Closure of minor skin wounds with sutures
- David deLemos, MD
David deLemos, MD
- Assistant Professor
- Baylor College of Medicine
- Section Editors
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Allan B Wolfson, MD
Allan B Wolfson, MD
- Section Editor — Adult Procedures
- Professor of Emergency Medicine
- University of Pittsburgh
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Laceration repair with sutures will be discussed here. Information concerning wound preparation and irrigation, topical and infiltrative anesthesia, and tissue adhesive and staples is found separately. (See "Minor wound preparation and irrigation" and "Topical anesthetics in children" and "Minor wound repair with tissue adhesives (cyanoacrylates)" and "Closure of minor skin wounds with staples".)
The basic principles of laceration repair have not changed significantly in the last century, but the therapeutic options now available are more innovative and rigorously studied. The development of topical anesthetics, tissue adhesives, and fast-absorbing sutures has made the management of lacerations less traumatic for the patient. In addition, the use of procedural sedation for difficult lacerations or for the extremely anxious child has made the experience more tolerable for the patient, family, and physician. The goals of wound management are simple: to avoid wound infection, assist in hemostasis, and to provide an esthetically pleasing scar . The majority of studies now are focusing on the esthetic nature of wound healing rather than infection rates, because infection rates remain low, regardless of management.
WOUND PHYSIOLOGY AND HEALING
The epidermis, dermis, subcutaneous layer, and deep fascia are the tissue layers of concern in wound closure :
●The epidermis and dermis are tightly adhered and clinically indistinguishable, and together constitute the skin. Dermal approximation provides the strength and alignment of skin closure.
●The subcutaneous layer is mainly comprised of adipose tissue. Nerve fibers, blood vessels, and hair follicles are located here. Although this layer provides little strength to the repair, sutures placed in the subcutaneous layer may decrease the tension of the wound and improve the cosmetic result.
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- WOUND PHYSIOLOGY AND HEALING
- WOUND ASSESSMENT
- WOUND PREPARATION
- SUTURE MATERIALS
- Absorbable sutures
- - Catgut
- - Polyglactin 910 (Vicryl)
- Vicryl Rapide
- - Poliglecaprone 25 (Monocryl)
- - Polyglycolic acid (Dexon)
- - Polydioxanone (PDS)
- - Polytrimethylene carbonate (Maxon)
- Nonabsorbable sutures
- SUTURE SELECTION
- SUTURING TECHNIQUES
- Percutaneous skin closure
- Dermal closure
- Alternative suture techniques
- - Running suture
- - Subcuticular running suture
- - Vertical mattress
- - Horizontal mattress
- SPECIFIC WOUND SITES
- GUIDELINES FOR SURGICAL CONSULTATION
- Dressing and bathing
- Prophylactic antibiotics
- Suture removal
- Follow-up visits
- UNIQUE PEDIATRIC CONSIDERATIONS
- Anxious parent
- Anxious and uncooperative patient
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS