What is the ideal time frame to close a wound using sutures?

From the Guidelines

The ideal time frame to close a wound using sutures is within 6-8 hours after injury, though this can extend up to 24 hours for facial wounds due to their rich blood supply. This recommendation is based on the most recent and highest quality study available, which suggests that delayed primary closure may be more appropriate for heavily contaminated wounds or those with delayed presentation, where the wound is initially cleaned and left open, then sutured 3-5 days later once it's clear no infection has developed 1.

Key Considerations

• The timing of wound closure varies by body location, with scalp and face wounds able to be sutured up to 24 hours after injury, trunk and extremities ideally within 6-8 hours, and hands and feet within 6 hours due to higher contamination risk.
• Before suturing, thorough wound cleaning with saline or antiseptic solution is essential, along with debridement of devitalized tissue if needed.
• Local anesthetic (typically 1-2% lidocaine, sometimes with epinephrine) should be used for patient comfort.
• The wound should be closed without tension, using appropriate suture material based on location and wound characteristics.

Suture Removal

• Sutures typically remain in place for 5-14 days depending on location - 5-7 days for the face, 7-10 days for the scalp, trunk and arms, and 10-14 days for legs and feet or high-tension areas.
• The use of negative pressure wound therapy (NPWT) may be beneficial in certain situations, such as closed fracture fixation after major extremity trauma, but its role in open fractures is less clear 1.

Evidence Summary

• A recent study published in the World Journal of Emergency Surgery found that delayed primary closure may reduce the rate of surgical site infections (SSIs) in contaminated and dirty abdominal incisions 1.
• Another study published in the same journal found that there is currently no evidence to support or refute delayed laparotomy closure, but suggested that surgeons should consider delayed closure of surgical wounds compared to primary closure in case of contaminated and dirty incisions with purulent contamination 1.
• A guideline summary published in The Journal of the American Academy of Orthopaedic Surgeons recommended the use of simple saline solution for initial wound management and the use of perioperative and postoperative systemic antibiotics for open fractures 1.

From the Research

Ideal Time Frame for Wound Closure

The ideal time frame for closing a wound using sutures is a topic of debate, with traditional practices suggesting that wounds should be closed within 6 to 8 hours to minimize the risk of infection 2. However, recent studies have challenged this notion, suggesting that the risk of infection is not directly correlated with the time of wound closure.

Key Findings

• A study published in 2014 found that the risk of infection is not significantly increased when wounds are closed later than 6 to 8 hours 2.
• The study reviewed five clinical studies on unselected patients with acute traumatic wounds and found that the evidence does not support an absolute time limit for wound closure.
• Another study published in 2016 focused on the use of antiseptics and antibiotics for surgical wounds healing by secondary intention, but did not provide direct evidence on the ideal time frame for wound closure using sutures 3.

Wound Closure and Infection Risk

• The risk of infection is a critical consideration when deciding when to close a wound, but the evidence suggests that the timing of wound closure is not the only factor to consider 2.
• Other factors, such as the type and severity of the wound, the presence of contamination or infection, and the overall health of the patient, should also be taken into account when making decisions about wound closure.

Antibiotic Prophylaxis and Wound Closure

• Studies have investigated the use of antibiotic prophylaxis in patients with open fractures or undergoing total joint arthroplasty, but these studies do not provide direct evidence on the ideal time frame for wound closure using sutures 4, 5, 6.
• However, these studies do highlight the importance of considering the risk of infection and the use of antibiotic prophylaxis when making decisions about wound closure.