From the Guidelines
Suturing of a laceration is generally appropriate within 8 hours after injury, as stated in the guidelines for the diagnosis and management of skin and soft-tissue infections 1.
Key Considerations
- The decision to suture a laceration depends on various factors, including the time elapsed since the injury, wound location, degree of contamination, and patient factors such as immune status and comorbidities.
- Wounds on the face seem to be an exception and can be closed primarily if seen by a plastic surgeon, provided there has been meticulous wound care, copious irrigation, and administration of prophylactic antibiotics 1.
- Infectious complications of bite wounds, such as septic arthritis, osteomyelitis, and subcutaneous abscess formation, can occur if the wound is not properly managed 1.
- Proper wound cleaning, debridement of devitalized tissue, and appropriate antibiotic coverage when indicated are essential regardless of closure timing.
Management Approach
- Wounds should be cleansed with sterile normal saline and superficial debris removed 1.
- Deeper debridement is usually unnecessary, but, if performed, should be done very cautiously to avoid enlarging the wound and impairing skin closure 1.
- Infected wounds should not be closed, and approximation of the margins by Steri-Strips and subsequent closure by either delayed primary or secondary intent seem prudent 1.
From the Research
Laceration Repair and Suturing
- The timing of suturing after a laceration injury is crucial in determining the appropriateness of the procedure.
- According to a study published in the American Family Physician in 2017 2, there is no defined "golden period" for wound repair without increasing the risk of infection.
- However, it may be reasonable to close a wound even 18 or more hours after injury, depending on the type of wound.
Factors Affecting Suturing
- The use of nonsterile gloves, irrigation with potable tap water, and local anesthetic with epinephrine does not increase the risk of wound infection 2.
- Tissue adhesives and wound adhesive strips can be used effectively in low-tension skin areas 2, 3.
- The development of antimicrobial sutures is an area of ongoing research, aiming to minimize the occurrence of surgical site infections 4, 5.
Maximum Hours for Suturing
- While there is no specific maximum number of hours mentioned in the studies, it is suggested that suturing can be performed even 18 or more hours after injury, depending on the wound type 2.
- The decision to suture should be based on the individual case, taking into account factors such as wound type, location, and patient condition.