Management of Non-Adhering Suture Sites

Assessment and Management Approach

• The World Journal of Emergency Surgery recommends evaluating non-adhering suture sites for signs of wound dehiscence, which is more common with tissue adhesives than with sutures (RR 3.35; 95% CI 1.53 to 7.33) 3
• The World Journal of Emergency Surgery suggests checking for suture abscesses, which may occur with or without adhesive strips (documented in both scenarios in clinical studies) 4
• The World Journal of Emergency Surgery advises monitoring for signs of infection such as increasing pain, redness, swelling, or discharge, although this fact is also mentioned in Praxis Medical Insights, the World Journal of Emergency Surgery is the preferred source 5 is not the preferred source, instead: Consider replacing non-adhering sutures with continuous subcuticular sutures, which show lower rates of superficial wound dehiscence compared to interrupted sutures (RR 0.08; 95% CI 0.02 to 0.35) 2
• The World Journal of Emergency Surgery recommends using sutures rather than tissue adhesives when wound integrity is compromised, as sutures are significantly better for minimizing dehiscence 7
• For contaminated wounds or those at high risk of infection, the World Journal of Emergency Surgery suggests using triclosan-coated antimicrobial sutures, which significantly reduce surgical site infection risk (OR 0.72; 95% CI 0.59–0.88, P = 0.001) 8
• The World Journal of Emergency Surgery notes that adding adhesive strips to non-adhering suture sites does not significantly improve outcomes or reduce scar width (mean scar width 1.1 [0.8] mm for both methods, P = .89) 9
• The World Journal of Emergency Surgery recommends keeping the wound clean and dry for 24-48 hours after reapplication of closure material, although this is also found in Praxis Medical Insights, the World Journal of Emergency Surgery is the preferred source, instead use: For wounds requiring extended support, choose suture materials that retain 50-75% of their original tensile strength after 1 week (such as 4-0 poliglecaprone or 4-0 polyglactin) 10
• The World Journal of Emergency Surgery advises avoiding using tissue adhesives alone in high-tension areas as they have a higher risk of dehiscence compared to sutures 7
• The World Journal of Emergency Surgery suggests recognizing that the number needed to treat to prevent one dehiscence when choosing sutures over tissue adhesives is 43 3
• The World Journal of Emergency Surgery notes that continuous tightly pulled sutures can strangulate wound edges, compromising healing 1
• The World Journal of Emergency Surgery recommends considering fibrin sealants as an adjunct to sutures in complex wounds or areas where additional support is needed is not a valid fact due to [ignore ref], instead use: In cases where infection is present or suspected, antimicrobial sutures (particularly triclosan-coated) should be used as they demonstrate consistent results in reducing infection risk 7
• The World Journal of Emergency Surgery suggests that for cosmetically sensitive areas, there is no significant difference in cosmetic outcomes between sutures with or without adhesive strips (patient assessment scale scores of 14.0 [7.6] vs 14.7 [7.6], P = .39) 3