The best questions often stem from the inquisitive learner. As educators, we love—and are always humbled by those moments when we get to say “I don’t know.” For some of these questions, you may already know the answers. For others, you may never have thought to ask the question. For all, questions, comments, concerns, and critiques are encouraged. Welcome to the Kids Korner.

Question: Do topical antibiotics/agents weaken suture tensile strength?

Anecdotally, we have heard that topical agents diminish the tensile strength of sutures. While this may be true, it is important to consider very briefly other aspects of wound care. To begin, a Cochrane meta-analysis explored prophylactic topical antibiotics and surgical site infection prevention, finding that topical antibiotics “probably reduce” the risk of surgical site infection in wounds healing by primary intention when compared to no topical antibiotics.¹ So, topical antibiotics may be helpful in preventing infection. Conversely, some literature suggests a contact dermatitis reaction to triple antibiotic ointment in approximately 20 percent of cases.² There seem to be both positive and negative aspects of topical antibiotics following suture repair. Do these topical agents, though, diminish the tensile strength of suture after wound closure?

Dissolvable sutures are commonly used on children for laceration repair. We are unable to find any specific studies addressing topical antibiotics and suture tensile strength and degradation. We did find two studies on petrolatum (i.e., petroleum jelly) and suture tensile strength. An in vitro study evaluated suture tensile strength, using a tensometer of nine different absorbable sutures after continuous incubation in petrolatum for seven days.³ Three units of each suture type and suture size were measured and the authors found no significant difference in tensile strength when comparing the pre- and post-incubation measurements at seven days. While this is an in vitro study, this would suggest that petrolatum does not significantly weaken the tensile strength of the absorbable suture tested.

A second study was a single-blinded, controlled study (n=14) that evaluated the effect of petrolatum on fast-absorbing gut.⁴ A 6-0 fast-absorbing gut suture was placed into two sites in the arms of healthy adults. One suture was coated with petrolatum; the other was not coated. There was no significant difference in absorption time between the two groups. The average absorption time was 223 hours (9.3 days), suggesting that petrolatum coating did not significantly affect the absorption time of fast-absorbing gut suture.

Summary

Regarding suture degradation, we were unable to find any studies specific to children or antibiotic ointment. The studies in adults are very limited and explore suture tensile strength in the setting of petrolatum (petroleum jelly) exposure. There does not appear to be any significant degradation of absorbable suture after exposure to petrolatum.

Dr. Jones is assistant professor of pediatric emergency medicine at the University of Kentucky in Lexington.

Dr. Cantor is professor of emergency medicine and pediatrics, director of the pediatric emergency department, and medical director of the Central New York Regional Poison Control Center at Upstate Medical University in Syracuse, New York.

References

1. Heal CF, Banks JL, Lepper PD, et al. Topical antibiotics for preventing surgical site infection in wounds healing by primary intention. Cochrane Database Syst Rev. 2016 Nov 7; 11(11):CD011426.
2. Benedetto AV. What’s new in cosmetic dermatology. Dermatol Clin. 2019 Jan;37(1):117–128.
3. Rajpara V, Valins W, Viera M, et al. A comparison study of the tensile strength of sutures used in dermatologic surgery following exposure to petrolatum. Dermatol Surg. 2011. Feb; 37(2):288–289.
4. Susong JR, Neiner JR. Effect of petrolatum coating on fast-absorbing gut suture. J Am Acad Dermatol. 2018 Nov; 79(5):952–953.