Suture Material and Technique for Superficial Skin Lacerations ≤5 cm
For superficial skin lacerations ≤5 cm, use 4-0 or 5-0 absorbable monofilament suture (poliglecaprone or polyglactin) in a continuous subcuticular technique, and remove non-absorbable sutures at 5-9 days depending on anatomic location if used instead.
Optimal Suture Material
Use 4-0 or 5-0 absorbable monofilament suture such as poliglecaprone (Monocryl) or polyglactin (Vicryl) for superficial laceration closure 1, 2.
These materials retain 50-75% of tensile strength after one week, providing adequate wound support during the critical healing phase 1.
Absorbable sutures eliminate the need for suture removal, reducing patient anxiety, discomfort, and follow-up visits 2, 3.
In facial lacerations specifically, 5-0 absorbable sutures produce cosmetic outcomes equivalent to non-absorbable materials while avoiding removal 2.
Preferred Suturing Technique
Employ continuous subcuticular suturing rather than interrupted transcutaneous sutures 4, 1, 5.
Continuous subcuticular technique reduces superficial wound dehiscence by approximately 8-fold (RR 0.08; 95% CI 0.02-0.35) compared to interrupted non-absorbable sutures 1, 5.
Surgical site infection rates are equivalent between continuous and interrupted techniques (RR 0.73; 95% CI 0.40-1.33), so infection risk does not favor either method 4, 1.
Place sutures in the subcuticular plane (beneath the epidermis) to optimize cosmetic results and minimize dehiscence 1.
Critical Technical Considerations
Avoid over-tightening the continuous suture, as excessive tension strangulates wound edges and negates the benefits of this technique 4, 1.
Simple interrupted sutures remain acceptable when continuous technique is not feasible, though they carry higher dehiscence risk 5, 6.
Do not add adhesive strips (steri-strips) over subcuticular sutures—they provide no additional benefit for infection prevention or wound outcomes 4, 1.
Suture Removal Timing (When Non-Absorbable Sutures Are Used)
If non-absorbable interrupted sutures are placed instead of absorbable subcuticular sutures, removal timing depends on anatomic location 4, 7:
- Face: 5 days
- Scalp: 7-10 days
- Trunk: 7-10 days
- Extremities: 10-14 days
- Joints (over extensor surfaces): 14 days
The evidence supporting these timeframes derives from expert opinion rather than controlled trials 7.
Alternative Closure Methods
Tissue adhesives (cyanoacrylate) are appropriate for low-tension linear lacerations and produce similar infection rates, patient satisfaction, and scarring compared to sutures 3, 7.
Staples may be considered for scalp lacerations where cosmesis is less critical 6.
Vertical or horizontal mattress sutures are associated with higher dehiscence rates and inferior cosmetic outcomes compared to subcuticular technique and should be reserved for specific high-tension situations 1.
Evidence Quality Note
The strong recommendation (Grade 1B) for continuous subcuticular absorbable sutures comes primarily from studies in pediatric appendectomy patients, introducing some uncertainty when extrapolating to traumatic lacerations in adults 1. However, facial plastic surgery studies in adults confirm equivalent or superior outcomes with absorbable materials 2, and the mechanical advantages of continuous subcuticular technique apply across wound types 4, 5.