Abstract
A short cut review was carried out to establish whether absorbable sutures offered any benefits over non‐absorbable sutures in the treatment of childhood facial lacerations. A total of 31 papers were found, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of this best paper are tabulated. We conclude that absorbable sutures appear to be as good as, and show a trend towards benefit in the treatment of paediatric lacerations.
Three part question
In [paediatric patients with traumatic lacerations], does [the use of absorbable sutures compared with non‐absorbable sutures] [increase the rates of complications and long term cosmesis]?
Clinical scenario
A 10 year old boy 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–November 2005 using the OVID interface; Cochrane Library, 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 Database of Systematic Reviews: [Suture and absorbable]
Search outcome
Medline: 31 papers found of which 30 were irrelevant or of insufficient quality (see table 3 for the single best paper). Cochrane: 23 papers found, no new additional references found.
Table 3.
| Author, date, and country | Patient group | Study type (level of evidence) | Outcomes | Key results | Study weakness |
|---|---|---|---|---|---|
| Karounis H et al, 2004, USA | Paediatric patients with traumatic lacerations | Prospective, randomised, 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% v 49%); RR 0.73, 95% CI 0.45 to 1.17 | 34% of patients were lost to long term follow up. |
| Wound dehiscence | 11% for non‐absorbable v 2% for absorbable, p = 0.07 | ||||
| Cosmesis at 4 months (measured by plastic surgeon on 100 mm VAS) | 79 mm for absorbable v 66 for non‐absorbable | ||||
| Cosmesis at 4 months as measured by optimal score on 6‐point scale | 36% for absorbable v 28% for non absorbable; RR 0.88, 95% CI 0.62 to 1.26 | ||||
| Surgical scar revision recommendation | 3 patients were recommended for revision: 2 were 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 randomised controlled trial showed no difference between absorbable sutures and non‐absorbable sutures in the rate of complications as well as cosmesis. 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.