Pediatric emergency medicine trisk 3378 3378

Type of Suture/Equipment. Suture material must have adequate strength while
producing minimal inflammatory reaction. Nonabsorbable sutures such as
monofilament nylon (Ethilon) or polypropylene (Prolene) retain most of their
tensile strength for more than 60 days and are relatively nonreactive. Thus, they
are appropriate for closing the outermost layer of a laceration. With nylon, it is
important to secure the knot adequately with at least four to five throws per knot.
Polypropylene is useful for lacerations in the scalp or eyebrows because it has a
blue color that is more visible and thus easier to remove, although it has memory
and therefore is somewhat more difficult to control while suturing. Silk is rarely
used because of increased tissue reactions and infection.
Absorbable sutures are also used in some wounds. Absorbable synthetic
sutures such as Dexon, Monocryl, or Vicryl should be used in deeper,
subcuticular layers. These materials may elicit an inflammatory response and may
extrude from the skin before they are absorbed, if they are placed too close to the
skin. When subcuticular sutures are used, they should be placed on the deeper
surface of the dermis, and epithelial margins may be approximated with either
tape strips or cuticular sutures. Synthetic absorbable sutures are less reactive than
chromic gut and retain their tensile strength for long periods, making them useful
in areas with high dynamic and static tensions. Absorbable sutures are also
advantageous for intraoral lacerations. Some recommend using rapidly
absorbable sutures (e.g., fast-absorbing gut or Vircyl rapide ) for skin closure of
facial wounds in children to avoid the need for subsequent suture removal.
Equally acceptable cosmetic results are found with absorbable sutures compared
with nonabsorbable sutures in pediatric facial laceration repair. Some hand
specialists also advocate for absorbable sutures for hand lacerations in young
children since removing them can be quite difficult in uncooperative young
patients.
A 3-0 suture is recommended for tissues with strong tension, such as fascia,
and 4-0 is recommended for deep tissues with light tension, such as subcutaneous
tissue. Skin is best closed with 4-0 to 7-0 and oral mucosa with 3-0 to 4-0 sutures.
The emergency provider should use the finest sutures (6-0) for wounds of the

face; heavier sutures for scalp, trunk, and extremities (4-0 or 5-0); and 3-0 or 4-0
for thick skin, such as the sole of the foot, or over large joints, such as the knee.
Needles are available in various forms, including cuticular, plastics, and
“reverse cutting.” The reverse cutting needle is used most for laceration repair. Its
outer edge is sharp to allow for atraumatic passage of the needle through the
relatively tough dermal and epidermal layers; this minimizes cutting of the skin
where suture tension is the greatest. A higher-grade plastic needle (designated P