Suturing unnecessary for hand lacerations under 2 cm

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Q&A

Suturing unnecessary for hand lacerations under 2 cm

J Fam Pract. 2003 January;52(1):12-31

By

Marc R. Via, MD

BACKGROUND: Do hand lacerations less than 2 cm require suturing? The value of wound closure and whether it is ever needed have never been studied objectively. Determining which wounds do not need closure could decrease pain and inconvenience for patients and decrease unnecessary use of medical resources.
POPULATION STUDIED: Patients in this study arrived at the Emergency Department of the University of California, San Francisco, Medical Center with full-thickness lacerations of the hand less than 2 cm in length and without tendon, joint, fracture, or nerve complications. The 91 participants were male and female patients (mean age, 39 years), with 95 lacerations that would normally be closed. Patients were excluded if they had diabetes, if they were receiving anticoagulants or chronic steroids, or if their lacerations were due to a bite or puncture wound or involved the nail bed.
STUDY DESIGN AND VALIDITY: This research was a randomized, controlled study. Neither patients nor physicians were blinded; however, 2 independent physicians blinded to treatment assignment assessed endpoints. Initial allocation to the treatment group was concealed from enrolling physicians. Patients were randomized to be treated with only tap water irrigation or sutures after the wound was anesthetized and cleaned. Both groups received identical antibiotic ointment and gauze dressing for 24 to 48 hours. Patients returned in 8 to 10 days, at which time the wound was assessed and assigned a wound score according to a previously validated clinical wound scale. At 3-month follow-up, a research assistant took digital photographs of the patients’ healed wounds, which were then rated for cosmetic appearance according to a previously validated visual analog scale.
OUTCOMES MEASURED: The primary outcome was cosmetic appearance after 3 months as assessed by the physicians and the patients. The authors also measured duration of treatment, pain during treatment, and time for patients to resume normal activities.
RESULTS: The primary outcome of cosmetic appearance as assessed by physicians blinded to treatment did not differ between patients treated with sutures and those under conservative management (visual analog score, 83/100 vs 80/100 mm; mean difference, 3; 95% confidence interval [CI], –1 to 8). Patients’ ratings of their wound appearance at 3 months were similar (83 vs 82 mm; mean difference, 1; 95% CI, –7 to 9). The mean time to receive treatment was significantly longer in the suture group than in the conservative treatment group (19 vs 5 min). Pain was less in the conservative treatment group than in the suture group (visual analog score, 13 vs 31 mm), whereas time to resume normal activities was the same in both groups (3.4 days).

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Suturing unnecessary for hand lacerations under 2 cm

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