This paper highlights the pearls and pitfalls for the hand therapist following the use of absorbable sutures in hand surgery through discussion of suture materials used by plastic and orthopaedic surgeons at the Mater Adult Hospital. We will demonstrate that hand therapists can be instrumental in early identification of tissue reactivity to suture material versus wound infection.

Multiple case studies will be discussed to link our clinical experience with a review of the current literature. Our review of the literature highlights that tissue reactivity is multi-factorial including patient, surgeon, and wound related factors and is not simply related to the type of suture used. However, knowledge of the differing physical and chemical structures of sutures may assist hand therapists in guiding intervention.

In the case of highly reactive and extruding sutures, close liaison with the surgeons is indicated. In our clinical experience we have recognised that by debriding suture micro-abscesses (Niessen et al; 1997) to allow visualisation of suture material, pulling the end of the suture out as far as possible and cutting it low so it retracts below the epidermis, promotes more rapid closure and minimises scar tissue. Out of concern patients may suspend home exercise programs unnecessarily resulting in increased scar adherence, we have found timely education of the patient supports confidence and compliance and results in improved outcomes. The pearls and pitfalls identified in this paper aim to educate the hand therapist, enabling them to provide optimal post-operative patient care and an opportunity for best functional outcome.