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Chapter 42. Lacerations: Suturing

Russell Horowitz, MD

  • • Improve cosmesis.

    • Reduce infection.

    • Restore function.

  • • Wounds on the trunk and torso that are greater than 12 hours old.

    • Wounds on the face that are greater than 24 hours old.

    • Puncture wounds.

    • Heavily contaminated wounds.

    • Bites, especially in areas of limited blood flow.

  • • Sterile gauze.

    • Sterile towels, drapes, and gloves.

    • Saline.

    • Sterile basin.

    • Detergent cleanser (Sur-Cleans) or povidone-iodine solution.

    • Suture material (Tables 42–1 and 42–2).

    • 30–60-mL syringe for irrigation (splash adapter optional).

    • Syringe with fine needle (25–30 gauge) for local analgesia infusion.

    • Suture scissors.

    • Needle holders.

    • Forceps with teeth.

    • Local anesthetic.

Table 42–1. Surface wound closure guidelines.
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Table 42–1. Surface wound closure guidelines.
SiteSuture MaterialSuture Removal
Face6-0 absorbing or nonabsorbing5 days
Scalp5-0 nonabsorbing7–10 days
Digits5-0 nonabsorbing7–10 days
Palms/soles2-0, 3-0, 4-0 nonabsorbing7–10 days
Torso4-0, 5-0 nonabsorbing7–10 days
Joint3-0, 4-0, 5-0 nonabsorbing10–14 days
Table 42–2. Suture material.
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Table 42–2. Suture material.
NameMaterialReactivityStrengthAbsorption and Characteristics
Absorbable
GutMonofilamentSevereGood7–10 days
Fast absorbing gutMonofilament heat treatedModerateGood5–7 days
Chromic gutMonofilament chemically treatedSevereGood10–14 days
Polyglycolic acid (Dexon)BraidedMildVery good60–90 days
Polyglactin 910 (Vicryl)BraidedMildVery good55–70 days
Polyglecaprone (Monocryl)MonofilamentMinimalVery good90–120 days
Nonabsorbable
SilkBraidedSevereGoodEasy to handle; ties well
Nylon (Ethilon, Dermalon)MonofilamentMildVery goodSlippery; requires many knots
Polypropylene (Prolene)MonofilamentMinimalExcellentSlippery; requires many knots

  • • Infection.

    • Stitch extrusion.

  • • Suturing requires a calm and unhurried approach.

    • The practitioner should be comfortable, since preparation and closure of even small lacerations in children may require more time than initially expected.

    • Determine the circumstances and mechanism of injury (eg, blunt or sharp) and risk of contaminants or retained foreign body.

    • Obtain past medical history (including allergies, status of tetanus immunization, medication use, and chronic diseases), since specific medications, such as corticosteroids, and conditions, such as diabetes, delay wound healing.

  • • The patient should be lying flat or sitting.

Figure 42–1.
image
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Diagram of skin laceration.

  • • Use universal precautions.

    • Document laceration length and depth.

    • Assess neurovascular status and investigate for tendon, muscle, or vascular injury.

    • Lidocaine is the most commonly used anesthetic for simple wound repair.

    • • Epinephrine may be added to reduce local bleeding but is contraindicated in end organs (eg, penis, toes, fingers, nose, pinnae).

      • Sodium bicarbonate can be combined with lidocaine to reduce pain associated with infusion.

    • When ...

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