Absorbable sutures appear clinically effective and may be more cost-effective than non-absorbable sutures for definitive closure of adult facial lacerations.
Date First Published:
February 4, 2026
Last Updated:
February 4, 2026
Report by:
Mairead Kelly, Specialised Foundation Doctor (Northern Care Alliance NHS Trust)
Search checked by:
Dan Horner, Consultant in Emergency and Critical Care Medicine
Three-Part Question:
In adult patients sustaining a facial laceration requiring closure with sutures does closure with absorbable sutures, compared to non-absorbable sutures improve clinical and/or cost effectiveness outcomes
Clinical Scenario:
A 35 year-old woman attends the ED with a significant laceration to her face that requires closure with sutures. She is travelling at present with plans to fly to Asia in the next few days, has no registered GP and is uncertain of how she can be followed up over the next few weeks. You prepare to close her laceration with 6-0 non-absorbable interrupted sutures as you have been previously taught that this method provides optimal conditions for wound healing and reduces the risk of complications. As you are gathering equipment, your supervising consultant asks whether she could get a similar result from absorbable sutures, saving her the need for further downstream healthcare resource use. You ask the patient to wait for 5 minutes while you grab a coffee and consult the evidence supporting this option.
Search Strategy:
MEDLINE and Embase from January 2010 to 6th January 2026 (restricted to age 18 years or older), Cochrane library (2026)
Search Details:
[(fac* N3 lacerat*) OR (fac* N3 tear*) OR (fac* N3 wound*) OR (fac* N3 incis*) OR (“facial injuries” (MeSH))] AND [(resorb* N3 sutur*) OR (absorb* N3 sutur*) OR (dissolve* N3 sutur*) OR (dissolve* N3 sutur*) OR (resorb* N3 stitch*) OR (absorb* N3 stitch*) OR (dissolve* N3 stitch*) OR (dissolve* N3 stitch*) OR “biodegradable polymer” OR (“sutures” (MeSH))]
OR
[(fac* N3 lacerat*) OR (fac* N3 tear*) OR (fac* N3 wound*) OR (fac* N3 incis*) OR (“facial injuries” (MeSH))] AND [(non?resorb* N3 sutur*) OR (non?absorb* N3 sutur*) OR “permanent suture” OR “nylon suture” OR “silk suture” OR “polypropylene suture” OR (non?resorb* N3 stitch*) OR (non?absorb* N3 stitch*) OR (un?absorb* N3 stitch*) OR “permanent stitch” OR “nylon stitch” OR “silk stitch” OR “polypropylene stitch” OR (“sutures” (MeSH))]
AND
“randomi?ed controlled trial” OR (“randomized controlled trial” (MeSH))
OR
[(fac* N3 lacerat*) OR (fac* N3 tear*) OR (fac* N3 wound*) OR (fac* N3 incis*) OR (“facial injuries” (MeSH))] AND [(non?resorb* N3 sutur*) OR (non?absorb* N3 sutur*) OR “permanent suture” OR “nylon suture” OR “silk suture” OR “polypropylene suture” OR (non?resorb* N3 stitch*) OR (non?absorb* N3 stitch*) OR (un?absorb* N3 stitch*) OR “permanent stitch” OR “nylon stitch” OR “silk stitch” OR “polypropylene stitch” OR (“sutures” (MeSH))]
AND
“randomi?ed controlled trial” OR (“randomized controlled trial” (MeSH))
Outcome:
270 articles were returned and screened by abstract. The full text of 6 papers were retrieved for detailed evaluation. We identified a recent systematic review including nine studies between 2003-2020, and a subsequent large UK randomised controlled trial reported in 2024. Of the remaining 4 full text articles, two were excluded as on full review they did not directly address the three-part question, one was excluded as pertaining to wounds from cosmetic surgical procedures only and a final paper was excluded as the results already featured within the identified systematic review.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Randomised controlled trial of resorbable versus non- resorbable sutures for lacerations of the face (TORN Face) Basyuni et al 1 September 2024 UK | 200 patients aged > 18 years attending the emergency department with facial lacerations, presenting to a single unit over a 16-month period | Single-centre, assessor-blinded, randomised controlled trial comparing wound closure using resorbable (Vicryl Rapide) and non-resorbable (Ethilon) sutures, with size 5-0 for skin closure. | Aesthetic outcome post-closure using Visual Analogue Scale (VAS) at 6 months. | VAS higher at 85.12 with resorbable sutures, compared to 82.94 with non-resorbable (p=0.213). No risk comparison reported. | Single-centre study with modest sample size, limiting generalisability. Minimal description of practitioner grade and surgically (OMFS) led trial, impacting generalisability to wound closure by emergency physicians Follow-up period of 6 months may not be sufficient to determine optimal scar outcome Designed as superiority trial, but key outcomes reported as non-inferior. |
| Patient-reported outcomes using Patient Scar Assessment Questionnaire (PSAQ). | Median PSAQ score of 11 [IQR 9 to 15] in both resorbable and non-resorbable groups (p=0.66). The majority of patients in both groups expressed satisfaction at the trial endpoint, with 94.3% reporting very satisfied or satisfied across 9 domains. | ||||
| Hamilton scar scale. | Median score of 1 in both groups, with similar IQR values and p=0.21. | ||||
| Preliminary cost analysis. | £277 per case episode for the resorbable group, compared to an estimate of £1479 for the non-resorbable group. | ||||
| Absorbable versus Nonabsorbable Sutures for Facial Skin Closure: A Systematic Review and Meta-analysis of Clinical and Aesthetic Outcomes. Malhotra et al. 19 June 2024 | A total of 804 patients requiring facial wound closure where 50.1% received absorbable sutures, and 49.9% non-absorbable. Mixture of adult/paediatric studies and one study focussed on a cosmetic procedure. | Systematic review and meta-analysis of 9 randomised controlled trials, with 8/9 deemed to be at overall low risk of bias. | Cosmetic VAS | No significant difference between absorbable and non-absorbable sutures on the cosmetic VAS (mean difference 1.06, 95% CI -4.09 to 6.22, p = 0.12). | Heterogenous population, suture materials and follow up. Included one aesthetic study following a surgical procedure. Limited statistical power and risk of type 2 error in results given superiority design across trials and small sample size across several outcome measurements. I2 value of 45% for cosmetic VAS comparison, suggesting heterogeneity of results. |
