II. Background: Suture Characteristics
- Tensile Strength
- Related to Suture size (see below)
- Related to weight required to break a Suture
- Knot strength
- Force required for a knot to slip
- Configuration
- Monofilament (less risk of infection)
- Braided multifilament (easier to handle and tie)
- Elasticity
- Degree Suture stretches and return to original length
- Memory or Suture stiffness
- High memory: Suture stiff, difficult handling, unties
- Tissue reactivity (inflammatory response to Suture)
- Reaction peaks in first 2 to 7 days
III. Background: Needles
- Curvature
- Straight needle
- Curved 2/8 of circle
- Curved 3/8 of circle (preferred needle in most cases)
- Curved 4/8 of circle
- Curved 5/8 of circle
- Needle Tip
- Tapered (used in vascular Sutures)
- Conventional cutting needle
- Reverse cutting needle (preferred in most cases)
- Sharp edge is on the outside of the needle's U-shape
IV. Background: Suture types recommended for skin closure
- Deep (dermal or buried) Absorbable Sutures
- Braided (do not use if increased risk of infection)
- Polyglactic Acid Suture or Polyglactin-910 (Vicryl, Dexon, Surgicryl, Polysorb)
- Vicryl is most commonly used for the deep layer, unless risk of infection (in which case use monofilament)
- Non-braided (monofilament)
- Polyglecaprone 25 (Monocryl)
- Indicated for the deep layer, when wounds are higher risk of infection, and Vicryl is contraindicated
- Polydioxanone (PDS)
- May be used as an alternative to Monocryl when higher risk of infection, but has a prolonged absorption period
- Polyglecaprone 25 (Monocryl)
- Braided (do not use if increased risk of infection)
- Superficial Sutures
- Nonabsorbable Sutures (standard approach)
- Absorbable Sutures
- Controversial, but used effectively, and with similar cosmetic results in children to avoid Suture removal
- Facial Lacerations: Fast Catgut
- Trunk or extremity Lacerations: Plain Catgut or Vicryl Rapide
V. Background: Suture Size (See Suture types above)
-
General
- Superficial facial lesions: 6-0 nylon
- Other superficial skin lesions
- Low skin tension areas: 5-0 nylon
- Higher skin tension areas: 4-0 nylon
- Annotation for Suture size indications below
- Skin: Superficial monofilament Nonabsorbable Suture
- Deep: Dermal Absorbable Sutures
- Size O: Largest Suture
- Size 2-O
- Size 3-O
- Size 4-O
- Size 5-O
- Size 6-O
- Skin: Ear, Lid, Brow, Nose, Lip, Face, Penis
- Size 7-O: Smallest Suture
- Skin: Eyelid, Lip, Face
VI. Background: Suture indications by location (see Suture types above)
- Mucosal Lacerations (mouth, Tongue or genitalia)
- Absorbable Suture: 3-0 or 4-0
- Scalp, Torso (chest, back, Abdomen), Extremities
- Superficial Nonabsorbable Suture: 4-O or 5-O
- Deep Absorbable Suture: 3-O or 4-O
- Face, Eyebrow, Nose, Lip
- Superficial Nonabsorbable Suture: 6-O
- Deep Absorbable Suture: 5-O
- Ear, Eyelid
- Superficial Nonabsorbable Suture: 6-O
- Hand
- Superficial Nonabsorbable Suture: 5-O
- Deep Absorbable Suture: 5-O
-
Foot or sole
- Superficial Nonabsorbable Suture: 3-O or 4-O
- Deep Absorbable Suture: 4-O
-
Penis
- Superficial Nonabsorbable Suture: 5-O or 6-O
VII. Background: Suture Removal Timing
- Scalp: 10 days
- Face, Ear, Eyebrow, Nose, Lip: 5 days
- Follow with papertape or steristrips
- Eyelid: 3 days
- Chest and Abdomen: 8-10 days
- Back: 12-14 days (10-12 days in children)
- Extremities: 10-14 days (8-10 days in children)
- Hand: 10-14 days
- Foot and sole: 12-14 days (8-10 days in children)
- Penis: 8-10 days
- Condition delaying Wound Healing: 14 to 21 days
- Chronic Corticosteroid use
- Diabetes Mellitus
VIII. References
- Epperson in Pfenninger and Fowler (1994) Procedures for Primary Care Physicians, Mosby, Chicago, p. 3-11
- Lin and Lin in Herbert (2014) EM:Rap 14(11): 8-10
- Mortiere (1996) Principles of Primary Wound Management
- Townsend (2001) Sabiston Textbook Surgery, p. 1552-3
- Howell (1997) Emerg Med Clin North Am 15(2):417-25 [PubMed]
- Moy (1991) Am Fam Physician 44(6):2123-8 [PubMed]