By Adam Rhodes, MD
Edited by Nicholas Otts, MD
A Common Problem:
A 6-year-old male presents with a laceration on his face. He screams, “no stitches,” and requires intranasal versed for sedation for the laceration repair. Absorbable sutures would negate a difficult followup visit for suture removal. But what about the cosmetic outcome, the infection risk, and other complications such as dehiscence? Is there evidence to support the use of absorbable sutures versus non-absorbable sutures in this scenario?
A Small Dose of EBM:
The literature over the last decade strongly supports the use of absorbable sutures.
A randomized controlled trial of pediatric patients in 2004 (using a wound evaluation score and a validated visual analog scale during follow up visits) determined that there was no difference in cosmetic outcome, dehiscence, or infection (1).
A caveat - the study used plain gut, whereas most PEM providers use fast absorbing plain gut.
Thankfully, a study in 2008 utilized fast absorbing gut with similar control trial structure (also using a visual analogue scale as well as parents and three blinded observers). It found no difference in infection, wound dehiscence, keloid formation, and parental satisfaction. (2)
Further, a meta-analysis of randomized controlled trials compared outcomes of absorbable versus non-absorbable sutures for skin closure in 2016. They concluded that absorbable sutures for skin closure were not inferior and recommended they be considered due to lower cost and time saving benefits. (3)
1. Karounis H, et. al. A randomized controlled trial comparing long term cosmetic outcomes of traumatic pediatric lacerations repaired with absorbable plain gut versus non absorbable nylon sutures. Acad Emerg Med 2004 Jul;11(7):730-5.
2. Luck et. al. Cosmetic outcomes of absorbable versus non absorbable sutures in pediatric facial lacerations. Pediatric Emerg Care 2008 Mar;24(3):137-42.
3. Xu B. et. al. Absorbable versus Nonabsorbable Sutures for skin closure: A meta-analysis of randomized controlled trials. Ann Plastic Surgery 2016 May;76(5):598-606.