| Wound dehiscence | No significant difference was found between suture types in terms of wound dehiscence (Risk Ratio 0.32, 95% CI 0.09 to 1.15, p=0.08). Direction of effect favoured absorbable sutures. | ||||
| Surgical site infection | No significant difference was found between suture types in terms of surgical site infection (Risk Ratio 0.68, 95% CI 0.21 to 2.22, p=0.52). Direction of effect favoured absorbable sutures. |
Author Commentary:
Non-absorbable sutures have traditionally been recommended for closure of facial lacerations where an optimal aesthetic result is required. This approach has been predicated on assertions of superior tensile strength, lower inflammatory response and precise closure ensuring best possible cosmesis. However, non-absorbable sutures require further healthcare interactions for review and removal, which can sometimes induce anxiety or require advanced procedures in young or vulnerable patients. Furthermore, if patients fail to engage with downstream healthcare, non-absorbable sutures can also result in tattoo / railroad scar lesions resulting from prolonged foreign body reactions. In paediatric patients, absorbable sutures have long been the preferred option in traumatic wound closure to prevent any need for general anaesthetic/sedation to facilitate future suture removal.
Overall, the quantity and quality of the evidence comparing outcomes from wound closure with absorbable sutures versus non-absorbable sutures is limited. The majority of studies are small in scale, with heterogenous methodology regarding intervention and assessment processes. Blinding of clinician or patient are difficult to achieve in trial designs of this nature, given the complexity of sham procedures and the variation in clinical management. Although most studies use a Visual Analogue Scale (VAS) to evaluate cosmetic outcomes, this method of evaluation can be relatively subjective and may vary between clinicians and patients. Only one study reported comparative costs of different approaches with a study population. Formal health economic analyses using quality of life measures have not been conducted. The majority of trials have also been led by surgical teams, raising questions about generalisability to emergency medicine delivered wound closure.
However, the available evidence suggests that, in general, using absorbable sutures for definitive closure in adult facial lacerations achieves comparable aesthetic outcomes without increasing complications and has a high rate of patient satisfaction. In addition, these data support the intuitive reduction in downstream healthcare resource use and overall costs of treatment, when considering appointment times and equipment use. On balance, this existing evidence supports the use of absorbable sutures as an option for closure of adult facial wounds. Given the limitations in the evidence base, patients should be presented with the options for wound closure in more complex scenarios and informed of the potential benefits and risks, to facilitate a process of shared decision making.
Overall, the quantity and quality of the evidence comparing outcomes from wound closure with absorbable sutures versus non-absorbable sutures is limited. The majority of studies are small in scale, with heterogenous methodology regarding intervention and assessment processes. Blinding of clinician or patient are difficult to achieve in trial designs of this nature, given the complexity of sham procedures and the variation in clinical management. Although most studies use a Visual Analogue Scale (VAS) to evaluate cosmetic outcomes, this method of evaluation can be relatively subjective and may vary between clinicians and patients. Only one study reported comparative costs of different approaches with a study population. Formal health economic analyses using quality of life measures have not been conducted. The majority of trials have also been led by surgical teams, raising questions about generalisability to emergency medicine delivered wound closure.
However, the available evidence suggests that, in general, using absorbable sutures for definitive closure in adult facial lacerations achieves comparable aesthetic outcomes without increasing complications and has a high rate of patient satisfaction. In addition, these data support the intuitive reduction in downstream healthcare resource use and overall costs of treatment, when considering appointment times and equipment use. On balance, this existing evidence supports the use of absorbable sutures as an option for closure of adult facial wounds. Given the limitations in the evidence base, patients should be presented with the options for wound closure in more complex scenarios and informed of the potential benefits and risks, to facilitate a process of shared decision making.
Bottom Line:
Absorbable sutures are a clinically effective option for closure of deep facial lacerations, achieving similar aesthetic and patient satisfaction results for lower cost and less downstream healthcare resource use.
Level of Evidence:
Level 1: Recent well-done systematic review was considered or a study of high quality is available
References:
- Basyuni et al. Randomised controlled trial of resorbable versus non- resorbable sutures for lacerations of the face (TORN Face)
- Malhotra et al.. Absorbable versus Nonabsorbable Sutures for Facial Skin Closure: A Systematic Review and Meta-analysis of Clinical and Aesthetic Outcomes.