Absorbable Suture vs Nylon in Pediatric Lacerations

October 14, 2017

Spoon Feed
There was no difference in cosmetic outcome with use of absorbable vs. nonabsorbable suture for pediatric lacerations, though there was a nonsignificant trend to absorbable being superior.  There was also no difference in dehiscence or infection rate between the two.

Why does this matter?
Putting in sutures may be frightening for kids.  If they must return for suture removal, this can be just as frightening.  Absorbable sutures have the advantage of not requiring removal but may have risk of causing an inflammatory reaction to the suture material.  It was thought that nonabsorbable material might illicit less tissue reaction and less subsequent scarring.  This RCT was done to help decide which was better.

“I promise, they don’t hurt to take out,” he says as the child wails…
This was a small RCT of pediatric patients with lacerations requiring suture repair.  They enrolled 95 patients to have either 5-0 or 6-0 absorbable or nonabsorbable sutures on the face or 4-0 or 5-0 in other areas. Complicated wounds, such as bites, were excluded. They found that for the primary outcome, a measure of cosmesis at 5-10 days (with a study nurse) and 4 months (with a plastic surgeon blinded to suture material), that there was no statistical difference between the absorbable and nonabsorbable suture groups.  There was a nonsignificant trend toward improved cosmetic outcome in the absorbable suture group at both short and long-term follow up.  Also, there was no difference in wound dehiscence or infection between the groups.  A large number of patients were lost to long-term follow up, which may have changed the overall outcome of the study either positively or negatively and had the effect of making it underpowered for the long-term outcome measure. It seems likely that absorbable sutures were at least not inferior to nonabsorbable.

Source
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.

Another Spoonful
BestBETs has this critical appraisal.