Absorbable Sutures for Facial Skin Closure
Primary Recommendation
For facial skin closure, use 5-0 rapidly absorbable coated polyglactin 910 (Vicryl Rapide) or 5-0 poliglecaprone 25 (Monocryl) with a continuous subcuticular technique. 1
Optimal Suture Material Selection
Rapidly absorbable synthetic monofilament sutures (5-0 size) are the preferred choice for facial skin closure because they eliminate the need for suture removal, reduce patient anxiety and discomfort, and produce equivalent cosmetic outcomes to non-absorbable sutures at 6 months. 1
Specifically, 5-0 coated irradiated polyglactin 910 (Vicryl Rapide) has been directly compared to non-absorbable 5-0 polypropylene in facial wound closure and demonstrated no difference in scar formation or wound complications. 1
Alternative option: 5-0 poliglecaprone 25 (Monocryl) is equally acceptable and retains 50-75% tensile strength after 1 week, providing adequate wound support during the critical healing period. 2, 1
Deep Layer Closure
For deeper tissue layers in facial wounds, use 4-0 poliglecaprone 25 (Monocryl) with buried dermal sutures before closing the skin surface. 1
This layered approach reduces tension on the skin closure and improves cosmetic outcomes. 1
Suture Technique
Employ continuous subcuticular suture technique rather than interrupted sutures, as this dramatically reduces superficial wound dehiscence by 92% (RR 0.08; 95% CI 0.02-0.35). 2
The continuous technique creates a continuous seal along the wound edge that better prevents bacterial invasion and provides prolonged wound support without requiring removal. 2
Critical Advantages of Absorbable Sutures for Facial Wounds
No suture removal required, which saves physician time and eliminates patient anxiety associated with removal procedures. 1
Equivalent long-term cosmetic results compared to non-absorbable sutures in clean facial wounds, with no difference in scar formation at 6-month follow-up. 1
Lower risk of wound dehiscence when using continuous subcuticular technique with absorbable material compared to interrupted non-absorbable sutures that require early removal. 2
Monofilament vs Multifilament
Prefer monofilament absorbable sutures over multifilament (braided) materials because monofilament causes less bacterial seeding and reduces infection risk. 3
While both 4-0 Vicryl (multifilament) and 4-0 Monocryl (monofilament) show comparable surgical site infection rates in some studies, monofilament theoretically offers lower bacterial colonization risk due to absence of interstices. 3, 4
Common Pitfalls to Avoid
Never use rapidly absorbable sutures for deep fascial closure—reserve them only for skin closure where they provide adequate strength during the 7-10 day critical healing period. 3, 2
Avoid using tissue adhesives alone for facial lacerations >0.5 cm, as they carry a 3.35-fold higher risk of wound breakdown compared to sutures (NNT = 43 to prevent one dehiscence). 2
Do not use multifilament sutures in contaminated or high-risk wounds; switch to monofilament or consider triclosan-coated sutures to reduce infection risk (OR 0.72; 95% CI 0.59-0.88). 3, 2
Post-Closure Care
Keep the wound clean and dry for the first 24-48 hours. 5
Monitor for signs of infection including increasing pain, redness, swelling, or discharge during the first 7-10 days. 2, 5
Absorbable sutures will dissolve completely between 42-56 days for rapidly absorbable materials (Vicryl Rapide) and 90-110 days for standard absorbable materials (Monocryl). 3, 6