Absorbable sutures in pediatric lacerations.

Report By: Robert Evans - Resident Physician
Search checked by Jeff Jones - Research Director of the Emergency Medicine Residency Program
Institution: Grand Rapids MERC/MSU
Date Submitted: 7th April 2005
Date Completed: 6th January 2006
Last Modified: 9th November 2005
Status: Green (complete)

Three Part Question

In [pediatric patients with traumatic lacerations], does [the use of absorbable sutures compared to non-absorbable sutures] [increase the rates of complications and long term cosmesis]?

Clinical Scenario

A 10 year old male presents after a suffering a laceration on his lower leg from a snow skiing accident. It cannot be closed using glue. You would like to save the child the pain and discomfort of suture removal. You wonder if absorbable sutures would increase the rate of complications or scarring.

Search Strategy

Medline 1966-011/05 using the OVID interface
Cochrane Library database of systematic reviews (2005)
[(exp lacerations or laceration.mp) AND (exp sutures/or suture.mp) AND (exp treatment outcome/ OR exp cosmetic techniques/ OR exp wound infection/)]. LIMIT to human AND English AND "all child (0 to 18 years)"
Cochrane
[absorbable and suture]

Search Outcome

Medline
31 papers found of which 30 were irrelevant or of insufficient quality.
Cochrane
23 citations. No additional references found

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Karounis H et al. July 2004 USA	Pediatric patients with traumatic lacerations.	Prospective, randomized, controlled trial.	Short term cosmesis (as measured with percentage of patients with optimal wound score on 6-point scale)	Better for absorbable but not statistically significant (63% vs 49%. RR 0.73 (95%CI 0.45 - 1.17)	34% of patients were lost to long-term follow-up.
			Wound dehiscence	11% for non-absorbable vs. 2% for absorbable. p=0.07
			Cosmesis at 4 months (measured by plastic surgeon on 100mm VAS)	79mm for absorbable vs. 66 for non-absorbable
			Cosmesis at 4 months as measured by optimal score on 6 point scale	36% for absorbable vs. 28% for non absorbable RR 0.88 (95% CI 0.62 - 1.26)
			Surgical scar revision recommendation	3 patients were recommended for revision. 2 in the absorbable group. All declined revision.

Comment(s)

The use of absorbable sutures in children has the benefit of avoiding the emotional and physical trauma and cost of suture removal. The only prospective randomized controlled trial showed no difference in complication rate as well as cosmesis between absorbable sutures and non-absorbable sutures. However, too many patients were lost to long term follow up.

Clinical Bottom Line

Absorbable sutures appear to be as good as, and show a trend towards benefit, in paediatric laceration.

References

Karounis H, Gouin S, Eisman H, Chalut D, Pelletier H and Williams B. A Randomized, Controlled Trial Comparing Long-term Cosmetic Outcomes of Traumatic Pediatric Lacerations Repaired with Absorbable Plain Gut Versus Nonabsorbable Nylon Sutures Academic Emergency Medicine Journal July 2004; 730-735