Does the use of absorbable sutures affect cosmesis in non-facial lacerations?

Date First Published:

May 11, 2026

Last Updated:

May 11, 2026

Report by:

Shreyas Shah, Emergency Medicine Resident (Queen's University)

Search checked by:

Mackenzie Senior, Emergency Medicine Resident

Three-Part Question:

In [patients presenting to the emergency department with simple non-facial lacerations] does the use of [absorbable sutures compared to non-absorbable sutures] affect [scar cosmesis]?

Clinical Scenario:

While working at your local emergency department, you see an otherwise healthy 35-year-old who has sustained a simple laceration to his palm from working with an X-ACTO knife. He confides in you that he is a world-famous hand model and has an important show in Milan next week. He does not have time to return to have his sutures removed but is invested in the cosmesis of his wound. He asks whether absorbable sutures may be a convenient but safe option. You consult the relevant literature to find out.

Search Strategy:

Ovid MEDLINE from 1946 to March 20th, 2026

Search Details:

(exp Lacerations/ OR laceration$.mp OR wound$.mp OR cut$.mp OR injur$.mp)

AND

(nonabsorb$.mp OR non-absorb$.mp OR nondissolv$.mp OR non-dissolv$.mp OR silk.mp OR nylon.mp OR polypropylene.mp OR ethilon.mp OR prolene.mp OR polyester.mp OR ethibond.mp OR dacron.mp)

AND

(absorb$.mp OR dissolve$.mp OR gut.mp OR polyglactin.mp OR vicryl.mp OR poliglecaprone.mp OR monocryl.mp OR polydioxanone.mp OR polyglycolic.mp OR dexon.mp)

AND

(trunk.mp OR extremit$.mp OR hand$.mp OR finger$.mp OR digit$.mp)

Inclusion Criteria:
- Randomized Controlled Trial
- Wounds to the trunk, extremity, or hands
- Wounds requiring single-layer closure
- Direct comparison of absorbable versus non-absorbable suturesIncludes cosmesis as a measured outcome

Exclusion Criteria
- Facial or mouth lacerations
- Wounds requiring multi-layer repair
- Wounds closed with a suture technique other than simple interrupted

Outcome:

A total of 191 articles were identified and screened by title and abstract, of which 19 were found to be relevant and underwent full-text review. Subsequently, 15 studies were excluded for the following reasons: did not measure cosmesis as an outcome (N=3), included wounds that were multi-layer or of the face and mouth (N=4), a suture technique other than simple interrupted was used (N=3), or were not a randomized controlled trial (N=3). We identified a relevant systematic review (N=1) and meta-analysis (N=1) but could not include either due to heterogeneity of wound closure method of included studies. Individual studies within the systematic review and meta-analysis were reviewed. One additional relevant publication that met inclusion criteria, and was not captured in our search, was identified and included in our final review. A total of 5 publications were ultimately found to be directly relevant and are detailed below.

Relevant Paper(s):

Study Title	Patient Group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
A comparison of cosmetic outcomes of lacerations on the extremities and trunk using absorbable versus nonabsorbable sutures Cena Tejani, MD, Adam B. Sivitz, MD, Micheal D. Rosen, MD, Albert K. Nakanishi, MD, Robert G. Flood, MD, Mathew A. Clott, MD, Paul G. Saccone, MD, and Raemma P. Luck, MD June 2014 United States of America	73 adult and pediatric patients presenting to the emergency department with single layer, linear, small (<8cm), minimally contaminated lacerations on the trunk or extremities.	Randomized control trial. Patients were randomized using block randomization to have their wounds closed with Vicryl Rapide (4-0 or 5-0) or Prolene (4-0 or 5-0).	Cosmesis measured by assessors blinded to allocation at 3 months post-repair using 0-100 visual analog scale (VAS).	No significant difference in cosmesis between Vicryl Rapide and Prolene.	Convenience sampling increases risk of selection bias. Small sample size limits statistical power. Loss to follow-up (113 randomized, 20 lost to each treatment group, 73 analyzed) may introduce attrition bias. Study did not assess patient-reported cosmetic outcomes. 3 months may not be sufficient to determine ultimate cosmesis of wound. Patients with significant previous medical history or use of daily steroids were excluded, which limits generalizability.
			________________
				Mean VAS score:
			Presence of train-tracking (crosshatching) scars.
				Vicryl Rapide 54.1 (95% CI = 44.5 to 67.0)

				Prolene 54.5 (95% CI = 45.7 to 66.3)

				Mean difference:

				0.5mm (95% CI = -12.1 to 17.2mm)
				___________________

				No statistically significant difference in presence of train-tracking scars between groups:

