From the Guidelines
For lower leg suturing, I recommend using 3-0 or 4-0 monofilament sutures, as they are associated with a lower risk of incisional hernia and wound complications compared to multifilament sutures, as suggested by the World Society of Emergency Surgery guidelines 1. The choice of suture material and size is crucial in lower leg suturing, as it affects the risk of wound complications and incisional hernia.
- Monofilament sutures, such as nylon or polypropylene, are preferred over multifilament sutures due to their lower risk of incisional hernia and wound complications 1.
- For most wounds, 3-0 or 4-0 non-absorbable sutures are suitable, providing good tensile strength while minimizing tissue trauma.
- Deeper layers may require 3-0 or 4-0 absorbable sutures, such as polyglactin 910 (Vicryl) or poliglecaprone 25 (Monocryl).
- When suturing near the ankle or areas with thin skin, consider using 5-0 sutures to minimize scarring.
- Proper wound closure technique is essential, as the lower leg experiences significant tension during movement and has relatively poor blood supply, particularly in the anterior shin area.
- Sutures should typically remain in place for 10-14 days due to the slower healing in this region.
- The use of triclosan-coated sutures may also be considered, as they have been shown to reduce the risk of surgical site infections (SSI) in some studies 1. However, the most recent and highest quality study suggests that monofilament sutures are the preferred choice for lower leg suturing, regardless of the use of triclosan coating 1.
From the Research
Suture Size for Lower Leg
- The appropriate suture size for the lower leg is not explicitly stated in the provided studies, but general guidelines for suture selection can be applied 2, 3.
- The smallest suture size that will accomplish the purpose should be chosen to minimize tissue trauma and foreign material within tissues 2.
- For skin/subcutaneous closure, fascial tension reduction sutures are recommended, where the tension is placed on the layer of deep fascia and superficial fascia 3.
- A study suggests using 0,2-0 polydioxanone sutures (PDS II) for deep/superficial fascia sutures, 4-0 or 5-0 PDS II for dermal sutures (if necessary), and 6-0 or 7-0 polypropylene or nylon sutures (Proline or Ethilon) for superficial sutures 3.
Considerations for Suture Selection
- Suture material should have predictable tensile strength, good handling, secure knot-tying properties, and could be enhanced with an antibacterial agent to resist infection 2.
- Monofilament sutures have lower resistance when passed through tissues, whereas multifilament sutures possess higher tensile strength and flexibility but greater tissue friction and pose risks of suture sinus and infection 2.
- The choice of suture material and size may depend on the specific surgical procedure, location, and patient factors, such as skin type and wound tension 3, 4, 5.