What is the appropriate time frame for suturing a wound?

From the Guidelines

The appropriate window for suturing a wound, particularly in contaminated or dirty abdominal surgeries, is between 2 to 5 days postoperatively, as this timeframe allows for delayed primary closure which may reduce the incidence of surgical site infections (SSI) 1.

Key Considerations

• The decision to suture a wound should be based on the wound's condition, with contaminated or dirty wounds potentially benefiting from delayed primary closure to reduce SSI risk.
• The timing of suturing is critical, with a window of 2 to 5 days postoperatively recommended for delayed primary closure in high-risk patients or contaminated wounds 1.
• Before suturing, thorough wound irrigation with normal saline and debridement of devitalized tissue are essential steps to minimize infection risk.
• Local anesthesia and tetanus prophylaxis should be considered as part of the wound management protocol.

Evidence-Based Recommendations

• For clean, uncontaminated wounds, primary closure can be considered immediately after proper cleaning and assessment.
• Heavily contaminated wounds, animal bites, or puncture wounds may require delayed primary closure or may not be suitable for primary closure regardless of timing.
• Prophylactic antibiotics may be indicated for contaminated wounds, bites, or in immunocompromised patients, but their use should be guided by clinical judgment and evidence-based guidelines.

Guideline Recommendations

• The World Society of Emergency Surgery guidelines suggest considering delayed primary closure of surgical wounds compared to primary closure in cases of contaminated and dirty incisions with purulent contamination 1.
• The guidelines also recommend a revision between two and five days postoperatively when delayed closure of the surgical incision is performed 1.

From the Research

Appropriate Window for Suturing

• The appropriate window for suturing is often considered to be within six hours of injury, which is characterized as the "golden period" 2.
• However, several studies have confirmed that delays in wound closure rarely cause infection, and that other factors such as wound length and depth, contamination of the wound, and diabetes are more significant risk factors for wound infection 2.
• One study found that the use of topical antibiotics resulted in significantly lower infection rates than the use of a petrolatum control, and that patients who presented to the ED within 12 hours of injury had similar infection rates regardless of the time elapsed before treatment 3.
• There is no robust evidence on the relative effectiveness of any antiseptic/antibiotic/anti-bacterial preparation evaluated to date for use on surgical wounds healing by secondary intention, and the quality of the evidence is generally low or moderate 4.
• A prospective study found that prophylactic, orally administered antibiotics do not decrease the incidence of infection in patients with suture closure of simple lacerations 5.
• Skin laceration repair is an important skill in family medicine, and physicians should be familiar with various suturing techniques, including simple, running, and half-buried mattress (corner) sutures 6.
• Studies have shown that tap water is safe to use for irrigation, that white petrolatum ointment is as effective as antibiotic ointment in postprocedure care, and that wetting the wound as early as 12 hours after repair does not increase the risk of infection 6.