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Get recommendations for wound closure, suture selection, and removal timing based on location and wound characteristics
Time since injury affects infection risk and closure decision
Most common. Avoid epi in fingers, toes, nose, ears, penis (end-arteries)
For end-artery locations or if vasospasm concerns
For small facial lacs in children (lidocaine-epinephrine-tetracaine)
| Location | Suture Size | Suture Type | Removal Time |
|---|---|---|---|
| Face | 5-0, 6-0 | Nylon, Prolene | 3-5 days |
| Scalp | 3-0, 4-0 or staples | Nylon or staples | 7-10 days |
| Trunk | 3-0, 4-0 | Nylon | 7-10 days |
| Upper extremity | 4-0 | Nylon | 7-10 days |
| Lower extremity | 3-0, 4-0 | Nylon | 10-14 days |
| Hand | 4-0, 5-0 | Nylon | 10-14 days |
| Over joint | 3-0, 4-0 | Nylon | 10-14 days (splint) |
| Location | Clean Wound | Contaminated Wound | Rationale |
|---|---|---|---|
| Face | Up to 24 hours | Up to 12 hours | Excellent blood supply, cosmetic priority |
| Scalp | Up to 18 hours | Up to 8 hours | Very vascular, good healing |
| Trunk/Extremity | Up to 12 hours | Up to 6 hours | Standard infection risk |
| Hand/Foot | Up to 12 hours | Up to 6 hours | Function critical, infection risk higher |
Note: These are general guidelines. Clinical judgment should consider wound characteristics, patient factors (diabetes, immunosuppression), and mechanism of injury.
Avoid primary closure for: wounds presenting beyond time limits, heavily contaminated wounds (animal bites, soil contamination), wounds with significant tissue loss or crush injury, puncture wounds, or wounds with signs of infection. These wounds should heal by secondary intention or delayed primary closure after adequate wound care.
Absorbable sutures (Vicryl, Monocryl) dissolve over time and are used for deep layers or in areas where removal is difficult (e.g., mouth, pediatric patients). Non-absorbable sutures (nylon, prolene, silk) must be removed but provide better cosmetic results for skin closure and are standard for most external lacerations.
Tissue adhesive (Dermabond) is appropriate for: clean, linear lacerations <5cm, low-tension areas, facial lacerations in children, wounds where suture removal might be difficult. Avoid adhesive for: jagged wounds, high-tension areas, over joints, hairy areas, or contaminated wounds. It provides similar cosmetic results to sutures for appropriate wounds.
The face has excellent blood supply, allowing faster healing. Early removal (3-5 days) minimizes scarring from suture tracks. Leaving sutures in too long on the face can cause permanent "railroad track" marks. Other areas with less blood supply need longer healing time (7-14 days) before sutures can be safely removed.
Signs of infection include: increasing redness extending beyond the wound, warmth, swelling, pus or cloudy drainage, increasing pain (especially after initial improvement), red streaks extending from wound, fever, or foul odor. Most wound infections develop 2-5 days after injury. Seek medical attention if any of these develop.
Consider specialist referral for: complex facial lacerations (plastic surgery), lacerations involving tendons, nerves, or vessels (hand surgery/vascular), intraoral lacerations through-and-through (oral surgery), eyelid margin or lacrimal duct involvement (ophthalmology), extensive crush injuries, or wounds requiring complex reconstruction. When in doubt, consult early.
This laceration repair calculator provides general guidance for simple lacerations. Complex wounds, wounds involving deeper structures (tendons, nerves, vessels), wounds in cosmetically sensitive areas, or wounds in high-risk patients may require specialist consultation. Always assess neurovascular status, tendon function, and consider X-ray for foreign bodies. Proper wound preparation, technique, and follow-up are essential for optimal outcomes. This tool does not replace clinical judgment or formal training in wound management.