CC BY 4.0 · Arch Plast Surg
DOI: 10.1055/a-2318-1287
Pediatric/Craniomaxillofacial/Head & Neck: Review Article

Absorbable versus Nonabsorbable Sutures for Facial Skin Closure: A Systematic Review and Meta-analysis of Clinical and Aesthetic Outcomes

1   Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
7   Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
Sophie Bondje*
2   Department of ENT Surgery & Cancer Services, Torbay Hospital, Torquay, United Kingdom
3   Urology Division, Department of Surgery, Addenbrooke's Hospital, University of Cambridge, United Kingdom
4   Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
5   Department of Plastic Surgery and Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia
6   Department of Surgery & Cancer, Imperial College London, London, United Kingdom
› Author Affiliations
Funding None.


When repairing facial wounds, it is crucial to possess a thorough understanding of suitable suture materials and their evidence base. The absence of high-quality and comprehensive systematic reviews poses challenges in making informed decisions. In this study, we conducted a review of the existing literature and assessed the quality of the current evidence pertaining to the clinical, aesthetic, and patient-reported outcomes associated with absorbable and nonabsorbable sutures for facial skin closure.

The study was registered on Prospective Register of Systematic Reviews. We conducted searches on Embase, Ovid, and PubMed/MEDLINE databases. Only randomized controlled trials (RCTs) were eligible for inclusion in this study. Additionally, the risk of bias in the randomized studies was assessed using Cochrane's Risk of Bias Tool.

The study included a total of nine RCTs involving 804 participants with facial injuries. Among these injuries, absorbable sutures were utilized in 50.2% (403 injuries), while nonabsorbable sutures were employed in 49.8% (401 injuries). The analysis of cosmesis scales revealed no statistically significant difference between absorbable and nonabsorbable sutures regarding infections (p = 0.72), visual analog scale (p = 0.69), wound dehiscence (p = 0.08), and scarring (p = 0.46). The quality of the included studies was determined to have a low risk of bias.

Absorbable sutures can be considered a suitable alternative to nonabsorbable sutures, as they demonstrate comparable aesthetic and clinical outcomes. Future high-quality studies with a level I evidence design and cost-effectiveness analysis are necessary to enhance clinician–patient shared decision-making and optimize the selection of suture materials.

Level of evidence is I, risk/prognostic study.

Authors' Contributions

K.M.: Conceptualization, methodology, writing—original draft, writing—review and editing.

S.B.: Data curation, writing—review and editing.

A.S.: Investigation, validation, visualization. writing.

H.M.: Original Draft, Writing, Editing, formal analysis.

A.K.: Funding acquisition, writing—review and editing.

Ethical Approval

This study was performed in-line with the principles of the Declaration of Helsinki. Approval was granted was waived due to the nature of the study.

Patient Consent

Not applicable.

* These authors contributed equally and are joint first authors.

Publication History

Received: 05 June 2023

Accepted: 15 April 2024

Accepted Manuscript online:
02 May 2024

Article published online:
19 June 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (

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