From the Guidelines
For lacerations on the forearm or forehead, 5-0 or 6-0 non-absorbable monofilament sutures such as nylon or polypropylene are recommended. The choice of suture material is based on the evidence that monofilament sutures are associated with a significantly lower risk of incisional hernia than multifilament sutures in both elective and emergency settings 1.
When considering the type of suturing, the following factors are important:
- The forearm generally requires 5-0 sutures with removal after 7-10 days
- The more cosmetically sensitive forehead area is better served with 6-0 sutures removed after 3-5 days
- Simple interrupted sutures are the standard technique for both locations
- Running subcuticular sutures may be preferred for forehead lacerations to minimize scarring
The choice of suture material and technique balances wound strength requirements with cosmetic outcomes. Monofilament sutures are preferred because they cause less tissue drag and inflammation compared to braided materials 1. For deeper lacerations, a layered closure may be necessary, using 4-0 or 5-0 absorbable sutures like polyglactin (Vicryl) for the dermis before closing the epidermis. Proper wound cleaning, debridement if needed, and consideration of tetanus prophylaxis are essential steps before suturing. Local anesthesia with 1% lidocaine with epinephrine (except for end arteries like fingers or toes) should be used for patient comfort during the procedure.
In terms of technique, the ‘small bite’ technique, which consists of a tissue stitch of approximately 5 mm from the median wound edges and a distance of approximately 5 mm from the other stitch, may be beneficial in reducing wound complications 1. However, more research is needed to confirm the effectiveness of this technique in emergency settings.
From the Research
Suturing for Lacerations on Forearm or Forehead
- The type of suture needed for lacerations on the forearm or forehead depends on various factors, including the size and depth of the wound, as well as the patient's overall health 2.
- For low-tension skin areas, tissue adhesives and wound adhesive strips can be used effectively 2.
- The use of nonsterile gloves during laceration repair does not increase the risk of wound infection compared with sterile gloves, and irrigation with potable tap water rather than sterile saline also does not increase the risk of wound infection 2.
- For closure techniques, simple interrupted sutures, simple running sutures, and vertical mattress sutures are commonly used, with nylon and polypropylene being the most commonly used superficial sutures 3.
- Absorbable sutures, such as polyglactin 910, can be used for subcuticular closure, and have been shown to not significantly increase the degree of inflammation in noncontaminated wounds 4.
Suture Materials and Techniques
- Modern suture materials should have predictable tensile strength, good handling, secure knot-tying properties, and could be enhanced with an antibacterial agent to resist infection 5.
- 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 5.
- Barbed sutures have transformed the way surgeons approximate wounds by eliminating knots, distributing wound tension, and increasing efficiency of closure 5.
- The selection of suture materials and techniques depends on the location and size of the wound, as well as the patient's overall health and the surgeon's experience 3.