SUTURES


GENERAL GUIDELINES

Site

Skin

Deep

Days to Removal

Scalp

4-0, 5-0

3-0, 4-0

5-8

Ear

6-0

--

5-7

Eyelid

6-0, 7-0

--

5-7

Eyebrow

5-0, 6-0

5-0

5-7

Nose, Lip

6-0

5-0

5-7

Oral Mucosa

--

5-0

--

Face, Forehead

6-0

5-0

3-5

Chest, Abdomen

4-0, 5-0

3-0

8-10

Back

4-0, 5-0

3-0

12-14

Extremities

4-0, 5-0

4-0

8-10

Extensor Joint

3-0, 4-0

--

10-14

Flexor Joint

4-0, 5-0

--

8-10

Hand

5-0

5-0

8-10

Extensor Tendon

4-0

--

--

Foot

3-0, 4-0

4-0

12-14

Vagina

--

4-0

--

Scrotum (Absorbable)

--

5-0

7

Penis

5-0


--

 

Suturing Guideline for Face & Scalp

Area Suture Size Anesthetic Removal
Scalp
  Galea Absorbable 4-0 Local Not removed
  Skin Staples Standard Local 10 d
Nonabsorbable monofilament 4-0 Local 10 d
Rapidly absorbing 4-0 Local Not removed
Forehead        
  Frontalis muscle Absorbable 4-0 Local or supraorbital Not removed
  Skin Nonabsorbable monofilament 5-0 or 6-0 Local or supraorbital 5 d
Tissue adhesive May need deep layer Not removed
Cheek and face
  Muscle or subcutaneous Absorbable 4-0 Local or infraorbital Not removed
  Skin Nonabsorbable monofilament 6-0 Local or infraorbital 5 d
Tissue adhesive May need deep layer Not removed
Eyelids
  Skin Nonabsorbable monofilament 6-0 or 7-0 Supra- or infraorbital 3 d
Nose
  Mucosa Rapidly absorbing 4-0 Intranasal pack Not removed
  Cartilage Absorbable 5-0 Intranasal pack Not removed
  Skin Nonabsorbable monofilament 6-0 Intranasal pack 3–5 d
Ears
  Skin Nonabsorbable monofilament 6-0 Auricular block 5 days
Lips
  Mucosa Rapidly absorbing 5-0 Local, infraorbital, or mental Not removed
  Muscle Absorbable 4-0 or 5-0 Local, infraorbital, or mental Not removed
  Skin Nonabsorbable monofilament 6-0 Local, infraorbital, or mental 3–5 d

SUTURE CHARACTERISTICS

Nonabsorbable Suture Characteristics
Suture Structure Raw Material Tensile Strength Retention In Vivo Tissue Reactivity Common ED Uses
Silk Braided Organic protein called fibroin  Degradation of fiber results in loss of strength over many months Significant inflammatory reaction Intraoral mucosal surfaces for comfort
Nylon (Ethilon®, Dermalon®)
 
Monofilament Polyamide polymer Hydrolysis results in loss of strength over years Minimal Soft tissue and skin reapproximation
Polypropylene (Prolene®, Surgipro®)
 
Monofilament Polypropylene polymer No degradation or weakening Least Soft tissue and skin reapproximation
Polyester (Mersilene®, Ticron®)
 
Braided and monofilament Polyethylene terephthalate No degradation or weakening Minimal Tendon repair using undyed (white) color
Polybutester (Novafil®)
 
Monofilament Poly (butylene) and poly (tetramethylene ether) glycol terephthalate No degradation or weakening Minimal Soft tissue approximation
Absorbable Sutures
  Types Material Tensile Strength Retention In Vivo Absorption Rate Tissue Reactivity Common ED Uses
Surgical gut Plain Collagen derived from bovine intestine Retains 50% tensile strength for 5–7 d Absorbed by proteolytic processes in weeks Moderate reactivity Rarely, for intraoral wounds
Chromic gut Chromium coating Collagen derived from bovine intestine Retains 50% tensile strength for 10–14 d Absorbed by proteolytic processes in weeks Moderate reactivity Rarely, for subcutaneous closures and intraoral wounds
Polyglycolic acid (Dexon®)
 
