Lacerations of the lower extremity are under greater tension than those of the upper extremity. Fascia may be loosely approximated with buried sutures of 4-0 absorbable material. Any lower extremity laceration under significant tension should be repaired with a multiple-layered closure first using buried deep 4-0 absorbable sutures followed by simple interrupted 4-0 nonabsorbable sutures. Simple interrupted sutures of 4-0 nonabsorbable suture material may be used for skin closure in lacerations under minimal tension, and horizontal mattress sutures are ideal for wounds under moderate tension in the lower extremity. Wounds proximal to the knee and in areas that are usually covered (i.e., where cosmesis is not an issue) can be closed with skin staples. In patients with diabetes or those with stasis changes, deep sutures should be avoided because they markedly increase the risk of wound infection. Skin staples or horizontal mattress sutures are an excellent alternative in these patients.
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