral include devascularization, amputation, and pressure injection injuries 3
• Bite wounds and open fractures require surgical exploration rather than simple suturing, even if the skin laceration appears superficial 3

Common Pitfalls to Avoid

• Do not use taper needles for skin closure, as they dilate rather than cut tissue and are designed for internal structures where cutting would cause bleeding or organ injury 2
• Avoid using smaller gauge sutures (6-0 or finer) for hand wounds under tension, as the significantly lower tear-through force increases risk of wound dehiscence 1
• Never close a hand wound without first ruling out tendon, nerve, or vascular injury, as missed deep injuries have serious functional and medicolegal consequences 3
• Keep dressings simple to allow early motion, as complex bulky dressings impede the early mobilization necessary for optimal hand function 3