Type of Suture/Equipment Suture material must have adequate strength while producing minimal inflammatory reaction Nonabsorbable sutures such as monofilament nylon (Ethilon) or polypropylene (Prolene) retain most of their tensile strength for more than 60 days and are relatively nonreactive Thus, they are appropriate for closing the outermost layer of a laceration With nylon, it is important to secure the knot adequately with at least four to five throws per knot Polypropylene is useful for lacerations in the scalp or eyebrows because it has a blue color that is more visible and thus easier to remove, although it has memory and therefore is somewhat more difficult to control while suturing Silk is rarely used because of increased tissue reactions and infection Absorbable sutures are also used in some wounds Absorbable synthetic sutures such as Dexon, Monocryl, or Vicryl should be used in deeper, subcuticular layers These materials may elicit an inflammatory response and may extrude from the skin before they are absorbed, if they are placed too close to the skin When subcuticular sutures are used, they should be placed on the deeper surface of the dermis, and epithelial margins may be approximated with either tape strips or cuticular sutures Synthetic absorbable sutures are less reactive than chromic gut and retain their tensile strength for long periods, making them useful in areas with high dynamic and static tensions Absorbable sutures are also advantageous for intraoral lacerations Some recommend using rapidly absorbable sutures (e.g., fast-absorbing gut or Vircyl rapide ) for skin closure of facial wounds in children to avoid the need for subsequent suture removal Equally acceptable cosmetic results are found with absorbable sutures compared with nonabsorbable sutures in pediatric facial laceration repair Some hand specialists also advocate for absorbable sutures for hand lacerations in young children since removing them can be quite difficult in uncooperative young patients A 3-0 suture is recommended for tissues with strong tension, such as fascia, and 4-0 is recommended for deep tissues with light tension, such as subcutaneous tissue Skin is best closed with 4-0 to 7-0 and oral mucosa with 3-0 to 4-0 sutures The emergency provider should use the finest sutures (6-0) for wounds of the face; heavier sutures for scalp, trunk, and extremities (4-0 or 5-0); and 3-0 or 4-0 for thick skin, such as the sole of the foot, or over large joints, such as the knee Needles are available in various forms, including cuticular, plastics, and “reverse cutting.” The reverse cutting needle is used most for laceration repair Its outer edge is sharp to allow for atraumatic passage of the needle through the relatively tough dermal and epidermal layers; this minimizes cutting of the skin where suture tension is the greatest A higher-grade plastic needle (designated P