Closure methods and suture selection are two of the primary decisions required before closing a laceration. In order to choose the correct method and suture, a few key elements need to be considered. Below are three resources from The Laceration Course, a new partnership with EB Medicine.
When to Use What
| Closure Type | Notes |
|---|---|
| Sutures | -More precise -Better tissue control -Time-consuming -Suture costs less than a reliable stapler |
| Staples | -Fast -Excellent hold -Similar scarring to sutures -Scalp -Large trunk and extremity wounds where cosmetic outcome is less concerning; discuss with patient for shared decision-making -Must have high-quality stapler |
| Dermabond | -Can be used more than we think -Wound must be dry, not oozing -Careful around eyes; use erythromycin ointment to remove if gets in eyes |
| Steri-strips | -Must have benzoin -Low-tension wounds -Good for skin tears -Can combine with dermabond or sutures for extra strength |
Suture Types
| Suture | Use |
|---|---|
| Prolene or Ethilon | -Everywhere except inside the mouth |
| Vicryl (standard and rapide) | -Absorbable -Under the skin-layered closure -Some advocate for children’s face if can not return for removal |
| Chromic gut | -Inside the mouth -Wet mucosa of the lip |
| Fast absorbing gut | -Facial lacerations |
Needle Type
| Needle | Use |
|---|---|
| Small needle (13mm) | -Face -Fingers -Small lacerations -Finer work |
| Large needle (24mm) | -Extremities -Trunk -Larger lacerations -More “bite” |
| Reverse cutting (cutting edge on outside; convex surface) | -Tougher tissues -Less risk of cutting through tissue |
| Regular cutting (cutting edge on all three sides) | -Most commonly used in acute setting |
We’re excited to announce that we’ve partnered with Dr. Patrick O’Malley, creator of The Laceration Course, to bring this high-impact course to practitioners who want to perfect their clinical skills. To celebrate the partnership, we’re offering 25% off The Laceration Course. Simply visit https://www.thelacerationcourse.com/ and use code TLC25 to save (discount expires July 31st!). We look forward to bringing you even more high-quality content, allowing you to take better care of your patients!
Last Updated on January 25, 2023
