Do absorbable sutures cause worse cosmetic outcomes?

Bottom Line Up Top: There is no difference in absorbable vs non-absorbable sutures for laceration repair for the face, trunk, and extremities for cosmesis or complication rates.

Clinical Scenario: An 8-year-old boy presents with his parents for evaluation of a linear forehead laceration after a fall on the slide at the playground. Based on your history and physical, you have no concern for a serious injury and his vaccinations are up to date. The laceration clearly needs a repair and you let the parents know that they’ll need to come back in 5 days to have the sutures taken out. Unfortunately, they tell you they’ll be traveling and won’t be able to come back. You contemplate your repair decision and ponder if you should use absorbable or non-absorbable sutures for repair?

What Your (chromic 🙂) Gut Says: Use the non-absorbable sutures. This is what a plastic surgeon may use and it’ll result in reduced scarring.

What The Evidence Says:

Bottom Line: Absorbable sutures appear to be a realistic option that appears to be non-inferior for laceration repairs. The use of absorbable sutures saves the patient from return visits for suture removal. This is particularly important in pediatric patients where removal can be challenging.It is important to realize that these studies exclude certain patient populations (e.g. DM, Immunosuppression) and also complicated wounds, such as lacerations with tendon, bone, or joint involvement. The majority of these studies were based in the Emergency Department, but this seems to cross specialties in the literature and Meta Analysis papers.

Bonus Pearls: The choice of the correct absorbable suture is important for your laceration repair, which can be chosen based on effective wound support time. Here are the absorbable sutures you would use on the skin that are most relevant to the Emergency Department:

Vicryl and Chromic Gut have effective wound support up to 3 weeks. This support time is too long to be useful in the ED for skin layer closure if you are electing for absorbable sutures.

Absorbable sutures should be best practice in several patient populations: those extremely difficult for suture removal, the elderly, patients unreliable to follow up, and those who are mobility challenged. Like other aspects of Emergency Medicine, shared decision making is important in the suture material decision.

Read More

Closing the Gap:

https://lacerationrepair.com/wound-blog/absorbable-sutures/

https://lacerationrepair.com/wound-blog/absorbable-sutures-revisited/

Related Topics:

Running vs Interrupted sutures: https://pubmed.ncbi.nlm.nih.gov/35715955/

Suture vs Tissue Adhesive: https://pubmed.ncbi.nlm.nih.gov/12574007/

References

Karounis H, Gouin S, Eisman H, Chalut D, Pelletier H, Williams B. A randomized, controlled trial comparing long-term cosmetic outcomes of traumatic pediatric lacerations repaired with absorbable plain gut versus nonabsorbable nylon sutures. Acad Emerg Med. 2004 Jul;11(7):730-5. doi: 10.1197/j.aem.2003.12.029. PMID: 15231459.

Luck R, Tredway T, Gerard J, Eyal D, Krug L, Flood R. Comparison of cosmetic outcomes of absorbable versus nonabsorbable sutures in pediatric facial lacerations. Pediatr Emerg Care. 2013 Jun;29(6):691-5. doi: 10.1097/PEC.0b013e3182948f26. PMID: 23714755.

Tejani C, Sivitz AB, Rosen MD, Nakanishi AK, Flood RG, Clott MA, Saccone PG, Luck RP. A comparison of cosmetic outcomes of lacerations on the extremities and trunk using absorbable versus nonabsorbable sutures. Acad Emerg Med. 2014 Jun;21(6):637-43. doi: 10.1111/acem.12387. PMID: 25039547. Xu B, Xu B, Wang L, Chen C, Yilmaz TU, Zheng W, He B. Absorbable Versus Nonabsorbable Sutures for Skin Closure: A Meta-analysis of Randomized Controlled Trials. Ann Plast Surg. 2016 May;76(5):598-606. doi: 10.1097/SAP.0000000000000418. PMID: 25643187.

Gillanders SL, Anderson S, Mellon L, Heskin L. A systematic review and meta-analysis: Do absorbable or non-absorbable suture materials differ in cosmetic outcomes in patients requiring primary closure of facial wounds? J Plast Reconstr Aesthet Surg. 2018 Dec;71(12):1682-1692. doi: 10.1016/j.bjps.2018.08.027. Epub 2018 Sep 14. PMID: 30268743.