Most lacerations are uncomplicated and can be repaired primarily. Complications (dehiscence, infection, improper healing, scarring) can be minimized by proper suturing techniques, including good wound edge approximation and decreasing wound tension. Wound edge eversion is also essential for proper healing as the edge will flatten with time.
Management and Disposition
Suture techniques must be individualized depending on physician’s skill, laceration type, and location. Suture material, size, and duration before removal are determined by anatomic site (Table 18.2).
TABLE 18.2Suture Materials, Size, and Duration by Anatomic Site |Favorite Table|Download (.pdf) TABLE 18.2 Suture Materials, Size, and Duration by Anatomic Site
|Anatomic Site ||Skin ||Deep ||Duration |
|Scalp ||5-0, 4-0 monofilament ||4-0 absorbable ||6-8 days |
|Ear ||6-0 monofilament ||N/A ||4-5 days |
|Eyelid ||7-0, 6-0 monofilament ||N/A ||4-5 days |
|Eyebrow ||6-0, 5-0 monofilament ||5-0 absorbable ||4-5 days |
|Nose ||6-0 monofilament ||5-0 absorbable ||4-5 days |
|Lip ||6-0 monofilament ||5-0 absorbable ||4-5 days |
|Oral mucosa ||N/Aa ||5-0 absorbable ||N/A |
|Face/forehead ||6-0 monofilament ||5-0 absorbable ||4-5 days |
|Chest/abdomen ||5-0, 4-0 monofilament ||3-0 absorbable ||8-10 days |
|Back ||5-0, 4-0 monofilament ||3-0 absorbable ||12-14 days |
|Arm/leg ||5-0, 4-0 monofilament ||4-0 absorbable ||8-10 days |
|Hand ||5-0 monofilament ||5-0 absorbable ||8-10 daysb |
|Extensor tendon ||4-0 monofilament ||N/A ||N/A |
|Foot/sole ||4-0, 3-0 monofilament ||4-0 absorbable ||12-14 days |
Deep interrupted absorbable sutures are used, if necessary, to reduce wound tension before superficial repair. Start the deep suture from the bottom of the wound, continue across the top (subdermally), and return to the bottom in finishing. This will leave the knot at the bottom of the wound, decreasing the chance suture material will exit at the surface. Simple interrupted closures involve single nonabsorbable sutures, each independently tied. The needle should penetrate the skin at 90 degrees and exit the other side of the wound at 90 degrees. Staples are a rapid means of closing linear wounds. They should not be used on the hands, feet, face, or over joints. Wound edge eversion is also critical to obtain the best outcome.
Running closure is a rapid technique using several bites along the length of a wound without tying individual knots. Knots are tied only at the beginning and end.
Liquid wound adhesives (eg, cyanoacrylate) have advantages due to speed and lack of a repeat visit for suture removal. Anesthesia may not be required. Small linear lacerations are ideal. The wound must be dry and free of active bleeding for proper adhesion. Antibiotic ointment should not be applied as this will dissolve the adhesive, although elastic wound strips may be used on top for added closure tension.