				Vicryl Rapide 6 patients, Prolene 3 patients (OR = 0.4, 95% CI 0.1 – 1.8)
Comparative analysis of suture choice in open bilateral carpal tunnel surgery: a randomized controlled trial Jessica Leary , Chris Frampton, Andrew Muller, and Timothy Lynskey March 2025 New Zealand	81 adult patients (162 hands) requiring closure of standardized palmar wounds after undergoing first-time elective open bilateral carpal tunnel release in an outpatient setting.	Randomized control trial. Patients were randomized using computer generated sheet to have the surgical wound of a pre-specified hand closed with Vicryl Rapide (3-0) or Prolene (4-0) sutures. They then received the opposite suture material on the opposite hand. Patients were blinded to the location of each suture type.	Patient and Observer Scar Assessment Scale (POSAS) recorded 6 weeks post-operatively	Vicryl Rapide wounds had higher observer-rated vascularity (3.4 vs 3.1, p<0.05) and higher patient-rated colour (3.5 vs 3.0, p<0.01) compared to Prolene	Small sample size limits statistical power. The observer score was completed by the treating surgeon who was unblinded to treatment allocation, or a registrar under their supervision. This increases the risk of detection bias. 6 weeks may not be sufficient time to determine ultimate cosmetic outcome. All repairs were done by the same orthopedic surgeon, which may limit generalizability of results.

			POSAS Patient Domains: Pain, itch, colour, stiffness, irregularity, overall opinion	There was no difference in any other patient-rated or observer-rated domains of the POSAS, including overall opinion.

			POSAS Observer Domains: Vascularity, pigment, thickness, relief, pliability, surface area, overall opinion
A randomised controlled trial of absorbable versus non-absorbable sutures for skin closure after open carpal tunnel release C. Theopold, S. Potter, M. Dempsey and M. O’Shaughnessy May 2012 Ireland	38 adult patients requiring closure of a standardized palmar wound after undergoing first-time elective open carpal tunnel release.	Randomized control trial. Patients randomized using sealed envelopes to have their palmar wounds closed with Vicryl Rapide (4-0) or Novafil (4-0).	Scar Assessment Scale (POSAS) recorded 6-weeks post-operatively.	No statistically significant difference between Vicryl Rapide and Novafil across total, patient-reported, observer-reported, or individual domain scores of the POSAS	Small sample size limits statistical power. Patients were not blinded to treatment allocation, which introduces risk of detection bias. 6-weeks of follow up may not be sufficient to determine ultimate cosmetic outcome.

			POSAS Patient Domains: Pain, itch, colour, stiffness, irregularity, overall opinion	Mean Total Score (SD): Vicryl Rapide 33.1 (9.2), Novafil 33.5 (11.0), p=0.91

			POSAS Observer Domains: Vascularity, pigment, thickness, relief, pliability, surface area*, overall opinion	Mean Score Patient-Rated Domains (SD): Vicryl Rapide 2.3 (0.9), Novafil 2.5 (1.2), p=0.55
			_________
				Mean Score Observer-Rated Domains (SD): Vicryl Rapide 3.2 (1.1), Novafil 3.1 (1.7), p=0.64
			*Study specifically replaced observer domain of ‘surface area’ with crosshatching (train-tracking) as an outcome of interest
				___________

				No statistically significant difference in presence of cross-hatching:
				Vicryl Rapide (SD): 3.3 (2.4)
				Novafil (SD): 2.7 (1.5)
				p=0.33
Absorbable or non-absorbable sutures? A prospective, randomized evaluation of aesthetic outcomes in patients undergoing elective day-case hand and wrist surgery RK Kundra, S Newman, A Saithna, AC Lewis, S Srinivasan, K Srinivasan July 2010 United Kingdom	70 adult patients undergoing elective day-case hand and wrist surgery including carpal tunnel decompression, excision of soft tissue lesions, Dupuytren’s contracture release, trigger finger release or other minor upper extremity procedures.	Randomized control trial. Patients randomized using sealed envelope technique to have their surgical wounds closed with Vicryl Rapide (3-0) or Nylon (3-0) sutures.	Wound satisfaction completed 3-months post operatively by patients using linear Visual Analogue Scale (0 to 100).	No statistically significant difference in mean wound satisfaction between groups (Vicryl Rapide 80.4, Nylon 82.5, p = 0.82).	Weak method of allocation concealment. Patients were the sole outcome assessor and were not blinded to treatment allocation which introduces risk of detection bias. 3-months may not be sufficient to determine ultimate cosmesis of wound. Study excluded patients on steroids or with medical problems affecting wound healing, which limits generalizability of results.