Braided Polymer of glycolic acid Retains 65% tensile strength at 2 wk, 35% at 3 wk Completely absorbed by slow hydrolysis by 60–90 d Minimal Approximation of deep soft tissue structures (i.e., dermis) and ligation of vessels
Polyglactin 910 (Vicryl®)
[4-0]
Braided Copolymer of lactide and glycolide coated with polyglactin 370 and calcium stearate Retains 65% tensile strength at 2 wk, 40% at 3 wk Completely absorbed by slow hydrolysis by 56–70 d Minimal Approximation of deep soft tissue structures, (i.e., dermis) and ligation of vessels
Polyglactin 910 (Vicryl PLUS®)
 
Braided Copolymer of lactide and glycolide coated with polyglactin 370 and calcium stearate; incorporates antibacterial agent Triclosan Retains 65% tensile strength at 2 wk, 40% at 3 wk Completely absorbed by slow hydrolysis by 56–70 d Minimal Approximation of deep soft tissue structures, (i.e., dermis) for ligation; especially useful in contaminated wounds
Polyglactin 910 (Vicryl Rapide®)
 
Braided Copolymer of glycolide and lactide coated with polyglactin 370 and calcium stearate Retains 50% tensile strength for 5 d; all lost by 2 wk Absorbed by hydrolysis; usually complete by 42 d Minimal to moderate Skin approximation when absorbable sutures used
Polyglactin 910 (Lactomer®)
 
Braided Copolymer of glycolide and lactide coated with caprolactone and glycolide Retains 40% tensile strength for 3 wk Absorbed by hydrolysis; usually complete by 56–70 d Minimal Subcutaneous soft tissue approximation
Polydioxanone (PDS II®)
 
Monofilament Polyester polymer Retain 50% tensile strength for 4 wk; 25% for 6 wk Minimal until 90 d; complete by 6 mo Slight Subcutaneous soft tissue approximation where more prolonged strength is needed
Poliglecaprone 25 (Monocryl®)
 
Monofilament Copolymer of glycolide and epsilon-caprolactine Retains 60% tensile strength for 1 wk; 30% at 2 wk Absorbed by hydrolysis within 3–4 mo Minimal Subcutaneous soft tissue approximation
Poliglecaprone 25 (Monocryl PLUS®)
 
Monofilament Copolymer of glycolide and epsilon-caprolactine; incorporates antibacterial agent Triclosan Retains 60% tensile strength for 1 wk; 30% at 2 wk Absorbed by hydrolysis within 3–4 mo Minimal Subcutaneous soft tissue approximation; especially in contaminated wounds
Glycomer 631 Monofilament Tetrapolymer of glycolide, trimethylene carbonate, anddioxanone Retains 70% tensile strength at 28 d; 13% at 56 d Complete by 90–110 d Slight Subcutaneous soft tissue approximation where more prolonged strength is needed
Lactide glycolide (Panacryl®)
 
Braided Copolymer of lactide and glycolide Retains 80% tensile strength at 3 mo, 60% at 6 mo, 20% at 1 y Complete within 1.5–2.5 y Minimal Subcutaneous soft tissue approximation (e.g., fascia) where more prolonged strength is needed, excellent handling
Polyglyconate (Maxon®)
 
Monofilament Polyglyconate polymer Retains 70% tensile strength at 28 d; 13% at 56 d Complete by 90–110 d Slight Subcutaneous soft tissue approximation where more prolonged strength is needed

 
Recommended Suture Size Based on Laceration Location
Location Suture Size
Scalp 4-0 Nylon or polypropylene
Face 6-0 Polypropylene or nylon
Trunk 4-0 Nylon
Extremities 4-0 Nylon
Digits 5-0 Polypropylene or nylon