Can you use absorbable sutures for pediatric lacerations?

10 Dec

pedslac1

Since we all know much children love needles and stitches, many pediatricians and EM physicians 
have been looking at ways to make lace
ration repair less painful.

Before we talk about the suture types, many physicians are using LET (lidocaine/epinephrine/tetracaine) gel (as we use prior to IV’s) for anesthesia to avoid an injection.  I have found this quite useful.  It takes ~ 20 minutes to work- you also do generally see blanching at the site.  It lasts up to 30-45 minutes after being wiped off for suturing.

 

There are numerous studies in the past 10 years suggesting absorbable sutures are at least equivalent to non-absorbable sutures for facial lacerations in children.  One of the more convincing studies I found is a study done by Karounis in 2004:

 

* Objective: Compare the long-term cosmetic outcome between absorbable and non-absorbable sutures in pediatric lacerations (not limited to the face).  They also looked at infection rate and dehiscence.

 

* Methods: RCT with 95 patients (1-18 years old) assigned to repair with plain gut (50 pts) or nylon (45 pts).   Wound evaluation scores (WES) assessed at 5-10 days by a nurse and then at 4-5 months by a plastic surgeon, who also assigned a visual analog scale (VAS)

 

pedslac2*ResultsSlight cosmetic improvement that is was not statistically significant in pts with plain gut (absorbable) repair.  This was seen in both the repeat WES and VAS.  No significant difference between infection rate or dehiscence rate (slightly lower in absorbable group but not statistically significant).

 

*Conclusion: This supports absorbable sutures being used for pediatric lacerations with good cosmetic outcomes without an increase in the rate of infection or dehiscence (both were slightly lower in the plain gut group).

 

Bottom Line: Using absorbable sutures in kids seems like a reasonable option.  On my pediatric EM rotation, we routinely used absorbable sutures for lacerations in kids- on the face and extremities (typically 5-0 to 6-0 fast gut on the face and 4-0 to 5-0 chromic gut on the body).

 

Submitted by H. Groth.

 

SourcesEvans, R et al. “Absorbable sutures in paediatric lacerations”. Emerg Med J, 2006 January; 23(1): 64-65.;  Luck, RP et al. “Cosmetic Outcomes of Absorbable Versus Nonabsorbable Sutures in Pediatric Facial Lacerations” Pediatric Emergency Care, 2008 March; 24(3); 137-142.; Karounis, H. et al. “A Randomized, Controlled Trial Comparing Long-Term Cosmetic Outcomes of Traumatic Pediatric Lacerations Repaired with Absorbable Plain Gut versus Nonabsorbable Nylon Suture” Academic Emergency Medicine, 2004 July; 11(7); 730-735.

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