			___________________	___________________

			Patient Scar Assessment Scale (PSAS) completed by patients 3-months post operatively.	No statistically significant differences in the mean score of any domains of the PSAS between suture groups.

			PSAS Domains
			Pain, itch, colour, stiffness, thickness, irregularity
Skin closure in carpal tunnel surgery: a prospective comparative study between nylon, polyglactin 910 and stainless steel sutures Tomas Menovsky, Ronald H. M. A. Bartels, Erik L. van Lindert and J. André Grotenhuis July 2004 Netherlands	61 adult patients requiring closure of a standardized palmar wound after undergoing first-time elective open carpal tunnel release.	Randomized control trial. Patients were randomized to receive either Nylon (4-0), Vicryl (4-0) or stainless steel (4-0) sutures.	Redness, granuloma formation and hypertrophy measured at 6-weeks post operatively by assessors blinded to allocation using a three-value score (0 = none, 1 = mild, 2 = severe)	Statistically significant (p <0.05) increase in severity of granuloma in patients who received Vicryl (1.28) compared to Nylon (0.37) and stainless steel (0.25).	Cosmetic outcomes were assessed using non-validated simplified three-point scale limited to three categories. Did not assess patient-reported cosmetic outcomes, which limits clinical relevance. Small sample size limits statistical power. Study does not comment on randomization method which may introduce systemic bias. Study does not report specific p-values for each comparison. 6 weeks may not be sufficient to determine long-term cosmesis.

				No statistically significant differences in redness or hypertrophy of the wound between the three suture groups.

Author Commentary:

Absorbable sutures offer the benefit of not requiring a repeat visit for removal, which has the potential to improve patient satisfaction and healthcare resource utilization. Providers may be hesitant to use absorbable sutures due to concerns regarding long-term cosmesis, stemming from the concept of increased tissue reactivity to the absorption process compared to relatively inert non-absorbable sutures.

The majority of evidence on this topic comes from Plastic Surgery literature. The included articles involved simple, single-layer wounds closed in a simple interrupted fashion. Though there are inherent limitations to measuring cosmesis due to its subjectivity, 4 of 5 studies utilized validated assessment tools – either a Visual Analog Scale and/or the Patient Observer Scar Assessment Scale. The same 4 of 5 studies specifically studied Vicryl Rapide as the absorbable suture of interest, whereas the fifth looked at Vicryl.

Overall, evidence suggests that the cosmetic outcome of wounds closed with absorbable sutures was comparable to those closed with non-absorbable sutures. Across studies, there were consistently no differences in satisfaction, general cosmesis, or overall wound opinion.

Limitations of current evidence are a lack of data in the emergency department setting, as well as exclusion of patients with medical conditions that affect wound healing – such as chronic steroids or diabetes – which limits generalizability to the diverse emergency department population. Only one of four articles included pediatric patients, who would be a population of interest given the distress that suture placement and removal can cause some children. The longest follow-up period of the included studies was 3 months, which may not be sufficient to determine ultimate wound cosmesis.

Bottom Line:

In patients with simple lacerations to the trunk, extremity, and hands, use of absorbable sutures – specifically Vicryl Rapide - has comparable cosmesis compared to nonabsorbable sutures.

Level of Evidence:

Level 2: Studies considered were neither 1 or 3

References:

Cena Tejani, MD, Adam B. Sivitz, MD, Micheal D. Rosen, MD, Albert K. Nakanishi, MD, Robert G. Flood, MD, Mathew A. Clott, MD, Paul G. Saccone, MD, and Raemma P. Luck, MD. A comparison of cosmetic outcomes of lacerations on the extremities and trunk using absorbable versus nonabsorbable sutures
Jessica Leary , Chris Frampton, Andrew Muller, and Timothy Lynskey. Comparative analysis of suture choice in open bilateral carpal tunnel surgery: a randomized controlled trial
C. Theopold, S. Potter, M. Dempsey and M. O’Shaughnessy. A randomised controlled trial of absorbable versus non-absorbable sutures for skin closure after open carpal tunnel release
RK Kundra, S Newman, A Saithna, AC Lewis, S Srinivasan, K Srinivasan. Absorbable or non-absorbable sutures? A prospective, randomized evaluation of aesthetic outcomes in patients undergoing elective day-case hand and wrist surgery
Tomas Menovsky, Ronald H. M. A. Bartels, Erik L. van Lindert and J. André Grotenhuis. Skin closure in carpal tunnel surgery: a prospective comparative study between nylon, polyglactin 910 and stainless steel sutures