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
![Laceration Repair, Suture,](https://i0.wp.com/foamed.ebmedicine.net/wp-content/uploads/2022/07/22C729C3-2F71-4E96-BBA4-7E0683BFF312.jpeg?resize=1024%2C397&ssl=1)
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
![Laceration Repair, Needle Anatomy,](https://i0.wp.com/foamed.ebmedicine.net/wp-content/uploads/2022/07/A7B09363-99BF-47F7-BDD6-9DA48D284EE6.jpeg?resize=1019%2C1024&ssl=1)
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 |
![Laceration Repair, The Laceration Course, EB Medicine](https://i0.wp.com/foamed.ebmedicine.net/wp-content/uploads/2022/07/E0C0108A-C663-4D8E-B0E7-1E082DABDCD4.png?resize=1024%2C536&ssl=1)
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