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
Patrick O’Malley is an emergency physician and course director of The Laceration Course and The Abscess Course. Follow him bellow for more…
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