What is the maximum time a laceration can be left open before closing?

From the Guidelines

The maximum time a laceration can be left open before closing is generally between 6-8 hours for most clean lacerations, but can be up to 24 hours for facial lacerations, and should be decided on a case-by-case basis considering the type of wound, its location, and the risk of infection. When considering the optimal time for closing a laceration, it's crucial to weigh the risks of infection and the benefits of prompt closure. According to the most recent and highest quality study available, 1, there is no strong evidence to support one method over another, but delayed primary closure may reduce the rate of surgical site infections (SSI) in contaminated abdominal surgeries. The decision to close a laceration should be based on the individual case, taking into account factors such as:

• The type of wound: clean, contaminated, or dirty
• The location of the wound: facial, hands, feet, or other areas
• The risk of infection: high or low Some key points to consider when deciding on the timing of laceration closure include:
• Bacterial colonization and the inflammatory process: as time passes, bacteria multiply within the wound, increasing infection risk, while inflammatory changes make tissue approximation more difficult and may lead to poorer cosmetic outcomes
• The importance of proper wound cleaning, irrigation, debridement of devitalized tissue, and assessment for foreign bodies before closure
• The potential benefits of delayed primary closure in reducing SSI rates, particularly in contaminated abdominal surgeries, as suggested by studies such as 1 and 1 It's essential to note that the optimal time for closure may vary depending on the specific circumstances of the case, and the decision should always prioritize minimizing the risk of infection and promoting optimal healing outcomes.

From the Research

Laceration Closure Time

• The maximum time a laceration can be left open before closing is not strictly defined, as studies have been unable to define a "golden period" for which a wound can safely be repaired without increasing the risk of infection 2.
• Depending on the type of wound, it may be reasonable to close even 18 or more hours after injury 2.
• The existing evidence does not support the existence of a golden period nor does it support the role of wound age on infection rate in simple lacerations 3.
• Time from injury to wound closure is not as important as previously thought, and improvements in irrigation and decontamination over the past 30 years may have led to this change in outcome 4.

Factors Affecting Infection Rate

• Diabetes, wound contamination, length greater than 5 cm, and location on the lower extremity are important risk factors for wound infection 4.
• Comorbidities such as diabetes, chronic renal failure, obesity, human immunodeficiency virus, smoking, and cancer should be considered when assessing the risk of infection 5.
• Gross contamination, involvement of deeper structures, stellate wounds, and selected bite wounds are also high-risk factors for infection 5.

Wound Management

• Good evidence suggests that local anesthetic with epinephrine in a concentration of up to 1:100,000 is safe for use on digits, and 1:200,000 is safe for use on the nose and ears 2.
• Tissue adhesives and wound adhesive strips can be used effectively in low-tension skin areas 2, 6.
• Maintaining a moist wound environment with occlusive dressings is more important than previously thought 5.